OA Flashcards
What is osteoarthritis?
a disease of synovial joints including mechanical, inflammatory, and metabolic factors which results in degeneration of the joint
How many Australians does OA currently affect?
10%
Where is OA most commonly seen within the body?
knee
Why is nutrition from synovial fluid so important to joints?
the region is avascular so it is the only source of nutrition
hence movement and exercise is so important for maintaining joint health
Can collagen be replaced once lost?
not adequately
Can proteoglycans be replaced once lost?
yes
What is the role of the synovial membrane?
remove particulate matter by phagocytosis
provide nutrition
synthesise components of synovial fluid
What is subchondral bone?
bone underlying the articular cartilage
What is primary OA?
OA not resulting from injury or disease
What are some risk factors of primary OA?
obesity 55-60 years of age genetic inheritance (hand & hip OA) female (knee OA) alignment inactivity
What is secondary OA?
OA that occurs in response to injury or disease
What are some risk factors of secondary OA?
injury/trauma
sport
occupation
What is the pain mechanism of OA?
primarily peripheral nociceptive
23% experience neuropathic pain
How does OA pain normally present?
intermittent & predictable (relating to mechanical)
How is OA diagnosed?
> 45 years
activity-related joint pain
no am stiffness or am stiffness <30 minutes
When would we refer a patient for imaging after diagnosing OA?
if a more sinister underlying condition is suspected
if it will change our treatment
What imaging can be used for OA?
Xray & MRI
What is the grading system used for OA based on xray imaging?
Kellgren & Lawrence scale
0: no OA
1: doubtful joint space narrowing, possible osteophytes (‘early OA’)
2: mild OA, definite osteophytes, possible JSN
3: moderate, definite JSN, osteophytes, some sclerosis, possible bone contour deformity
4: severe, large osteophytes, no joint space, severe sclerosis, definite bony contour deformity
What are the three important regions to look at on an MRI for OA?
bone marrow lesions
cartilage lesions
osteophytes
What are some clinical features of OA?
gradual onset of symptoms pain with loading activities stiffness with prolonged rest palpation: some swelling, warmth, bony enlargement functional impairments reduced sleep reduced quality of life psychosocial impariements co-morbidities instability/giving way
What is the Trendelenberg sign? (in regards to hip OA)
reduced hip flexion, abduction & internal rotation
What are the three pyramids of OA treatment according to Roos 2012?
1: education, exercise & weight control
2: pharmacological pain relief, aids & passive treatments given by a therapist
3: surgery
What is Nordic walking and how can it benefit those with OA?
walking with two hiking poles resulting in a full-body workout
evidence suggests its more effective than strength training for reducing pain and improving function and can have a longer effect
True or false… exercise has an effect on OA pain relief similar to NSAIDS?
true
How can resistance training, directly and indirectly, affect pain and function in those with OA?
directly: relief of symptoms
indirectly: increases in muscle strength leading to relief of symptoms
What is an acceptable amount of pain during exercise for patients with OA? (on a scale of 0-10)
How quickly should this pain resolve?
2-5
should resolve in 24 hours
What should we focus on when educating patients with OA?
what is OA
what causes & doesn’t cause OA
OA treatment
benefits of physical activity & exercise
What does first line treatment entail for patients with OA?
education, exercise & weight control
What does second line treatment entail for patients with OA?
pharmacological pain relief and passive treatment from a physio
When do we see the effects of NSAIDS peak in patients with OA?
2 weeks
How soon are GI issues as side effects of NSAIDS seen in patients with OA?
as early as 4 weeks
When do the effects of corticosteroid injections typically peak for patients with OA?
2 weeks
What is the downside to corticosteroid injections for pain relief in patients with OA?
cartilage breakdown
accelerated progression of OA
osteonecrosis
rapid joint destruction
True or false… physical therapy is more effective in pain relief than corticosteroid injections for patients with OA
true
What kinds of aids are recommended for those with OA?
walking stick, knee brace (both tibiofemoral & patellofemoral), hand orthosis,
Why are modified shoes not recommended for those with knee OA?
there is insufficient evidence to recommend them
What does third line treatment entail for those with OA?
surgery
When would arthroscopic surgery be indicated?
only when there is mechanical locking in the joint
Is arthroscopic surgery beneficial for pain relief for those with OA?
no
When would knee or hip replacement surgery be indicated for patients with OA?
when conservative management has failed and there is severe disease
How much more likely is someone under 55 to need a revision surgery after a total joint replacement?
5 times (than someone over 75)
