OA Flashcards
OA hip signs
Pain:
Progressively increasing
Aggravated - movement; when hip is loaded wrong or too long; cold weather
Eased with continuous movement
Commonly in groin/thigh, radiating to buttocks or knee
End-stage: Constant pain, night pain
Stiffness:
Morning stiffness with end-stage osteoarthritis, usually eased with movement (<1 hour)
“Locking” of hip movement
Decreased range of motion - leading to joint contractures and muscle atrophy
Crepitis with movement
Gait abnormalities - short limb gait, antalgic gait, trendelenburg gait, stiff hip gait
Leg length discrepancy
Local inflammation
OA Definition/Description
Osteoarthritis (OA) is the most common chronic condition of the joints. OA can affect any joint, but it occurs most often in knees, hips, lower back and neck, small joints of the fingers and the bases of the thumb and big toe. In normal joints hyaline cartilage covers the end of each bone. Hyaline cartilage provides a smooth, gliding surface for joint motion and acts as a cushion between the bones. In OA, the cartilage breaks down, causing pain, swelling and problems moving the joint.
As OA worsens over time, bones may break down and develop growths called spurs. Bits of bone or cartilage may flake off and float around in the joint. In the body, an inflammatory process occurs and cytokines (proteins) and enzymes develop that further damage the cartilage. In the final stages of OA, the cartilage wears away and bone rubs against bone leading to joint damage and more pain
A recent definition was issued by Kuttner et al, in 1994 and reads as follows: “Osteoarthritis is a group of overlapping distinct diseases, which may have different etiologies but with similar biologic, morphologic, and clinical outcomes. The disease processes not only affect the articular cartilage, but involve the entire joint, including the subchondral bone, ligaments, capsule, synovial membrane, and periarticular muscles. Ultimately, the articular cartilage degenerates with fibrillation, fissures, ulceration, and full thickness loss of the joint surface.”
the prevalence increases sharply from the age of 45 years
OA Etiology
Risk factors for developing OA include age, female gender, obesity, anatomical factors, muscle weakness, and joint injury (occupation/sports activities)
Primary osteoarthritis:
Wear and tear on joints as people age cause primary OA. Therefore it starts showing up in people between the ages of 55 and 60. Theoretically, everyone experiences cartilage breakdown as they get older, but some cases are more severe than others.
Secondary osteoarthritis:
Secondary OA involves a specific trigger that exacerbates cartilage breakdown. Common triggers for secondary OA include
Injury: Bone fractures increase a person’s chance of developing OA and can bring about the disease earlier.
Obesity: According to the Arthritis Foundation, every pound of extra body weight places three pounds of pressure on the knees and six pounds on the hips. The weight speeds up the wear and tear of joint cartilage.
Inactivity
Genetics: Researchers have noticed that OA runs in families, so certain genes could also put you at risk.
Inflammatory Diseases: Perthes’ disease,Lyme disease and all chronic forms of arthritis (e.g., costochondritis, gout, and rheumatoid arthritis)
History of certain conditions eg Diabetes, Marfan Syndrome, Wilson’s Disease, Joint infection, Alkaptonuria, Congenital disorders of joints, Ehlers-Danlos Syndrome, Hemochromatosis
OA Characteristics/Clinical presentation
Pain: This is a ‘mechanical’ type of pain which is generated by mobilization, increases with fatigue and decreases with rest. Pain occurs in the morning or after a period of inactivity. Mostly, there’s no overnight pain. The intensity of pain is variable. Sometimes it’s dull and tolerable, other times it’s very heavy with short peaks. It can be stimulated by cold, trauma and fatigue. This pain occurs at the level of the subchondral bone and in capsuloligamentar and muscular structures.
Limited Rom
Crepitus - Morning stiffness less severe than RA.
Definition/Description RA
Rheumatoid arthritis (RA) is a systematic autoimmune inflammatory disease that results in persistent inflammation of synovial tissue especially of the wrists, hands and feet. RA is a long-term disease that leads to inflammation of the joints and surrounding tissues and can also affect other surrounding structures like the tendon sheath, the bursa and tendons. This pathology causes pain, stiffness in the morning and after periods of inactivity, joint swelling, weakness, fatigue and restricted joint mobility leading to reduced function.
Without treatment, RA can possibly lead to joint deformities in the later stages of the disease which then function of the joints could be lost permanently. Thus, RA causes dramatic interference with quality of life if early diagnosis and appropriate treatment are not obtained. Individuals with RA are 8 times more likely to have the functional disability compared with adults in the general population from the same community.
The disease course typically follows three possible paths:
Monocyclic: Having one episode that does not reoccur. This usually ends within 2-5 years of initial diagnosis.
Polycyclic: The disease severity varies over the course of the progression of the condition.
Progressive: Condition continues to become more severe and non-remitting.
Characteristics/Clinical Presentation
In rheumatoid arthritis, joint complaints are in the foreground.
Typically in a first stage, there is:
a chronic, symmetrical inflammation of the joints of the hands and the feet, especially the metatarsophalangeal joints (MTP), the wrists, the metacarpophalangeal joints (MCP) and the proximal interphalangeal joints (PIP).
Softening of the ligaments can lead to deformation of the fingers, like subluxations of the metacarpophalangeal joints.
Rheumatoid arthritis causes deformity, pain, weakness and restricted mobility and will result in loss of function.
The three most important complaints are the pain, morning stiffness and fatigue.
Muscular strength, muscular endurance and aerobic endurance are typically reduced in patients with rheumatoid arthritis in comparison with healthy patients.
In 80-90% of the patients with rheumatoid arthritis the cervical spine is involved, which can lead to instability, caused by the ligamentous laxity. Usually, the instability occurs between the first and second cervical vertebrae. This instability can lead to pain and neurological symptoms, like a headache and tingling in the fingers
