OA Flashcards
1
Q
OA
A
- AKA Degenerative joint disease or hypertrophic arthritis
- Most common joint disease
- Affects almost 50% in those >65 y.o. and almost everyone >75 y.o. (generally from age and repetitive motion)
- Women twice as likely to develop OA, especially in knees and hands
- Characterized by pain, joint stiffness, muscle weakness
2
Q
OA General Criteria
A
- Presence of Pain
- Bony changes on exam
- Normal erythrocyte sedimentation rate
- Characteristic radiographs
- Presence of erosion and marked proliferation in proximal and distal interphalangeal joints of hands
3
Q
Hip OA Criteria
A
- Hip pain PLUS 2 of the following:
- ESR < 20
- Radiographic femoral or acetabular osteophytes
- Radiography joint space narrowing
4
Q
Knee OA Criteria
A
- Knee pain and radiographic osteophytes PLUS 1 of the following:
- Age > 50 y.o.
- Morning stiffness of 30 minutes or less
- Crepitus (creaking) on motion
5
Q
OA General Information
A
- Primarily idiopathic
- Generally asymmetrical
- Treat to relieve pain
6
Q
OA Labs
A
- ESR < 20
- RF Titer < 1:40 (negative)
- Non-inflammatory synovial fluid
7
Q
OA Pharmacological Treatment Options
A
DEPENDS ON AFFECTED SITE: -Tylenol -Topical NSAIDs/capsaicin pOral NSAIDs (<75 y.o.) -COX-2 selective inhibitor -Tramadol -Duloxetine -Intraarticular CS
8
Q
ESR
A
- General marker of inflammation
- Measures how quickly RBCs settle in blood sample
- Nonspecific
- Increased fibrinogen auses RBCs to stick together and settle faster
- High ESR, more inflammation
9
Q
OA Etiology
A
- Increased body weight strongly associated with hip, knee, and hand OA
- Activities involving repetitive motion or injury increase risk
10
Q
Localized v.s. Generalized OA
A
Localized = 1-2 sites Generalized = 3+ sites
11
Q
OA Pathophysiological Changes
A
- Initial thickening of articular cartilage as ECM is damagedand water content increases
- Proliferation of chondrocytes
- Decline in response of chondrocytes to stabilize or restore tissue, resulting in progressive cartilage loss
- Increased turnover of adjacent subchondral bone
- Release of vasoactive peptides and enzymes, causing cartilage degradation, neovascularization, ad increased leakiness of adjacent cartilage
12
Q
As cartilage is destroyed…
A
- More brittle, stiffer bone with decreased weight-bearing ability
- Development of sclerosis and microfractures
- Microfractures lead to new bone formation at the joint margins called “osteophytes”
13
Q
Joint Capsule and Synovium
A
- Inflammation from inflammatory mediators from chondrocytes
- Inflammation localized to affected joint
14
Q
OA Physical Exam - Hands
A
- Asymmetrical involvement
- Distal interphalangeal (DIP) joints - Heberden’s nodes (osteophytes)
- Proximal interphalangeal (PIP) joints - Bouchard’s nodes
15
Q
Pain of OA
A
- Activation of nociceptive nerce endings within the joint by mechanical and chemical irritants
- Distention of synovial capsule by increased joint fluid
