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PHTH 565 RHEUMATOLOGY > OA > Flashcards

OA Flashcards

1
Q

T/F OA is a “wear and tear” arthritis

A

F

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2
Q

T/F OA is a “whole joint disease”

A

T

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3
Q

What are the components of the joint affected in OA

A

Cartilage
Synovial Membrane
Ligaments
Bone

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4
Q

Is the synovial membrane as affected in OA as it is in RA

A

no more affected in RA

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5
Q

What is OA characterized by

A

cell stress and extracellular matrix degradation

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6
Q

What initiates OA

A

micro and macro injury that activates maladaptive repair responses including pro-inflammatory pathways of innate immunity

Release of inflammatory enzymes + abnormal biomechanical forces -> damage of cartilage -> cartilage loss

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7
Q

What occurs to bone in OA

A

Increase in bone turnover and localized density - osteophytes

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8
Q

OA risk factors?

A
  • Age
  • Sex
  • Genetic
  • Obesity
  • Physical inactivity
  • Injury
  • Joint stress
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9
Q

Knee OA prevalence

A
  • African american > Caucasians
  • Medial compartment: Caucasian>chinese (men
  • lateral compartment: Chinese>Caucasian (men)
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10
Q

Hip OA prevalence

A

Caucasian > Chinese

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11
Q

Hand OA prevalence

A

Asymptomatic: Caucasian>Mexican americans>african americans

- Caucasian>Chinese

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12
Q

What occurs to bone turnover and localized density in OA vs normal aging

A

Increases in OA

Decreases in normal aging

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13
Q

What occurs to water content in cartilage in OA vs. normal aging

A

Increased in OA

Decrease in NA

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14
Q

What occurs to fibrillation in OA vs. normal aging

A

In OA: focal + progressive (will see it crossing joint line
In NA: at WB sites & not progressive

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15
Q

What occurs to metabolism and inflammatory enzymes in OA vs. normal aging

A

In OA: Increased

In NA: normal metabolism and no inflammation

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16
Q

What occurs to lean muscle mass in OA vs. normal aging

A

OA: Decrease (type I fibres)
NA: Decrease Type II fibres (fast)

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17
Q

What is the clinical pattern of OA in the knee

A

mostly bilateral; tibio-femoral?patella-femoral

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18
Q

What is the clinical pattern of OA in the hip

A

UNilateral> bilateral

19
Q

What is the clinical pattern of OA in the spine

A

Facet joint OA

20
Q

What is the clinical pattern of OA in the hand

A

PIP, DIP, CMC joints

This is unlike RA - which normally occurs in the MCP and rarely occurs in the CMC joint

21
Q

What is OA in the PIP called

A

Bouchard’s Node

22
Q

What is OA in the DIP called

A

heberden’s Node

23
Q

How does OA get diagnosed?

A
  1. Radiographic OA
  2. Symptomatic OA
  3. MRI- Defined OA
24
Q

What grading system is used for diagnosis of OA via radiography

A

Kellgren-Lawrence Grading System

25
Q

What are the main features you would see in Xray of someone with OA

A
  • Loss of joint space
  • Osteophytes
  • Subchondral scelerosis
  • Subchondral cyst formation
26
Q

What are subchondral sclerosis caused by

A

Increased periarticular bone density

27
Q

What is the first characteristic of OA you would see on an xray (what is the first clincal sign to occur)

A
  • Osteophytes
28
Q

What causes subchondral cyst formation

A

Typically cyst formation

29
Q

Using the Kellgren-Lawrence Grading system, what are the grades? At what grade do you begin to see changes on xray

A

0 - No radiographic features
1 - Doubtful: minute osteophyte, doubtful significance
2 - Minimal: Definite osteophyte, unimpaired joint space
3 - Moderate: Moderate decrease in joint space (pain)
4 - Severe; Joint space greatly impaired, sclerosis of subchondral bone (pain and all other Loss syndromes)

30
Q

Clinical Feature of OA

A
  • Pain after using the joint
  • Relieved by rest
  • Morning stiff less than 30mins
  • Stiffness after a period of inactivity
  • Only 40% of patients with joint damage experience pain
31
Q

Why may there be no pain in OA

A

Cartilage likes pressure and compression - unless soft tissue structures are being put on strain there is often limited pain, other causes of pain can be bone being exposed (very painful!!) or inflammation

32
Q

what needs to occur for symptomatic diagnosis of OA

A

Yes to all 4 questions: Constant or intermittent discomfort or pain…
- at any time on most days of the month?
- In the past year?
- Worse with activity?
- Relieved with rest?
One or more of 3 signs:
- Effusion. Flexion contracture. Gait abnormality

33
Q

___% of people with knee pain had MRI-detected OA that was not evident on xray

A

55%

34
Q

MRI is very useful to catch OA early, how does it do this?

A
  • Picks up on bone marrow edema (bone bruise) which are found in acute traumatic injuries
35
Q

Is there an association between weather and OA

A
  • The climate is not the cause or the cure but warmth does relieve symptoms
  • changes in barometric pressure and ambient temperature may affect OA
36
Q

What is the first line of treatment for oa

A
  • Exercise
  • Weight loss
  • Acetaminophen
37
Q

70% of knee joint loading is in the _____ compartment when walking - bringing the leg into the ___ position

A

medial

varus

38
Q

relationship between quad strength and hip/knee OA

A

in women only - lower risk with greater quad strength

39
Q

Is obesity related to risk of OA in WB or non-WB joints

A

Both - because fat tissues can increase the levels of inflammatory enzymes in the body

40
Q

Is BMI or waste circumference used to determine risk of OA

A

BMI

41
Q

If you lose 1 lb of weight you lose _____lb of knee joint load per step

A

4 lb

42
Q

Best to start diet or exercise program first?

A

both at same time

43
Q

Which diet is best : atkins, ornish, weight watchers, zone diets

A

all reduce weight but with poor adherence - need to choose one which person will stick to!

PHTH 565 RHEUMATOLOGY (7 decks)

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