OA and treatment

Question 1

what is OA

and what it causes

Answer 1

OA is a long-term chronic disease characterized by the deterioration of (articular) cartilage in joints which results in bones rubbing together and creating stiffness, pain, and impaired movement.

Question 2

does inflammation occur in OA

Answer 2

Yes, Degenerative disease of chondral cartilage

Inflammation occurs late in disease cf. rheumatoid

Question 3

what is the order of progression (very brief summary)

Answer 3

(mechanical stress to then inflammation -> primary OA secondary inflammation)
wear and tear 
degrades articular cartilage 
lose joint space 
then inflammation

Question 4

compare it to RA

Answer 4

inflammation first then wear and tear

Question 5

endogenous predispositions to OA

Answer 5

age
gender
high BMI (educating weight loss key part of conservitive treatment)

Question 6

external risk factors

Answer 6

trauma
overload
(preventing high stress excerises)

Question 7

what is the function of meniscus cartilage

Answer 7

shock absorber

Question 8

how should the articlar cartilage and the whole joint look like

Answer 8

smooth shiny white

Question 9

what are the main risk factors of OA

Answer 9

Age, excess weight/obesity

Question 10

what are other risk factord

Answer 10

mechanical constraints(intense sport) 
hereditary 
female gender/menopause 
oestrogen defiency 
metabolic syndrome 
cruitate ligament rupture

Question 11

what portions of teh spine does OA effect

Answer 11

lumbar and cervical spine

Question 12

What joints in teh hand

Answer 12

DIP PIP

Question 13

what main joints effected

Answer 13

big joints (knee hip spine and fingers)

Question 14

if other joint affected like ankle

Answer 14

maybe due to other conditions

Question 15

RA affects ehich joints in teh hands

Answer 15

NOT THE DIP PIP

metacarpal phalangeal joints

Question 16

OA signs/symptoms

Answer 16

Pain is related to use
Pain gets worse during the day
Minimal morning stiffness (<20 min) and after inactivity (gelling)
Range of motion decreases
more stiffnes at the end of the day 
Joint instability 
Bony enlargement
Restricted movement
Crepitus
Variable swelling and/or instability

Question 17

what is the assessment carried out

Answer 17

Look
Feel
Move
Special tests

Question 18

what can you look fpr

Answer 18

alignment of the knee and knee scar indicating kneee surgey

Question 19

what do you feel

Answer 19

may have fluid around the joints, so a bubble of fluid that can be moved around

Question 20

what do you move

Answer 20

the knee while patinet is lying down

angle of flexion

Question 21

what is the special test

Answer 21

anterior draw

Question 22

what is the significance of the test

Answer 22

cruitiate ligament not wotking

Question 23

why is that significant

Answer 23

can cause artitits by increase in wear and tear

Question 24

what lab/blood test can be doen

Answer 24

none

Question 25

what else can you anaylse

Answer 25

Cartilage degradation products in serum and joint fluid

Question 26

what changes can be seen in a x ray

Answer 26

loss of joint space sclerosis osteophytes sunchondral cyst

Question 27

what is scelrosis

Answer 27

Sclerosis- thickening of bone- shown by the white --

Question 28

what is subchondral cyst

Answer 28

a fluid-filled space inside a joint that extends from one of the bones that forms the joint. shown as dark region

Question 29

osteophytes

Answer 29

are cartilage-capped bony proliferations (spurs)

Question 30

what is conservative OA manadgement

Answer 30

``` Weight loss Analgesics: oral/topical NSAIDS, Physiotherapy Walking aids Avoidance of exacerbating activity Injections (steroid/viscosupplementation) ```

Question 31

what injections can be given

Answer 31

Steroids Lubrication gel Platelet rich plasma ???stem cells (not a lot of evidence)

Question 32

operations

Answer 32

``` Operative Replace (knee/hip) Realign (knee/big toe) Excise (toe) Fuse (big toe) ?arthroscopy if loose bone in joint Denervate (wrist) ```

Question 33

what q to ask to distinguish between OA and RA

Answer 33

the pain throughout the day worse or better after movement one knee both knee

Question 34

what is important to ask if yiu want to do a surgery or injection

Answer 34

what med they take to see if their are any blood thinners

Question 35

outline the transition from a meniscal tear to OA

Answer 35

``` Injury meniscal tear surgery/removal increased pressure articular cartilage wear loss of joint space OA ```

Question 36

what is seen on the DIP with patients of OA

Answer 36

heberdens nodes

Question 37

what about PIP

Answer 37

bouchards nodes

Question 38

what are they caused by

Answer 38

osteophytes

Question 39

what do patients with hip joint problem present with

Answer 39

deep groin pain taht radiates into thhe medial thigh | knee pain

Question 40

steriod treatment

Answer 40

Steriord help as an antilinflammaoty for 2/3 months maybe up to a year But too much steroids can cause adverse side effects like  infection, and actually cause A because inflammation in needed to heal and thus may not heal

Question 41

what is the platelet therapy

Answer 41

Blood centrifugated to get platelets Platelets have lots of anti inflammatory mediators Injected to the knee Helping cartilage effects

Question 42

what sort of bones are bouchards and heberedens

Answer 42

cortical

Question 43

4 core points of physiotherapy

Answer 43

Muscle strength Conditioning Proprioception Massage/muscle stretching