OA Treatment Flashcards
State 5 symptoms of OA [5]
Joint pain with use
Morning stiffness lasting <30 mins
Crepitus on motion
Joint instability or buckling
OA
What are the arrows pointing at? [1]
Osteophytes: cartilage-capped bony proliferations (bony spurs) that most commonly develop at the margins of a synovial joint
What are the core (non-pharmalogical treatments) for OA? [2]
Lose weight
Exercise: aerobic AND resistance exercise
State a non-pharmological adjunct for OA pain relief [1]
Transcutaneous electrical nerve stimulation (TENS)
What physiologically happens if give exercise for OA [2]
- No changes in joint space width
- If cartilage is lost it stays lost
- But reduced pro-inflammatory cytokines
What type of diet is recommended for OA? [1]
Med. diet:
* Oily fish and healthy fats, anti-oxidant rich foods and stabilising blood sugar
Pharmacological managementfor OA
COME BACK
- Start with oral analgesics &/ or topical NSAIDs
- Where paracetamol or topical NSAIDs are ineffective then substitute with oral NSAID/COX-2 inhibitor
- Intra-articular injections; Corticosteroid injections
Why are topical NSAIDs prescribed prior to oral NSAIDs? [2]
Target specific areas
Don’t need PPIs
Why are only three intra-articular injections (corticosteroid injections) recomended?
If prescribe too much: softens cartilage which can cause further problems
What symptom would indicate that surgery is required for OA? [1]
Waking at night because of the pain
State 6 surgical interventions for OA [6]
Arthroscopic lavage
Arthroscopic lavage plus debridement
Microfracture
Mosiacplasty (osteochondral transplant)
Chondrocyte grafts
Joint replacement
Explain mechanism of arthroscopic lavage plus debridement treament for OA
Needs to be large joint
Camera inserted into joint; assess damage for inflammation and pieces of cartilage that have worn off and leaving exposed bone
Wash out synovial fluid and get rid of floating bits of cartilage
Debridement: tidies up exposed & frayed areas; remove cartilage
Healthy on L, OA on R
Explain mechanism of Arthroscopic washout and debridement plus microfracture [2]
Same mechanism as arthroscopic washout and debridement
After debridement: have area of exposed bone: drilling into subchondral bone and bone marrow pluripotent stem cells
Stimulates repair of articular cartilage
Cartilage recovers within 4-6 months
What is the name for treatment of adding hyaluronic acid in OA? [1]
Explain the MoA [3]
Some reduction in hyaluronic acid in OA (but not as much as RA)
Viscosuplementation: addition ofyaluronic acid responsible for viscoelastic properties of synovial fluid
MoA:
* Hyaluronan reduces MMP activity
* Returns higher molecular weight hyaluronans increases viscosity
* Provides direct analgesic effect
State advantages [4] and disadvantages [2] of Viscosuplementation
Advantages
* Works well at all stages of OA
* Improves patient assessed pain
* Well tolerated
* Long term effectiveness
Disadvantages
* Severe OA may not respond as well
* Some local adverse effects at injection site
Explain the MoA of chondrocyte grafting
Take chondrocytes from other areas of the body (e.g. costochondral joint)
Grow chondrocytes in culture
Place in graft and get more hyaline cartilage
OA treatment
Explain MoA of mosaicplasty (osteochondral grafting) [1]
Take undamaged cartilage from less weight bearing regions plus the underlying bone and move to OA region
State three locations of chondrocytes for chondrocyte grafting [3]
Rib costochondral process
Non damaged part of joint
Also cartilage implants from young individuals available
Describe mechanism of osteotomy [1]
Realignment of joint surfaces
Which part of the knee is more commonly effected by OA? [1]
medial compartment affected
State which bone would have osteotomy to for the following
If genu valgus then osteotomy to []
If genu varus then osteotomy on the []
If genu valgus then osteotomy to femur
If genu varus then osteotomy on the tibia
Treatments for OA
Explain two novel targets for OA [2]
Platelet rich plasma (PRP): take blood and centrofuge. Take the PRP and inject into joint
Bone marrow and centrofuge; get bone marrow aspirate concentrate (BMAC) & inject. Creates NEW joint space !!
Treatment for OA
Which IL can you target / block to treat OA? [1]
IL-1 blockage
OA treatment
Adalimumab targets which cytokine? [1]
TNF inhibition
OA diagnosis
State 4 things assess for OA when using X-ray? [4]
LOSS:
- Loss of joint space
- Osteophytes
- Subarticular sclerosis
- Subchondral cysts
How do you distinguish OA from RA? [2]
- by the pattern of joint involvement
- the absence of systemic features and marked early morning stiffness that occur in rheumatoid arthritis
OA
Heberdens nodes occur at which joint space? [1]
DIPs
