Orthopaedics & Rheumatology_ Degenerative Joint Disease Flashcards
What is the most common joint disorder?
Osteoarthritis
Describe the pathogenesis of OA.
- Progressive destruction of articular cartilage by proteolytic enzymes, remodeling of subchondral bone
- its a wear and repair process
What are the most common joints involved in localized idiopathic OA?
- Weight bearing (knees, hips, and cervical and lumbar spine)
- hands
- distal interphalangeals [DIPs]
- distal interphalangeals [PIPs]
- carpal metacarpals [CMCs])
- feet
- metatarsal phalangeals [MTPs])
What spinal levels are most commonly involved by OA?
- C5; T8; L3: areas of greatest flexibility
At least how many joints must be involved for generalized idiopathic OA?
Three
What are the risk factors associated with idiopathic OA?
- Advanced age
- female sex
- obesity
What are some predisposing factors of secondary OA? R
- repeated joint stress
- genetic collagen abnormalities
- metabolic and endocrine diseases
- hemochromatosis
- diabetes mellitus
- hypothyroidism
- inflammatory joint diseases
- neuropathic arthropathy
What is the most common symptom of OA?
- Dull, achy pain aggravated by joint use and relieved by rest.
- Pain may occur at rest and at night with advanced disease.
- It is usually localized and asymmetrical.
What are the key physical examination findings of OA?
- Heberden and Bouchard nodes
- squared appearance of hand if first CMC joint involved
- osteophytes
- limited movement
- crepitus
- joint effusion
- malalignment in advanced cases
What are osteophytes?
- Bony enlargements at joint margins formed in response to cartilage degeneration
What joint when enlarged in OA is called a Heberden node?
DIP
What joint when enlarged in OA is called a Bouchard node?
PIP
What is the most likely result of the following laboratory tests in OA? Rheumatoid factor
Normal, although may be elevated in elderly
What is the most likely result of the following laboratory tests in OA? ESR
Normal, except in unusual inflammatory variations
What is the most likely result of the following laboratory tests in OA? Synovial fluid
Clear color, viscous fluid, WBC count <2000/mm3
What are the complications of OA in the following locations? Feet
Hallux valgus or Hallux rigiditus at MTP
What are the complications of OA in the following locations? Knees
- Baker cysts
- varus angulation
- valgus angulation
What are the complications of OA in the following location? Spine
- Osteophytes arising from vertebral bodies may lead to spinal cord compression/spinal stenosis
- spondylolisthesis (slipping of one vertebral body on another)
What are the usual treatment options of OA ?
- Lifestyle modifications and conservative management options
- Pharmacologic options
- Surgical options
What are the usual Lifestyle modifications and conservative management options of OA?
- Balancing rest and exercise
- physical therapy
- weight loss
- joint protection
- physiotherapy (heat, cold, ultrasound)
- orthotics
What are the usual Pharmacologic management options of OA?
- Paracetamol and/or tramadol
- NSAIDs in combination with GI protecting agent (only for short-term use)
- intra-articular corticosteroids
What are the usual surgical management options of OA?
- Arthroscopic irrigation or synovectomy
- arthroplasty
- artificial joints
What are appropriate indications for an intra-articular corticosteroid injection?
- Rheumatoid arthritis
- osteoarthritis
- crystal-induced arthritis
- tenosynovitis and bursitis
- entrapment neuropathies
What are the most common local side effects after a corticosteroid injection? What injection sites have an increased risk of infection and should be injected judiciously when other treatment options have failed? Olecranon and prepatellar bursae What are some of the adverse systemic effects of corticosteroid injections? Transient serum cortisol suppression, hyperglycemia
- Lipodystrophy
- discomfort
- loss of skin pigmentation
- transient increased pain for 24-48 hours
