Osteoarthritis Flashcards

1
Q
  • MOST COMMON TYPE OF ARTHRITIS
  • LEADING CAUSE OF DISABILITY IN THE ELDERLY
  • PREVALENCE RISES STRIKINGLY WITH AGE, BEING UNCOMMON IN ADULTS AGEDD <40 Y.O, HIGHLY PREVALENT TO AGES >60
A

Osteoarthritis

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2
Q

Usually spared joints in Osteoarthritis are the:

A
  • wrist
  • elbow
  • ankle
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3
Q

Symptomatic OA of the knee (pain on most days of a recent month plus x-ray evidence of OA in that knee) occurs in 12% of persons age ___ in the United States and 6% of all adults age___

A
  • > 60
  • > 30
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4
Q
  • is joint failure, a disease in which all structures of the joint have undergone
    pathologic change, often in concert.
  • the pathologic sine qua non of disease is hyaline articular cartilage loss, present in a focal and, initially, nonuniform manner
  • increasing thickness and sclerosis of the subchondral bony plate, by outgrowth of
    osteophytes at the joint margin, by stretching of the articular capsule, by variable degrees of synovitis, and by weakness of muscles bridging the joint
A

OA

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5
Q

Joint protectors include:

A
  • joint capsule and ligaments
  • muscle
  • sensory afferents
    -underlying bone
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6
Q
  • reduces friction between
    articulating cartilage surfaces
  • hyaluronic acid and lubricin
A

Synovial fluid

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7
Q

bridge the joint are key joint protectors.

A

Muscles and tendons

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8
Q

Risk factors for osteoarthritis

A
  • Previous damage (e.g..
    meniscectomy)
  • Bridging muscle weakness
  • increasing bone density
  • Malalignment
  • Proprioceptive deficiencies
  • Increase age
  • female gender
  • racial/ethnic factors
  • genetic susceptibility
  • nutritional factors
  • obesity
  • injurious physical activities
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9
Q

rarely inherited and is more often a consequence of aging

A

“generalized OA”

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10
Q

confer a high risk of OA

A

polymorphism within the growth differentiation factor 5 (GDF5) gene

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11
Q

distortions of hip joint anatomy in children that often lead to

A
  • congenital dysplasia
  • Legg-Perthes disease
  • slipped capital femoral epiphysis
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12
Q

recedes the development of disease and is not just a
consequence of the inactivity present in those with disease
- it Is a stronger risk factors for disease in women and men
- have more severe symptoms from the disease

A

Obesity

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13
Q

two categories of repetitive joint use:

A
  • occupational use
  • leisure time physical activities
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14
Q

SOURCES OF PAIN IN OSTEOARTHRITIS

A
  • cartilage is aneural, cartilage loss in a joint is not accompanied by pain
  • pain arises from structures outside the cartilage
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15
Q

pain is episodic, triggered often by overactive use of a diseased joint

A

Early in disease

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16
Q

Stiffness of the affected joint may be prominent, but morning stiffness is usually brief about

A

<30 min

17
Q

CLINICAL FEATURES OF OA

A
  • In knees, buckling may occur, in part, from weakness of muscles crossing the joint
  • buckling, catching or catching could also signify internal derangement, like an anterior cruciate ligament or meniscal tear
  • for hip pain, it can be detected by loss of internal rotation on passive movement, and pain isolated to an area lateral to the hip joint usually reflects the presence of trochanteric bursitis
18
Q

Test for OA if signs and symptoms suggests inflammatory arthritis

A

Blood tests

19
Q

more helpful diagnostically than an X-RAY

A

Exam of the synovial fluid

20
Q

If the synovial fluid white count is ____, inflammatory arthritis or gout or
pseudogout is likely, the latter two being also identified by the presence of crystals.

A

> 1000/pL

21
Q

goals of the treatment of OA:

A
  • alleviate pain
  • minimize loss of physical function
22
Q

Patients with mild and intermittent symptoms may need only

A

reassurance or nonpharmacologic treatments.

23
Q

Patients with ongoing, disabling pain are likely to need

A

both nonpharmacotherapy
and pharmacotherapy

24
Q

NONPHARMACOTHERAPY
Ways of lessening focal load across the joint include:

A
  1. avoiding painful activities as these are usually activities that overload the joint:
  2. improving the strength and conditioning of muscles
    that bridge the joint, so as to optimize their function
  3. unloading the joint, either by redistributing load within the joint with a brace or a splint or by unloading the joint during weight bearing with a cane or a crutch
25
Q

Why Tx of Exercise in OA needed?

A
  • First, there is a decline in strength with age.
  • Second, with limited mobility comes disuse muscle atrophy.
  • Third, patients with painful knee or hip OA alter their gait so as to lessen loading
    across the affected joint, and this further diminishes muscle use
  • Fourth, “arthrogenous
    a inhibition” may occur, whereby contraction of muscles bridging the joint is inhibited by a nerve afferent feedback loop emanating in a swollen and stretched joint capsule
26
Q

Trials in Knee and hip OA have shown that exercise

A

lessens pain and improves physical function

27
Q

TREATMENT:

Correction of Malalignment

A
  • either surgically or with bracing, may relieve pain in persons whose knees are malaligned
  • Fitted braces that straighten varus knees by putting valgus stress across the knee can be effective
  • Using a patellar brace to realign the patella, or tape to pull the patella back into the trochlear sulcus or reduce its tilt, has been shown, when compared to control in clinical trials, to lessen patellofemoral pain
28
Q

Most effective exercise regimens consist

A

aerobic
and/or resistance training

29
Q

PHARMALOGICAL TX FOR OA

A

ORAL NSAIDs and COX-2 inhibtors

30
Q
  • produce 30% greater improvement in pain than high-dose acetaminophen
  • should be administered topically or taken orally on an “as needed” basis
    because side effects are less frequent with low intermittent doses.
A

NSAIDS

31
Q

The American Heart Association has identified ___ as putting patients at high risk, although low doses of celecoxib (S200 mg/d of celecoxib) are not associated with an elevation of risk

A

rofecoxib and all other COX-2
inhibitors

32
Q

only conventional NSAID that appears safe from a
cardiovascular perspective, but it does have Gl toxicity

A

Naproxen

33
Q

Recent guidelines recommend against the use for OA

A

glucosamine or chondroitin

34
Q

Surgery when the px w/ knee or hip OA has failed nonsurgical tx modalities w/ limitations of pain or function that compromise the quality of life, the px w/ reasonable expectations and readiness for surgery should be refereed for

A

total knee or arthroplasty