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443-SRH and MSK > Osteoarthritis > Flashcards

Osteoarthritis Flashcards

1
Q

what is osteoarthritis?

A

a degenerative joint disease that is painful and often disablint as a chronic disease

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2
Q

what joints does OA affect

A

any= knee, hip, neck, spine, ankle, etc

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3
Q

what is the primary issue causing OA

A

loss of articular cartilage

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4
Q

T or F: OA only affects the articular cartilage

A

F- is a disease of the entire joint, but the primary issue is loss of articular cartilage

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5
Q

what is the most common chronic joint disase

A

OA`

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6
Q

by 65yrs of age, 80% of the population has some _______ of OA

A

radiographic evidence

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7
Q

what are the 3 parts that are affected in OA pathology

A

cartilage
synovium
bone

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8
Q

describe what happens to the cartilage in OA

A

initial cartilage swelling and matrix synthesis, unbalanced cycle of articular cartilage destruction/ repair followed by gradual cartilage loss (degradation >repair)

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9
Q

describe what happens to the synovium in OA

A

synovial inflammation and cytokine release = breakdown and more inflammation, ligament stretching and further fibrotic thickening/ encapsulation

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10
Q

describe what happens to the bone in OA

A

may see endochondral bony growths- osteophytes
early periarticular bone turnover
late subchondral plate sclerosis

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11
Q

list 3 causes of Oa

A

obesity
occupation, sports, trauma
genetic factors

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12
Q

what is the most important preventable RF for OA

A

obesity

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13
Q

obesity is a predictor of
1. shoulder OA
2. rapidly progressing OA
3. needing a prosthetic joint replacement
4. heberden’s nodes

A

3

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14
Q

what is the relationship between quad muscles and OA

A

quad weakness = joint looseness and more likely to see ligament injury
usually quad would help stabilzie the joint

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15
Q

what are some genetic factors for OA

A

heberden’s nodes, bouchard’s nodes, F>M

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16
Q

what is primary OA? what are the types

A

Primary OA: more common, no identifiable cause
Types: localized, generalized, erosive

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17
Q

what is secondary OA?

A

Secondary OA: known association with underlying cause
Ex- post trauma, genetic, obesity

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18
Q

what is the clinical presentation of OA

A

Progressive development (usually over years) of pain, joint stiffness, loss of movement/ function

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19
Q

waht differentiates RA and OA

A

OA pain usually confined to affected joints (asymmetric), while RA pain is usually symmetric and multi joint

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20
Q

OA pain tends to worsen with

A

exercise, AM inactivity

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21
Q

OA pain tends to improve with

A

rest

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22
Q

what is the gold standard imaging for OA

A

x ray

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23
Q

what are the hallmarks of OA seen on xray

A

joint space narrowing + osteophyte formation (most common), subchondral cysts, boney sclerosis

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24
Q

what are the clinical and radiographic criteria for knee OA

A

Pain in knees most days AND
Osteophytes on xray AND
One of the following
>50yrs
Morning stiffness <30min
Crepitus on motion

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25
Q

what are the clinical criteria only for knee OA

A

Pain in the knee most days and at least 3 of the following
>50yrs
Morning stiffness <30min
Crepitus on motion
Bony enlargement
Bony tenderness
No palpable warmth

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26
Q

what are the clinical and radiographic criteria of hip OA

A

Pain in the hip most days + at least 2 of the following
ESR <20 mm/h
Femoral or acetabular osteophytes on xray
Joint space narrowing on xray

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27
Q

what is the primary nonpharm tx for OA

A

exercise and weight loss

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28
Q

list 3 nonpharm tx for OA

A

PT/OT
exercise
taichi
activity mod + pt education
GL:D canada

29
Q

what is GLA:D canada

A

8 wk education nand exercise program for those with knee or hip OA: includes 2 education sessions + 12 supervised exercise sessions (2x/wk)
Assoc with improvement in pain and function, licensed through Canadian orthopedic foundation

30
Q

how much weight loss is recommended for OA if pt is obese

A

~10%, but even 4% is disease modifying

31
Q

when might surgery be used for OA? how effective is it?

A

for severe pain/ disability that can not be treated with meds
20-25% see no improvement in pain

32
Q

name the 5 classes of oral meds for OA

A

acetaminophen, NSAIDs, glucosamine and chondroitin, opioid analgesics, antidepressants

33
Q

topical tx for OA

A

topical NSAIDs, capsacin, other topical rubefacients

34
Q

what are the 2 intraarticular injections for OA

A

corticosteroids
viscosupplementation/ hyaluronic acid

35
Q

name the 3 first line options for OA

A

acetaminophen, NSAIDs, topical NSAIDs

36
Q

how long is an adequate trial of acetaminophen

A

2-3wks

37
Q

acetaminophen appears more effective than placebo for ______ OA pain (small improvement at _______), effect size may be small, less eff than NSAIDs

A

knee or hip
2 wks

38
Q

acetaminophen improves function in pts with ____ or ______ OA

A

hip or knee

39
Q

NSAIDs is associated with improvement in pain, function, and stiffness at 3mths in ________ OA

A

knee

40
Q

what characteristics of OA do NSAIDs improve? what kind of OA?

A

pain, function, stiffness of knee OA

41
Q

which NSAIDs are better than APAP for pain

A

naproxen, ibuprofen, diclo

42
Q

which NSAIDs are better than APAP for function and stiffness

A

naproxen, ibuprofen, diclo, celecoxib

43
Q

ACR 2019 recommends considering topicals ______ (before/after) PO NSAIDs

A

before

44
Q

what are some non NSAID topicals that may help OA pain

A

Methyl salicylate, trolamine salicylate, capsaicin, menthol (rubefacient)

45
Q

ACR 2019: ________for capsaicin in knee OA, _________for hand OA (may touch eye = irritate)

A

conditional rec
conditional rec against

46
Q

is capsacin recommended for hand OA

A

conditional recommended against- may irritate eyes

47
Q

duloxetine class

A

SNRI

48
Q

duloxetine is _______ for knee, hip, and or hand OA

A

conditionally rec

49
Q

duloxetine is conditionally recommended for _____,________,_________ OA

A

knee, hip, hand

50
Q

what is another drug class used for OA pain that tramadol may interact with

A

antidepressants

51
Q

tramadol effect on OA (select all that apply)
1. significant improvement in pain
2. significant improvement in function
3. pain improvement may not be significant
4. functional improvement may not be significant
5. increased risk of serious AEs
6. are conditionally recommended
7. are conditionally not recommended

A

3,4,5,6

52
Q

what does the ACR say about opioid use in OA

A

conditional rec against use, but recognize that they may be used in certain circumstances

53
Q

what are glucosamine and chondroitin

A

endogenous cartilage maintianing substances

54
Q

what is the proposed MOA of glucosamine and chondroitin

A

stimulate production of cartilage, prevent inflammatory cartilage destruction, maintain joint fluid viscosity

55
Q

glucosamine and chondroitin onset of pain relief

A

1-3wks

56
Q

those with ___________ allergies should not use glucosamine and chondroitin

A

shellfish

57
Q

what dose the ACR say about glucosamine and chondroitin use in OA

A

glucosamine strongly recommended against for knee, hip, and/or hand OA. chondroitin strongly recommended against for knee and/or hip OA, but conditionally recommended for hand OA

58
Q

name the 7 NHPs used in O

A

SAMe
avocado/ soybean unsaponifiables
MSM
vit D
antioxidants
boswellia serrata extract
ginger

59
Q

ASU effect in OA

A

reduce pain and NSAID use in pts with knee/ hip OA

60
Q

vit D efficacy in OA

A

supplementation for 2 yrs did not reduce knee pain or cartilage volume loss in pts with symptomatic knee OA

61
Q

boswellia serrat extract eff in OA

A

assoc with improvement in knee pain, flexion, and walking distance over 8 wks

62
Q

what CS may be injected in OA

A

triamcinolone
methylprednisone

63
Q

how often can intraarticular CS be used in OA

A

3-4x/yr max (and no more freq than q3mths)
Repeated inj may damage cartilage

64
Q

when should pain relief start with IA CS for OA? when does it peak? how long does it last?

A

starts at 24-72hrs, peaks 7-10d, can last 4-8wks
Should minimize activity and stress on joint for several days after injection

65
Q

what is the ACR rec for intraarticualr CS

A

strongly recommended for knee/ hip
conditionally for hand

66
Q

which of the following is false about hyaluronic intraarticular tx
1. it assists with joint lubrication and cartilage rehydration
2. it lasts longer than CS injections
3. it has a slower onset than CS but may be more effective
4. is conditionally recommended in knee and hand OA
5. 3+4

A

3+4

67
Q

what does the ACR say about hayluronic inj for OA

A

conditionally recommended against in knee and/or hand OA, strongly against in hip OA

68
Q

T or F: in most pts, APAP with NSAIDs is enough for OA pain

A

T

443-SRH and MSK (24 decks)

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