Osteoarthritis

Question 1

Classification (2)

Answer 1

Primary OA: unknown cause
Secondary OA: known cause (trauma, infection, osteonecrosis)

Question 2

Classification - Radiographic Findings Grade 1

Answer 2

Possible osteophytes.
No joint space narrowing.

Question 3

Classification - Radiographic Findings Grade 2

Answer 3

Definite osteophytes.
Possible joint space narrowing.

Question 4

Classification - Radiographic Findings Grade 3

Answer 4

Moderate multiple osteophytes.
Definite joint space narrowing.
Some sclerosis.
Possible deformity of bone ends.

Question 5

Classification - Radiographic Findings Grade 4

Answer 5

Severe sclerosis.
Definite deformity of bone ends.

Question 6

OA Radiographic Findings in order of presentation (5)

Answer 6

1. Joint space widening (loss of cartilage)
2. Subchondral bone sclerosis
3. Subchondral bone cysts
4. Osteophytes (bone enlargement)
5. Joint space narrowing

Question 7

Etiology and Risk Factors (10)

Answer 7

Multifactorial - poorly understood.
Genetics
Ageing
Nutrition
Weight control
Female (menopause)
Bone density
Immune response
Smoking
High intensity sports

Question 8

Pathogenesis - Articular, Subchondral and Synovial Membrane Changes

Answer 8

Articular: Cartilage softening, thinning.
Subchondral: Disorganized bone remodeling, increased abnormal collagen I. Sclerosis and osteophytes.
Synovial membrane: Hyperplasia.

Question 9

End Stage OA: Joint Failure - Characteristics (6)

Answer 9

Total loss of cartilage
Structural changes, instability
Loss of muscle function
Severe pain at night and during activity.
Impaired physical function
Reduced QoL, ADLs, disability

Question 10

OA Management (5)

Answer 10

Based on severity of disease.
Non-medical: NSAIDS, intra-articular corticosteroid injection
Physiotherapy - Exercise!
Weight loss
Arthroplasty

Question 11

Signs and Symptoms of Primary OA - Subjective Findings, Aggravates and Eases (5)

Answer 11

Sudden or gradual onset.
Deep ache, difficulty walking, standing, stairs.
Stiffness <30 min in the morning or after prolonged activity.
Aggravators: Activity (pain after), prolonged sitting.
Eases: Rest, medication.
Eases: R

Question 12

Signs and Symptoms of Primary OA -Most common Signs (7)

Answer 12

Bony Enlargement
Limited ROM
Crepitus
Tenderness on Palpation
Joint Effusion
Malalignment
Joint deformity

Question 13

Hip OA Diagnostic Cluster (5)

Answer 13

Hip scour test
Passive internal rotation <25°
Hip pain when squatting
Painful active flexion
Painful active extension
3/5 positive = very likely hip OA

Question 14

Knee OA Diagnostic Cluster (6)

Answer 14

Pain + at least 3/6:
>50 years old
Morning stiffness <30 min
Crepitus during ROM examination
Tenderness on palpation
Bony enlargement on joint
No temperature increase

Question 15

Osteoarthritis vs. Rheumatoid Arthritis (8)

Answer 15

Degenerative vs Autoimmune disease
Cartilage loss vs inflamed synovium
>40 y.o. vs 25-50 y.o.
Sudden or gradual onset vs gradual onset
Morning stiffness <30min vs >1h
Asymmetrical vs Symmetrical-multi joint
No systemic symptoms vs systemic symptoms (fatigue, fever, anorexia)
No signs of inflammation vs signs of inflammation