Osteoarthritis

Question 1

What part of the joint is involved in OA

Answer 1

the entire joint structure:

cartilage, subchondral bone, ligaments, menisci, synovium, and capsule

Question 2

OA is most characterized by

Answer 2

cartilage loss

Question 3

What is responsible for the pain in OP

Answer 3

osteophytes

**also responsible for dec ROM

Question 4

What joints are commonly affected by OA?

Answer 4

Hip
knee
hands
spine
feet

Question 5

what contributes most to disability in OA?

Answer 5

pain and functional limiatations

Question 6

epidemiology of OA

Answer 6

inc with age (due to decreased cellularity of cartilage)

women > men

Question 7

risk factors for OA

Answer 7

age
obesity
female
joint malalignment
trauma (previous surgery, fracture, etc)

also, hypermobility, osteoporosis, congenital joint dysplasia and dislocation, occupation and sport

Question 8

What is the etiology of secondary OA

Answer 8

suboptimal repair of normal cartilage injury due to..

1. Pre-existing joint damage (RA, gout, spondylarthritis, septic arthritis, Paget’s)
2. Metabolic disease (Chondrocalcinosis, Hemochromatosis, Acromegaly)
3. Systemic disease (Hemophilia, Hemaglobinopathies (sickle cell dz))

Question 9

Pathogenesis of OA

Answer 9

mechanical stress –> release of MMPS by chondrocytes –> degradation of collagen and proteoglycans –> pro inflamm cytokines (IL-1 and TNF) are releases + NO –> increased cartilage degradation > production –> chondrocytes sense damage and attempt to repair –> repair is disordered –> hypertrophy of bone at joint margins = osteophytes –> more inflammation –> destructive cycle continues

Question 10

in OA there is increased expression of ____ in chondrocytes

Answer 10

inducible COX 2

Question 11

in OA ____ may contribute to the pain and predict progession of disease and need for joint replacement

Answer 11

bone marrow lesions

Question 12

what does an osteophyte consist of?

Answer 12

fibrocartilage and bone

Question 13

WHere are osteophyts found?

Answer 13

periph of joints at the interface of cartilage and periosteum

Question 14

clinical presentation of OA

Answer 14

symp:

• joint pain
• morning stiffness (short lived
• functional limitations

signs:

• crepitus
• restricted ROM
• bony enlargements/osteophytes

(also, joint effusions, bony instability, muscle atropy)

sometimes will have elevated ESR or CRP

Question 15

treatment goal for OA

Answer 15

Symptom relief, improve quality of life, and prevent progression of disease

Question 16

non pharmacological treatment of OA

Answer 16

weight loss, hot/cold, exercise, orthotics

Question 17

pharmacological treatment of OA

Answer 17

topical capsaicin, NSAID, lidocane
acetaminophen, NSAIDs, narcotics
intra-articular corticosteroids and HA derivatives

Question 18

heberdons nodes vs bouchard’s nodes

Answer 18

Hep: osteophytes on DIP
Bouch: PIP

Question 19

early vs late joint changes in RA

Answer 19

early: cartilage surface irregularity and superficial clefts
late: cartilage ulceration that exposes bone

Question 20

bony changes in OA

Answer 20

due to chondocytes sensing damage and attempting to repair it –> they form clusters or cloves and cause…

sclerotic subchondral bone
hypertrophy = osteophytes

Question 21

Early and polyarticular is assc with a mutation in

Answer 21

COL2A1 gene

Question 22

deficiency in ____ is assc with OA

Answer 22

TFG-B and IGF-1

Question 23

_____ gene is assc with an increase in severity of OA

Answer 23

IL-1 receptor agonist gene