Osteoarthritis Flashcards
What is the WHO definition of OA?
A long term chronic diseases characterized by the destruction of cartilage in joints which results in bones rubbing together creating stiffness, pain and impaired movement
What on chondral cartilage?
Cartilage which lies on the surface of the bones to allow low friction movements
OA is a degenerative disease of what cartilage?
Chondral Cartilage
When does inflammation occur in OA relative to RA?
Inflammation occurs late in the onset of disease compared to RA
What are the main inflammatory cytokines involved in OA?
TNF-alpha and IL-1Beta
What are two examples of proteinases?
Matrix Metalloproteins and aggrecanases
What is the effect of inflammatory cytokines like TNF on the articular cartilage membrane?
TNF increases the synthesis of proteinases and other catabolic factors which degrade the articular cartilage membrane
What factors can lead to endogenous predisposition OA?
Age, gender, genetics and high BMI
What external factors can increase the risk of OA?
Trauma and overload
How do subchondral cysts form?
When inflammatory cells eat away at bone
How does loss of joint space lead to sclerosis?
When osteoblasts try and make more bone to compensate for the loss of bone and it thickens
Which type of cartilage is broken down by Matrix Metallo Proteinases?
Hyaline articular cartilage
What causing the caving in of the bones?
When the lateral sides of the knee cartilage has been degraded
Describe the cycle which is involved in the development of OA?
Joint pain -> Lead to limited mobility -> Lack of physical activity -> Leads to obesity -> Increased pressure on joints
What are the main locations where OA can be found?
Knee, Hip, Spine, Fingers
What affect does having a family history of Osteoarthritis have on the age on onset of OA?
it causes a left shift in the curve - onset is earlier
How does the pain of OA change throughout the day?
gets worse throughout the day
How long does morning stifness/pain last with OA?
Minimal - less than 20 minutes
Compare the timing of pain between OA and RA?
OA gets worse throughout the day and RA is worse in the morning and gets better throughout the day
What is crepitus?
When you get crunching of your bones as they are rough surface on rough surface
What happens to a patients range of motion when they suffer from OA?
Range of motion is limited
What are the four stages of assessment for OA?
Look
Feel
Move
Special Tests
What is the bone deformity commonly seem in OA patients when standing?
Valgus deformity - this is were the lateral sides of the articular cartilage are further degraded than the medial resulting in the inwards collapse of the legs
What is the bulge test for knee effusion?
The dimple of fluid will disappear when it gets pushed away and bulge again the fingers are moved
What is the name given to fluid swellings in the knee joints?
Fluid effusion
What are the two things that should be felt for during an OA assessment?
Knee effusion and warmth which would indicate inflammation
What is a lab tests which can be done to test for OA?
Check for cartilage degradation products in the serum and joint fluid
What are four radiological changes seems with OA?
Osteophytes, sclerosis, loss of joint space and subchondral cysts
What are injections which can be given to manage OA?
Steroid, lubrication gel, platelet rich plasma, hyaluronic acid
What are some conservative OA management strategies?
Weight loss, analgesics, phsiotherapy, walking aids, avoiding exacerbating activity
What operative procedure is done if OA is found in the knee?
Knee replacement
What operative procedure is done if OA is found in the wrist?
Denervate wrist
What are some signs and symptoms which patients might present with if they have OA?
Swollen joint, ballotable effusion, warmer indicating inflammation, limited range of motion
What are the seven elements of the flow chart which outlines the progression of injury to OA?
Injury -> meniscal tear -> surgery / removal -> increased pressure in the knee -> articular cartilage wear -> loss of joint space -> OA
Which nodes are found at the DIP joints?
Heberdens nodes
Which nodes are found at the Proximal Interphalangeal Joints?
Bouchards
Between DIP and PIP joints, which are more likely to be found in OA?
DIP
