Osteoarthritis

Question 1

Etiology of Osteoarthritis (OA)

Risk factors

Answer 1

most commony type of arthritis
- age of onset is variable
- sequence of joints involved is variable (but multiple for sure!)
- can be asymptomatic or have failure of joints

Risk Factors
- females
- older age
- genetics
- previous trauma to joints
- anatomical variations of joints & shapes
- obesity!! weight on joints
- occupation and activity level
- nutrtion: increased omega 6 FA increase the risk
- smoking
- bone density

Question 2

OA symptoms

Answer 2

Pain
- related to use of the joint
- can be relieved with rest
- can occur at any time of day
- can be assoiciated with neuropathic pain

Stages of the OA can be predictable
- stage 1: predicatable pain following mechanical insult (like activity)
- stage 2: pain is more constant, effecting daily activities and has stiffness
- stage 3: a dull, aching pain which is constant and has associated intermittent intesne pain which severely limits function

(the symptoms do NOt have to progress in the above stages; could remain in one stage)

Question 3

OA presentation (Physical exam findings)
which joints are effected

Answer 3

on Exam
- joint LINE tenderness (lateral or medial)
- limited active and passive ROM
- bony swelling
- joint deformity
- instability of the joint (buckling)

Joints Effected
- DIP: distal interphalageal
- Thumb base
- First MTP: metatarsal phalngeal (foot)
- lower cervival and lumbar spine
- hip
- knee

Classic Signs
- Herberden’s Nodes : osteophytes grow at the DIP and widen the joint space
- Bouchard’s Nodes: at the PIP: hard outgrowths of the joint space

Question 4

Diagnosis
- imaging (findings)
- labs

Answer 4

the diagnosis of OA can be clinical imaging can help but is not necessary

X-ray
- osteophytes
- joint space narrowing : lost cartilage
- subchondral sclerosis: seen as thickening of the outline of bones (will appear whiter on xray)
- cyst formation : as joints rub together with loss of cartilage creating fluid spaces
- (in early disease: xray could be normal!)

MRI
- cartilage defects
- bone marrow lesions

US
- synovial inflammation
- bome marrow lesions

Labs
- synovidal joint fluid analysis: < 2,000 WBC (less than septic or gout)

Question 5

Red Flags which may make you think its not osteoarthritis

Answer 5

• younger pt.
• unusualy site with joint inflammation
• resting/nighttime pains
• rapidly progressing pain
• weight loss
• constitutional symptoms
• locking joints

here: get additionl labs to rule out
- ESR/CRP
- RF, CCP, ANA (RA)
- TSH
- CBC (infection)
- uric acid (gout)

Question 6

Treatment of OA
- treatment appraoch
- non -pharm
- pharm
- surgical
- other

Answer 6

treat like a chronic disease: educate pt. and consistenly reassess (ADLS, QOL, mood, fall risk, social support, comorbitidites)

Non-Pharm
- exercise
- PT
- assistance devices

Pharm
- NSAIDS (watch in PUD and kidney issues)
- duloxetine
- topical (lidocaine/NSAIDS)
- injections (steroids not great here tho)
- opioids (try to avoid)
- tylenol

Surgery
- arthroplasty (replace)
- arthrodesis (fusion at joint)
- osteotomy (reposition or remove)

Other
- accupuncture
- ciropractor
- TENS
- massage