Osteoarthritis

Question 1

What are alternate names for Osteoarthritis?

Answer 1

Degenerative Joint Disease, Osteoarthrosis

Question 2

Definition of osteoarthritis

Answer 2

progressive deterioration and lost of articular cartilage, leading to loss of normal joint structure and function

Question 3

What type of process leads to osteoarthritis?

Answer 3

Mechanical processes instead of inflammatory

Question 4

what are the functions of articular cartilage?

Answer 4

help support load placed on surface, smooth gliding of surfaces

Question 5

what is articular cartilage made up of?

Answer 5

chondrocytes, water, matrix

Question 6

articular cartilage overview

Answer 6

imbalance of synthesis and degradation, doesn’t bind water well, doesn’t cross-link appropriately

Question 7

what happens to the joints?

Answer 7

narrowing of the joints, bones rub together

Question 8

What is the primary cause of osteoarthritis?

Answer 8

Primary: unknown or hereditary (most common)
Secondary: other rheumatic diseases, trauma, structural abnormality of joint, neurologic disorders (loss of sensation or proprioception, leading to easier injuries), metabolic disease (diabetes, hypothyroidism, hemachromatosis, acromegaly)

Question 9

incidence of osteoarthritis

Answer 9

rises w/ age (esp. over 50 yrs old)
Knee>hip>hand
Women>men

Question 10

symptoms of osteoarthritis

Answer 10

joint pain on use or motion
loss of motion or function
minimal stiffness (s NOT osteoarthritis

Question 11

potential cause of pain

Answer 11

synovitis, stretching of joint capsule, periosteal irritation from osteophytes, trabecular microfracture, intraosseous hypertension, muscle spasm

Question 12

non articular causes of hip pain

Answer 12

bursitis, fascia lata syndrome, meralgia paresthetica (femoral cutaneous nerve), arterial insufficiency, lumbar radiculopathy, spinal stenosis, sacroiliac joint disease

Question 13

Physical exam of osteoarthritis features

Answer 13

bony enlargement of joint- FIRM to touch
minimal joint tenderness
effusions can occur
late in process (limited ROM, crepitus, malalignment/instability, atrophy of adjacent muscle)

Question 14

Osteoarthritis vs Rheumatoid arthritis

Answer 14

OA is mechanical, RA is inflammatory
OA is distal (DIP), RA is proximal (wrist, MCP,PIP)
OA is often asymmetric, RA is symmetric
OA has bone overgrowth and spurs, RA has swelling and tenderness

Question 15

Risk factors for OsteoArthritis

Answer 15

• Systemic: age, obesity, genetics, gender (fem), maybe menopause
• Local: trauma, muscle strength, joint proprioception, repetitive use, configuration of joint

Question 16

Obesity and osteoarthritis

Answer 16

risk of osteoarthritis increases by 40% for every 10 lbs of weight gain (risk reduction also corresponds)

twin study; heavier one consistently more likely to have OA

Question 17

osteoarthritis isn’t just result of pain induced disuse and atrophy, also affects

Answer 17

• quadriceps strength

- symptomatic and asymptomatic (asymptomatic seen on radiograph)

Question 18

diagnosis of osteoarthritis

Answer 18

primarily based on history and physical
X-ray knees and hands
-labs often aren’t necessary (non-inflammatory picture, no anemia as seen w/ chronic disease as long as OA is the only process)

Question 19

radiographic findings on osteoarthritis

Answer 19

• loss of joint space
• osteophytes (bone spurs) at joint margins
• sclerosis of subchondral bone
• subchondral cysts
• RARE to see periarticular osteoporosis and joint ankylosis

Question 20

Non-pharmacologic treatment of osteoarthritis

Answer 20

• education: patient and family
• exercise: strengthening and aerobic (bc if not, they get less active and fatter, lose muscle, lose flexibility and cardio, less coordination, osteoporosis, social isolation, depression, reduced pain threshold)
• footwear and walking aids
• diet
• weight loss
• OMT
• PT/OT

Question 21

Pharmacologic treatment of gout

Answer 21

Systemic drug therapy:

• acetaminophen (4g/day)
• NSAIDs and Misoprostol (one that bypasses stomach, pricey)
• cox2 (celecoxib)
• glucosamine/chondroitin sulfate

Intra-articular therapy

• corticosteroid
• hyaluronic acid (pricey)

Topical

• capsaicin P
• methylsalicylate
• combination agents

Question 22

Acetaminophen vs NSAIDs

Answer 22

High dose acetaminophen vs low and high dose ibuprofen= 4 wk trial, no significant difference

no difference btwn acetaminophen vs naproxen

Question 23

estrogen treatment for osteoarthritis

Answer 23

significant reduction in moderate to severe symptomatic OA if hip in caucasian post-menopausal women
women taking estrogen for 10+ yrs and still receiving it have lowest rate of OA
RECENT studies raised concerns of STROKE and HEART DISEASE RISK