Osteoarthritis Flashcards
What is arthritis? What is it a product of?
inflammation of the joint
- synovitis - reversible
- osteoarthritis - irreversible bone changes
What is the goal to arthritis treatment?
- return to function
- QoL improvement
What is the top cause of chronic pain in dogs?
osteoarthritis —> diminished QoL, limited activity, reduced performance
What are 7 aspects to the multimodal approach to osteoarthritis treatment?
- NSAIDs and adjunct meds
- weight optimization - lessens workload
- supplements
- eicosapentaenoic acid-rich diet
- rehabilitation
- disease-modifying agents
- IA injections
What are 4 aspects to the normal joint anatomy?
- bone - cancellous to absorb shock
- cartilage
- soft tissue - fibrous synovial lining
- synovial fluid
Where does pain begin first in the joint?
synovial membrane —> rich vascularization and neural systems
What are the 2 roles of synovial fluid?
- reduce friction between articular cartilages during movement
- provides nutrition to components of the joint
What cartilage makes up the joint? How does it receive nutrition? What cells are responsible for its health?
hyaline —> avascular
movement of fluid under the influence of weight-bearing
chondrocytes - secretes ECM
What is subchondral bone? How does it compare to cortical bone? What is its major role?
thin layer of bone that joins hyaline cartilage with cancellous bone to support the bony plate
10x more deformable
distributes forces across joint
What 3 things make up the pathology of osteoarthritis?
- synovial membran inflammation
- deterioration of cartilage
- osteophytosis and bone remodeling
What is the defining element of osteoarthritis?
mechanical failure of articular cartilage
What are the 4 stages of osteoarthritis?
- stage 0-1 = pre-osteoarthritis
- stage 2 = mild osteoarthritis, synovial inflammation
- stage 3 = moderate osteoarthritis
- stage 4 = severe osteoarthritis
OA:
What is a common sign of osteoarthritis?
hard to transition weight to painful limbs
- dogs typically get up by pushing weight forward and not thrusting back legs
What is felt on orthopedic exams in patients with osteoarthritis?
- crepitus
- decreased ROM
- effusion
- pain
- instability
What is seen on neurologic exams in patients with osteoarthritis?
- proprioceptive defects
- spinal reflexes diminished
- motor strength decreased
- pain
What diagnostics are used for osteoarthritis?
- 2 view radiographs
- CT/MRI
- arthroscopy
What pharmaceuticals are commonly used for osteoarthritis?
- NSAIDs: Rimadyl, Galliprant
- Amantadine
- Gabapentin
How does Adequan work?
disease-modifying OA agent
- polysulfated glucosaminoglycan enhances healing and joint resurfacing
What tends to have the greatest effect in treating patients with OA?
weight reduction
- metabolic + mobility prescription diets
What are some environmental modifications that can help patients with OA?
- harness (help ‘em up)
- ramps
- yoga mats/rug for traction
What rehabilitation strategies can help patients with OA?
- hold/cold packs
- hydrotherapy
- photobiomodulation (laser)
- manual therapy
- therapeutic exercise
What are 6 common components of intra-articular injections that can help patients with OA?
- hyaluronic acid
- polysulfated glycosaminoglycan
- corticosteroids
- mesenchymal stem cells
- platelet-rich plasma
- radiosynoviorthesis
What 5 mechanisms of action does hyaluronic acid have? What does this result in?
- induced cellular proliferation and ECM production
- stimulated synoviocytes, causing endogenous hyaluronan synthesis
- inhibits inflammatory mediators, like MMP-3, IL-1, TNF-a, PGE2
- anti-apoptotic effect on chondrocytes
- blocks expression of certain proteases
restores physiochemical properties of the joint
In what 3 ways are steroids able to decrease pain and inflammation seen with OA? Are they commonly used?
- reduced synovial blood flow
- lower WBC and inflammatory modulator response
- alters local collagen synthesis
NO —> chronic use causes cartilage degradation
What are mesenchymal stem cells? How do they treat OA?
multipotent cells with the ability to differentiate into severe different specialized cells, like chondrocytes, osteoblasts, adipocytes, and assists with tissue regeneration —> immunomodulatory +/- regeneration
reduces pain and increases limb function
How is platelet-rich plasma able to help for patients with OA?
contains other growth factors and substances that are normally in the plasma, like IGF-1
- can be injected into the joint capsule or as a platelet-rich fibrin clot to act as scaffolding
What is radiosynoviorthesis?
application of a low dose of radioactive Synovetin-OA (Tin-117m), concentrated in joints which blocks pro-inflammatory mediators that initiate pain and hypersensitize the CNS
- long-term = cancer development, so low energy that safety is not commonly a concern
What distance should be between family members and pets with joints treated with radiosynoviorthesis?
- can remain 1 foot from the joint for 15 mins
- can remain 3 feet away for 4 hours
- can remain more than 3 feet away for unlimited time
3 weeks past treatment = no need to keep distance
In what 5 ways is Synovetin commonly used?
(radiosynoviorthesis)
- with or in the place of NSAIDs
- with NSAID failure
- when NSAIDs can cause safety issues
- when compliance may be an issue
- to reduce NSAID use
