Osteoarthritis

Question 1

Most joint disorders affect ________ joints

Answer 1

synovial

Question 2

A synovial joint is composed of: (4)

Answer 2

an outer fibrous capsule
interior synovial membranes
articular cartilage
synovial fluid

the bones come together and move easily bc of the smooth surfaces of articular cartilage and lubricating synovial fluid

Question 3

A joint disorder is termed _________

Answer 3

arthropathy

Question 4

Arthropathy

Answer 4

a joint disorder
when the disorder involves INFLAMMATION of one or more joints–> arthritis

Question 5

Osteoarthritis (OA)

Answer 5

degeneration of joints caused by aging and stress
most common form
most common cause of disability in US
obesity and longer life expectancy is causing the incidence of OA to increase

occurs with wear and tear on the joints over time, and leads to inflammation in the joint, NOT systemic, just localized

Question 6

OA: Common Joints Affected (6)

Answer 6

cervical spine
lumbosacral spine
hip
knee
hands
first metatarsal phalangeal joint (big toe)

Question 7

What joints are typically spared in OA? (3)

Answer 7

wrist
elbow
ankles

Question 8

OA: Risk Factors (6)

Answer 8

-aging: men before 45, women after 45
-obesity
-history of participation in team sports
-history of trauma or overuse of joint
-heavy occupational work
-misalignment of pelvis, hip, knee, ankle or foot

Question 9

OA: Etiology (3)

Answer 9

stresses applied to joint (weight bearing)
degeneration of cartilage
-excessive loading of
healthy joint
-normal loading of
previously injured joint
chronic disease

Question 10

OA: Pathophysiology

Answer 10

prolonged excess pressure on joint wears away cartilage and subchondral bone exposed–> leads to cyst development—-> cysts move through remaining cartilage and destroys the rest—-> localized inflammation lead to more degradation—-> chondrocytes synthesize fluid called proteoglycans to try and repair–> causes swelling—-> osteoblasts activation leads to bone spurs & synovial fluid thickening—-> loss of cartilage narrows the joint space

Question 11

_________ are important hallmark of OA

Answer 11

osteophytes

Question 12

OA: CM (7)

Answer 12

-deep, aching joint pain, especially with exertion (relieved with rest)
-joint pain w/ cold weather
-stiffness in morning
-crepitus of joint during morning
-joint swelling
-altered gait
-limited range of motion

Question 13

OA: Physical Exam Findings

Answer 13

joint deformity
joint tenderness
decreased range of motion
fingers often involved:
-Herbeden’s nodes: DISTAL interphalangeal joint
-Bouchard’s nodes: PROXIMAL interphalangeal nodes

Question 14

OA: Goals for Treatment

Answer 14

manage pain
maintain mobility
minimize disability

Question 15

OA: Pharmacotherapy

Answer 15

Goal to manage pain and reduce swelling
Mild to Moderate: acetaminophen, topical capsaicin, NSAIDs (OTC)
Moderate to Severe: NSAIDs (Rx), NSAIDs + colchicine, acetaminophen + tramadol, opioids, steroid injections (into joint)

Question 16

NSAIDs

Answer 16

use lowest effective dose possible
can affect kidney function
risk for GI bleed:
-this risk increases dramatically with aging
-CONTRAINDICATED for pts with PUD
-use with caution in those with history of GI bleeds or on anticoag therapy

Question 17

OA: Other Treatment

Answer 17

dietary supplements: Chondroitin sulfate and glucosamine
artificial joint fluid-contains hyaluronic acid
joint replacement, arthroplasty

Question 18

Degenerative Disc Disease (DDD)

Answer 18

DDD is a common cause of pain, motor weakness, and neuropathy

Question 19

DDD most often occurs in _________

Answer 19

lumbar or cervical spine

Question 20

Degenerative Discs

Answer 20

-intervertebral disc compression occurs with age
-motor and sensory spinal nerves enter and exit from the spinal cord and travel through narrow openings of the vertebral bone
-with age, intervertebral discs dehydrate and vertebral bone become compressed–> impinge on the entering and exiting nerves
-dysfunction of motor and sensory spinal nerves impedes movement and sensation in the extremities
-may see weakness and parasthesias

Question 21

DDD: Lumbar S/S

Answer 21

-pain in the lower back that radiates down the back of the leg (also called “sciatica”)
-pain the in the butt or thighs
-pain that worsens when sitting, bending, lifting, or twisting
-pain that is minimized when walking, changing positions, or lying down
-numbness, tingling, or weakness in the legs
-foot drop

Question 22

DDD: Cervical S/S

Answer 22

-chronic neck pain that can radiate to the shoulders and down the arms
-numbness or tingling in the arm or hand
-weakness of the arm or hand