Osteoarthritis

Question 1

True or false: osteoarthritis is the most common form of arthritis

Answer 1

True

Question 2

Is osteoarthritis inflammatory?

Answer 2

No, it’s degenerative mechanical shearing

Question 3

What are risk factors for osteoarthritis?

Answer 3

Age (50+)
Female
Obesity
Occupation/ sports
Genetic

Question 4

What gene is associated with osteoarthritis?

Answer 4

COL2A1

Question 5

In osteoarthritis, there is increased _____ breakdown than repair

Answer 5

collagen

Question 6

There is increased chondrocyte m__________ secretion in osteoarthritis

Answer 6

metalloproteinase

Question 7

What type of collagen does metalloproteinase degrade and what else can it cause?

Answer 7

Type 2
Can cause cysts

Question 8

How does the bone try to overcome the degradation of type 2 collagen?

Answer 8

Makes more Type 1 collagen resulting in abnormal bony growths(osteophytes) and remodelling

Question 9

What are abnormal bony growths called?

Answer 9

Osteophytes

Question 10

What is the typical pain pattern in osteoarthritis?

Answer 10

Transient pain in the morning, gets worse as the day goes on

Question 11

What are the names of the 2 types of nodes that can form on the fingers?

Answer 11

Bouchard and Hebderen

Question 12

Where do Heberden nodes form?

Answer 12

Distal Inter-Phalangeal Joints (DIPJ)

Think H after B, so further

Question 13

Where do Bouchard nodes form?

Answer 13

Proximal Inter-Phalangeal Joints (PIPJ)

Think B before P, so closer

Question 14

Other than pain and nodes (Hebderen and Bouchard) what are other symptoms of osteoarthritis?

Answer 14

Asymmetrical, hard and non-inflamed joints, typically the joints that are most stressed (base of thumb and big toe, hip/knee)

No extra-articular symptoms

Question 15

What would blood test show in osteoarthritis?

Answer 15

Normal

Question 16

How do you diagnose osteoarthritis?

Answer 16

X Ray
Showing loss of joint space, osteophytes, subchondral sclerosis, subchondral cysts

Question 17

How do you manage osteoarthritis?

Answer 17

Weight loss (decrease load on joint)
Weight bearing (improve strength and function)
physio (support joint)

Oral paracetamol
NSAIDs for pain relief with a PPI

Last resort = consider arthroplasty for
knee and hip replacement.

Question 18

What mnemonic helps to remember the changes on an X-ray due to osteoarthritis?

Answer 18

LOSS

Question 19

What does L stand for in LOSS?

Answer 19

Loss of joint space

Question 20

What does O stand for in LOSS?

Answer 20

Osteophytes

Question 21

What does the first S stand for in LOSS?

Answer 21

Subchrondral sclerosis
(increased density of the bone on the joint line, where the bones come in contact with each other)

Question 22

What does the second S stand for in LOSS?

Answer 22

Subchondral cysts

(Small fluid-filled holes in the bone, along the joint line)

Question 23

True or false: activity helps the joint pain and stiffness?

Answer 23

False
It worsens with activity (unlike inflammatory arthritis)

Question 24

Osteoarthritis leads to d_____, i_____ and reduced function in the joints

Answer 24

deformity, instability

Question 25

What joints are commonly affected by osteoarthritis?

Answer 25

Knees Hips Sacro-iliac joints Base of thumb (carpometacarpal) DIPJs Wrist Cervical spine (cervical spondylosis)

Question 26

What type of joint is at the base of the thumb (where metacarpal articulates with trapezium at CMC joint)?

Answer 26

Saddle joint

Question 27

A diagnosis of osteoarthritis can be given without further investigations if the patient is...

Answer 27

Over 45 Presents with typical activity related pain No morning stiffness

Question 28

What can cause temporary reduction in inflammation and improve symptoms in osteoarthritis?

Answer 28

Intra-articular steroid injections

Question 29

What is a GI side effect of using NSAIDs?

Answer 29

Gastritis and peptic ulcers (Inhibit prostaglandin production, reduced production of protective mucous in stomach, decreases bicarbonate secretion and impairs blood flow to gastric mucosa. Can stimulate release of gastric acid. Reduced mucosal defence and increased acidity = ulcers. Injury can lead to erosions and inflammation = gastritis. Can exacerbate effects of any Helicobacter pylori infection. NSAIDs also inhibit platelet function so increase risk of bleeding.

Question 30

How do NSAIDS cause AKI and CKD?

Answer 30

Inhibition of prostaglandin production means reduced renal blood flow (no vasodilation). Potential ischaemic injury = CKD NSAIDs can constrict afferent arteriole of glomerulus reducing GFR and impairing kidney function. Non-selective COX inhibitors may have direct toxic effects on renal tubular cells = AKI NSIADs can also cause fluid retention and sodium imbalance, exacerbating hypertension and pre-existing kidney disease.

Question 31

How can NSAIDs exacerbate asthma?

Answer 31

Inhibited prostaglandin production so no bronchodilation and inflammation may worsen as NSAIDs activate mast cells. mast cells release histamine which contribute to bronchoconstriction and airway inflammation.

Question 32

In osteoarthritis, damage to articular cartilage leads to c______ replacing the type II collagen with type I

Answer 32

chondrocytes

Question 33

In osteoarthritis, the chondrocytes become exhausted and apoptosis occurs. Leads to decreased elasticity and increased cartilage b_______ leaving clefts in articular surfaces

Answer 33

breakdown

Question 34

Due to damage and inflammation, the new bone forms on the edges of bone with outward growth. These growths are called...

Answer 34

Osteophytes

Question 35

What is the structure called at proximal interphalangeal finger joints in osteoarthritis?

Answer 35

Bouchard nodes

Question 36

What is the structure called at distal interphalangeal finger joints in osteoarthritis?

Answer 36

Heberden nodes