Osteoarthritis Flashcards
True or false: osteoarthritis is the most common form of arthritis
True
Is osteoarthritis inflammatory?
No, it’s degenerative mechanical shearing
What are risk factors for osteoarthritis?
Age (50+)
Female
Obesity
Occupation/ sports
Genetic
What gene is associated with osteoarthritis?
COL2A1
In osteoarthritis, there is increased _____ breakdown than repair
collagen
There is increased chondrocyte m__________ secretion in osteoarthritis
metalloproteinase
What type of collagen does metalloproteinase degrade and what else can it cause?
Type 2
Can cause cysts
How does the bone try to overcome the degradation of type 2 collagen?
Makes more Type 1 collagen resulting in abnormal bony growths(osteophytes) and remodelling
What are abnormal bony growths called?
Osteophytes
What is the typical pain pattern in osteoarthritis?
Transient pain in the morning, gets worse as the day goes on
What are the names of the 2 types of nodes that can form on the fingers?
Bouchard and Hebderen
Where do Heberden nodes form?
Distal Inter-Phalangeal Joints (DIPJ)
Think H after B, so further
Where do Bouchard nodes form?
Proximal Inter-Phalangeal Joints (PIPJ)
Think B before P, so closer
Other than pain and nodes (Hebderen and Bouchard) what are other symptoms of osteoarthritis?
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
What would blood test show in osteoarthritis?
Normal
How do you diagnose osteoarthritis?
X Ray
Showing loss of joint space, osteophytes, subchondral sclerosis, subchondral cysts
How do you manage osteoarthritis?
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.
What mnemonic helps to remember the changes on an X-ray due to osteoarthritis?
LOSS
What does L stand for in LOSS?
Loss of joint space
What does O stand for in LOSS?
Osteophytes
What does the first S stand for in LOSS?
Subchrondral sclerosis
(increased density of the bone on the joint line, where the bones come in contact with each other)
What does the second S stand for in LOSS?
Subchondral cysts
(Small fluid-filled holes in the bone, along the joint line)
True or false: activity helps the joint pain and stiffness?
False
It worsens with activity (unlike inflammatory arthritis)
Osteoarthritis leads to d_____, i_____ and reduced function in the joints
deformity, instability
What joints are commonly affected by osteoarthritis?
Knees
Hips
Sacro-iliac joints
Base of thumb (carpometacarpal)
DIPJs
Wrist
Cervical spine (cervical spondylosis)
What type of joint is at the base of the thumb (where metacarpal articulates with trapezium at CMC joint)?
Saddle joint
A diagnosis of osteoarthritis can be given without further investigations if the patient is…
Over 45
Presents with typical activity related pain
No morning stiffness
What can cause temporary reduction in inflammation and improve symptoms in osteoarthritis?
Intra-articular steroid injections
What is a GI side effect of using NSAIDs?
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.
How do NSAIDS cause AKI and CKD?
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.
How can NSAIDs exacerbate asthma?
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.
In osteoarthritis, damage to articular cartilage leads to c______ replacing the type II collagen with type I
chondrocytes
In osteoarthritis, the chondrocytes become exhausted and apoptosis occurs. Leads to decreased elasticity and increased cartilage b_______ leaving clefts in articular surfaces
breakdown
Due to damage and inflammation, the new bone forms on the edges of bone with outward growth. These growths are called…
Osteophytes
What is the structure called at proximal interphalangeal finger joints in osteoarthritis?
Bouchard nodes
What is the structure called at distal interphalangeal finger joints in osteoarthritis?
Heberden nodes
