Osteoarthritis Flashcards
Lecture 1 Learning outcomes for MCQ
How does osteoarthritis occur?
when abnormal loads are placed on a normal joint or when normal loads are placed on an abnormal joint
How is OA characterised?
Pain Limited ROM plus or minus deformity of the joint
OA of the facet joint of the spine is called what???
Spondylosis
What is OA associated with?
Increased BMI and aging
What percentage of the population over 55 years have OA?
44-70%
What percentage of the population over 75 years of age have OA?
85%
What joints of the hand most commonly are associated with OA?
DIPJ and CMC
Name a biochemical change in OA?
articular cartilage
Name a biochemical change in OA?
Loss of proteoglycan relative to collagen
Name a biochemical change in OA?
Decrease in water content and permeability
Name a biochemical change in OA?
reduction in collagen tensile stiffness and strength
Name a biochemical change in OA?
Proteolytic enzymes- matrix mer
mettalloproteases (MMPs)
Name a biochemical change in OA?
Pro-inflammatory cytokines; TNF, IL 1b
Pathology of OA
Failed attempt at repair
Pathological changes in OA
Joint Space Narrowing
Pathological changes in OA
bony sclerosis
Pathological changes in OA
excessive shear at the joint space
Pathological changes in OA
osteoblast activity as attempt to redistribute load
Pathological changes in OA
osteophyte formation
How many stages of degeneration are there in knee OA?
IV
Stage IV Knee OA
joint-space greatly reduced 60% cartilage lost - large osteophytes
What are modifiable risk factors in OA?
Obesity (knee/hip)
What are modifiable risk factors in OA?
Occupation / heavy work
What are modifiable risk factors in OA?
Excess physical activity
What are unmodifiable risk factors in OA?
Age
What are unmodifiable risk factors in OA?
Genetics 40%-80%
What are unmodifiable risk factors in OA?
Local bony changes Pincer/cam/hip dysplasia
What are unmodifiable risk factors in OA?
Previous joint trauma
What are unmodifiable risk factors in OA?
ACL injury
What are unmodifiable risk factors in OA?
intra-articular fracture
What are unmodifiable risk factors in OA?
female gender
Which is an example of Primary OA?
Idiopathic (spontaneous onset)
Which is an example of Primary OA?
Small joints, hand, hip & knee
Which is an example of Primary OA?
May affect >1 joint
Which is an example of Primary OA?
Genetics
Which is an example of Secondary OA?
Specific to one joint
Which is an example of Secondary OA?
Post-inflammatory arthritis e.g. RA
Which is an example of Secondary OA?
Post-traumatic (e.g. tibial plateau fracture)
Which is an example of Secondary OA?
Post-traumatic OA e.g. post ACL repair
Clinical Dx of OA
joint pain
Clinical Dx of OA
stiffness <30mins am or prolonged rest
Clinical Dx of OA
+/- crepitus on movement
Clinical Dx of OA
bony enlargement
Clinical Dx of OA
little to
no swelling
Is radiological Dx necessary for OA?
Clinical Dx can be made without x-ray imaging
What are radiological symptoms of OA?
joint space narrowing
What are radiological symptoms of OA?
+/- Osteophyte formation
What are radiological symptoms of OA?
+/- Bony sclerosis
Name a differential diagnosis to OA of the hip
Hip labral tear
Name a differential diagnosis to OA of the hip
FAIS - CAM / PINCER deformity
Name a differential diagnosis to OA of the Knee
degenerative meniscal injury
Pain referral differential diagnosis?
Knee pain referred from the hip
Pain referral differential diagnosis?
Hip pain referred from the spine
What are the most common joints of the hand in OA?
CMC, PIP, DIP
Having at least on co-morbidity is significantly associated with worse, or greater deterioration of symptoms of pain and physical function. True or False?
True
Is OA related pain mechanical or inflammatory in nature?
mechanical
Name OA pain symptoms
Activity related pain, worse at end of day after rest
How are symptoms of OA related pain eased?
Movement
What are symptoms of pain as OA disease progresses?
Night pain and resting pain
Dose cartilage cause OA pain?
No - it is anerual
Causes of OA related pain
peri-articular-capsule/ligaments
Causes of OA related pain
Periosteal
Causes of OA related pain
muscular
Causes of OA related pain
compensatory movement e.g. LBP
Causes of OA related pain
low grade inflammation
Stiffness is. a symptom of OA, how does this differentiate from RA stiffness?
The duration of stiffness
What can indicate OA joint in a physical examination?
Hard end feel
What can indicate OA joint in a physical examination?
Loss of PROM
Is stiffness objective or subjective?
Either
Name subjective features of OA
Psychological health
Name subjective features of OA
Fatigue, second to joint stiffness limited ROM & pain
Symptoms of a physical examination of an OA joint can present as…
heat
Symptoms of a physical examination of an OA joint can present as…
Erythema
Symptoms of a physical examination of an OA joint can present as…
Tenderness
Symptoms of a physical examination of an OA joint can present as…
Effusion
Symptoms of a physical examination of an OA joint can present as…
Discomfort
Symptoms of a physical examination of an OA joint can present as…
Pain
How can you tell if there is a loss of ROM in OA joints
compare right to left
Examination findings found?
Pain inhibition
Examination findings found?
disuse atrophy
Examination findings found?
Reduced function related to specific body region
Examination findings included
knee valgus/varus
Examination findings included
hand heberden’s (DIP) & Bouchard’s nodes (PIP)
Examination findings in more advanced OA included
Foot-Hallux Valgus
Joint instability examination findings in more advanced OA included
Ligament laxity, compounded by muscle weakness
Pharmacological management of knee OA with comorbidities
Topical NSAIDS - Feldene & Voltorol
Name an oral NSAIDS for OA
difene, aulin, mobic
What are the side effects of difene, aulin and mobic?
GI & CVS side-effects (may need proton pump inhibitor
What are side effects of intra-articular steroid injections for knee OA?
Recurrent cortisone injections can decrease cartilage volume.
What DMOADS are not recommended for OA?
Chondroitin sulphate & Glucosamine
does Paracetamol have a benefit in OA?
No
Are opioids recommended for OA pain relief?
No
What surgical options are available for OA hip and knee?
THR / TKR / Osteotomy
Name an outcome measure used by physiotherapists in OA patients?
WOMAC
Name an outcome measure used by physiotherapists in OA patients?
KOOS
Name an outcome measure used by physiotherapists in OA patients?
HOOS
Name an outcome measure used by physiotherapists in OA patients?
AUSCAN
Name the molecular composition of bone
30% Organic, 70% Mineral (inorganic)
What inorganic minerals make up the 70% of inorganic composition of bone?
Calcium, Phosphate, Magnesium, Sodium &
5% water.
What are the 2 classification types of bone?
Cortical Bone & Trabecular bone
What does cortical bone consist of?
Dense calcified tissue, providing structure and protection.
What dose Trabecular Bone consist of?
horizontal and vertical interconnecting plates permit marrow, blood vessels and connective tissue to be in contact with the endosteum
