osteoarthritis Flashcards
1
Q
what is the primary aetiology of osteoarthritis? (2)
A
- age
- gender
2
Q
when does osteoarthritis incidence increase?
A
- increases after menopause
3
Q
how does culture act as a primary factor in osteoarthritis?
A
- cultural norms
- genes
4
Q
what are the six secondary aetiology factors of osteoarthritis?
A
- obesity
- bone density
- joint injury
- development disorders
- femoral acetabular impingement
- lifestyle
5
Q
does obesity always act as secondary factor to osteoarthritis?
A
- knee yes
- hip not proven
6
Q
how does bone density link to osteoarthritis?
A
- people with known osteoporosis have lower incidence of hip OA
7
Q
what is one of the strongest risk factors for developing OA?
A
- joint injury
8
Q
what development disorders act as secondary factors of OA? (3)
A
- perthes disease
- development dysplasia
- slipped capital femoral epiphysis
9
Q
how does lifestyle contribute to osteoarthritis?
A
- repetitive excessive loading thought to increase OA but regular recreational activities does not
10
Q
are X-rays used in diagnosis of osteoarthritis? what does this include?
A
- MRI and CT scans
- can detect OA but rarely used
11
Q
what are the main four physical symptoms of osteoarthritis?
A
- pain and stiffness
- characteristic morning stiffness
- restricted ROM
- decreased functional ability
12
Q
what are the symptoms described as?
A
- generally getting worse
13
Q
what is the onset of symptoms in people with OA?
A
- idiographic onset
14
Q
what do osteoarthritic individuals often experience on a day to day basis?
A
- good and bad days
15
Q
what may happen to leg length due to osteoarthritis?
A
- leg length discrepancy due to loss of joint space
16
Q
what is osteoarthritis characterised by?
A
- characterised by flare- up/ remissions so symptoms will vary in severity dependably
17
Q
what are the 6 main signs of osteoarthritis?
A
- age
- loss of ROM
- swollen joints
- joint deformity
- decreased functional ability
- bony lumps and boggy swelling
18
Q
what does ACR stand for?
A
- American college of rheumatology
19
Q
what is the ACR algorithm?
A
- clinical classification criteria for osteoarthritis of the hip
- without an x-ray
20
Q
what are the clinical ACR guidelines for hip OA?
A
- pain and internal rotation <15 and flexion of hip <115 or internal rotation >15, pain at internal rotation, stiffness <60 min and age > 50 years
21
Q
why are x-rays designated as gold standard by WHO?
A
+ cheap
+ instant
+ easily intepreted
22
Q
what are the three main x-ray based grading systems?
A
- Kellgren- Lawrence system
- croft modification of the kellgren- Lawrence system
- croft minimal joint space grading system
23
Q
what is the most widely used X-ray grading scale of OA?
A
- Kellgren- Lawrence system
24
Q
how many grades are there in the Kellgren- Lawrence system?
A
- grade 0 to grade 4
25
what is grade 0 of the Kellgren- Lawrence system
- no osteoarthritis
26
what is grade 1 of the Kellgren- Lawrence system?
- doubtful narrowing of joint space and possible osteophytic lipping
27
what is grade 2 of the Kellgren- Lawrence system?
- minimal definite osteophytes, definitie minimal/ little narrowing of joint space
28
what is grade 3 of the Kellgren- Lawrence system?
- moderate multiple osteophutes, definite narrowing of joints space narrowing of at least 50%
- some sclerosis and possibly deformity of bone contour
29
what is grade 4 of the Kellgren- Lawrence system?
- large osteophytes
- severe loss of joint space
- severe sclerosis
- definite deformity of bone contour
30
how many grades are there in the croft radiographic grading scale?
- grade 0 to grade 5
31
what is grade 0 in croft radiographic grading scale?
- no change
32
what is grade 1 in croft radiographic grading scale?
- definite osteophytes only
33
what is grade 2 in croft radiographic grading scale?
- joint space narrowing only (defined as an minimal joint space of 2.5mm)
34
what is grade 3 in croft radiographic grading scale?
presence of two of the following:
- joint space narrowing
- osteophytosis
- subchondral sclerosis (of >5mm)
- cyst formation
35
what is grade 4 in croft radiographic grading scale?
presence of three of the following:
- joint space narrowing
- osteophytosis
- subchondral sclerosis (of >5mm)
- cyst formation
36
what is grade 5 in croft radiographic grading scale?
- same as grade 4
- with deformity of the femoral head or total hip replacement due to OA
37
how many grades in the croft minimal joint space grading scale?
- grade 0 to grade 2
38
what is grade 0 in croft minimal joint space grading scale?
- minimum joint space > 2.5mm
39
what is grade 1 in croft minimal joint space grading scale?
- minimum joint space of >1.5mm < 2.5mm
40
what is grade 2 in croft minimal joint space grading scale?
- minimum joint space <1.5mm
41
what positive correlation does the Kellgren and Lawrence Scale and the Croft minimum have?
- positive correlation with the clinical symptoms of pain and disability
42
what are the three treatment options of individual with osteoarthritis?
- conservative
- pharmacological
- surgery
43
what conservative treatment has strong evidence for OA? (3)
- exercise
- education
- self management
44
what devices can be used for conservative treatment for OA?
- assistive devices
- walking aids
45
what advice should be given in conservative treatment of OA?
- advice on weight loss
46
what other therapies/ techniques can be used in combination with exercise? (4)
- manual therapy
- electrotherapy
- thermotherapy
- acupuncture
47
what are the 4 guidance organisations acronyms that provide best practice evidence?
- OARSI
- ACR
- EULAR
- NICE
48
what is OARSI?
- osteoarthritis research society international
49
what is ACR?
- American college of rheumatology
50
what is EULAR?
- European league against rheumatism
51
what is NICE?
- national institute for health and care excellence
52
when should surgery be offered?
- only offered if conservative treatment is not effective
53
what should you explain when educating patients with osteoarthrosis? (2)
- explain what arthritis is
- explain why self- management is key
54
how would you educate people about how osteoarthritis is characterised?
- characterised by flare ups with a quiescent background
55
what should you educate patients with osteoarthritis to take?
- take prescribed medication
56
what can you educate osteoarthritis patients to use? - give some examples
- use aid and adaptations to help e.g., splints, assistive devices
57
what other information may help osteoarthritis patients?
- community exercise groups
- charities that help with OA
58
what level of exercise is best for osteoarthritis patients?
- low impact exercises are best e.g., swimming, aqua- exercises, dog walking, gardening, cycling, yoga, tai chi
59
what exercises should be completed everyday?
- flexibility and range of motion exercises
60
what do you measure activity with?
- measure activity with time
- start with short exercise sessions then slowly increase
61
what is more important than intensity or effort of exercise?
- time exercising is more important
62
what should you take before exercising?
- always take any prescribed analgesia
63
what other exercises may you wish to engage in?
- group exercises
64
how many sessions should osteoarthritis patients do a week?
- try to do 2-3 sessions a week of aerobic exercise at moderate intensity for general health
65
how many sessions of strengthening exercise should be done in a week?
- 2 to 3 sessions
66
what should you explain about the exercise plan?
- explain how it varies with flare- up or quiescent phase
67
what is the self management strategy in the inflammatory phase?
- use ICE
68
what is the self management technique in the quiescent phase?
- heat
69
what should you be?
- be organised
- keep track of symptoms, medication levels
70
what does pacing self- management technique involve?
- know your daily symptoms and plan around
- little and often is better than boom/ bust
- accept help
- take rests throughout the day
- plan around flare- up or quiescent background
71
what should the patients do if there is a set back?
- should accept the set back
- can sometimes plan for it
72
what other strategies may be used in self management? (3)
- good sleep
- well balanced diet
- lose weight
73
what injections can be used in pharmacological management?
- steroid injections
- hyaluronic acid injections
74
what other pharmacological management could you use for osteoarthritis?
- prescribed analgesia
- NSAID
- opioids
75
why is topical medication usually not used?
- because it doesn't dissolve deep enough
76
what are glucosamine and chondroitin?
- other treatment that can be used for osteoarthritis
- substances found in health collagen
77
what are some other treatments that may be helpful in osteoarthritis patients?
- cummin
- ginger, vit D, vit E
- bee pollen
- copper bracelets
78
what is the surgical treatment option ?
- joint replacement
79
what is the most successful surgical treatments for OA?
- total hip replacement is the most effective
- knee replacements very effective but not as good as THR
80
what are the three outcome measures for OA?
- AIMS1
- WOMBAC
- DASH
81
what does AIMS stand for?
- arthritis impact measure
82
what does AIMS1 include?
- 9 scales
- mobility, PA, dexterity, household activities, social activities, ADLs, pain, depression and anxiety
83
what does AIMS2 include that is different from AIMS1?
- arm function
- social support
- work
84
what is the limitation of AIMS measure?
- it is lengthy so time consuming
85
what is WOMBAC?
- western ontario and mcmaster universities osteoarthritic index
86
what does the WOMBAC test? how many questions?
- most accepted lower limb OA measure
- 5 questions on pain
- 2 questions on stiffness
- 17 on physical function
87
what does DASH stand for?
- disabilities of the arm, shoulder and hand
88
what is the DASH measure used for?
- used for any MSK disorder of the upper limb
89
how many questions does the DASH measure contain?
- 30 questions with specific extensions of 10 questions for either work or sport
