osteoarthritis

Question 1

What parts of the joint are affected in osteoarthritis?

Answer 1

bone: sclerosis (incr. dense bone below the joint space that is trying to support the bone given a lack of cartilage), osteophyte formation
cartilage: loss of substance of hyaline and fibrocartilage
joint capsule: stretching
periarticular muscles and tendons are weak and atrophic

Question 2

What is the take home summary of osteoarthritis?

Answer 2

non-inflammatory breakdown of articular cartilage, esp. in weight bearing joints
healing response leads to boney overgrowth
subsequent symptoms and functional limitation cause significant morbidity

Question 3

What are some major risk factors for the development of osteoarthritis?

Answer 3

age, genetic predisposition to premature cartilage loss, congenital hip problems
repetitive stress and joint overload; injury
race: incr. knee in whites; incr. hand involvement in Asians
female
weak quads
OBESITY

Question 4

General clinical symptoms of osteoarthritis?

Answer 4

joint pain, swelling, stiffness, crepitus

Question 5

What kind of pain to pts with osteoarthritis have?

Answer 5

dull aching pain that is improved after rest and exacerbated by use. they have incr. pain at the end of the day

Question 6

What kind of stiffness to pts with osteoarthritis experience?

Answer 6

30 min or less in the morning

gelling: stiffness after periods of rest that is morpronounced than the stiffness in the morning

Question 7

Describe the swelling of osteoarthritis

Answer 7

transient in early stages, but later is permanent due to bony changes. Knee OA can cause joint effusion

Question 8

Physical findings in OA

Answer 8

deformity with limited range of motion and malalignment. may see boney enlargement and effusions

Question 9

radiologic findings in OA

Answer 9

joint space narrowing, osteophyte formation, subchondral sclerosis, subchondral cysts

Question 10

How does articular cartilage change in the early stages of osteoarthritis?

Answer 10

it becomes thicker with increased water content and an increased rate of proteoglycan synthesis

Question 11

How does articular cartilage change in the late stages of osteoarthritis?

Answer 11

decr. proteoglycan conc, cartilage thining, loss of integrity with vertical clefts. you also see erosions, neovascularization, and fibrocartilaginous repair (repair with fibrosis instead of true repair?)

Question 12

What factors are involved in degeneration of the matrix in osteoarthritis?

Answer 12

matrix metalloproteins, MMP inhibitors, and IL-1 and TNF-alpha (though less important than in RA)
MMPs inclulde stromelysin, collagenase, and gelatinase.

Question 13

General categories for tx in OA

Answer 13

education, pharmacologic, rehabilitative, alternative, surgical

Question 14

How is education helpful in osteoarthritis? What are some goals?

Answer 14

helps explain that the goals of treatment are to target pain, inmprove function, modify risk factors to decr. progression, and to prevent disability
Encourage lifestyle modifications: loos weight, joint unloading exercise (water)
use of thermal modalities
use of walking aids

Question 15

General strategy for pharm management of osteoarthritis

Answer 15

Start with acetaminophen (up to 4 gm/day)
then try NSAIDs at lowest effective dose. Consider adding a PPI like omeprazole or use a COX2 selective inhibitor to mitigate GI risk
consider tramadol- but be aware this is now considered an opioid!
consider topical capsaicin. consider intraarticular corticosteroids for knee probs
(opioids)

Question 16

Rehab tx for osteoarthritis

Answer 16

physical therapy, occupational therapy to help with ADLs and ambulation, custom footwear, orthotics, and braces, esp. if not needed all the time. assistive devices for ambulation reduce hip contact forces