Osteoarthritis Flashcards
How does osteoarthritis distribute throughout the body?
- Hands (Basilar CMC is common)
- Spine
- Hips
- Knees
- 1st MTP
IS OA mono,oligo, or polyarticular?
Can be all of them!
What are the clinical characteristics of someone with OA?
- Age > 50
- Morning stiffness < 30 min
- Crepitus
- No inflammation
- Bony enlargement
What lab findings would you see in OA?
ESR not elevated (<40)
RF titer low
Noninflammatory synovial fluid
What are the radiographic findings of someone with OA?
- osteophytes
- joint space narrowing
- Subchondral cysts/sclerosis
- malalignment
What are causes of secondary OA?
- Inflammatory dz (RA)
- Trauma
- Hemachromatosis
What are osteophytes?
Areas of bone hypertrophy with absent cartilage
What are the histological changes you would see in OA?
Hypercellularity of cartilage
Loss of acid mucopolysaccharide (red areas)
Eventual clefts show up in the cartilage
What are the physical changes in the cartilage seen in OA?
- Higher water content of cartilage=soggy
- Cartilage is more pliable
- Osteophytes
- cartilage loss
- narrowing of joint spaces
Describe the pathophysiology of OA
Proliferation of adult chondrocytes
- > Matrix degradation and downregulating of cartilage repair
- > BMP, TGF beta released into the joint space
What are the differences in distribution of OA vs RA? And timing of onset?
OA: SLOW insidious onset of a FEW joints. Can commonly present first in the knees/hips
RA: subacute or acute onset of many joints almost always the hands first
OA of the DIP joint is called?
Heberdon’s
OA of the PIP joint is called?
Bouchard’s
Which part of the knee is more commonly affected in OA?
Medial knee is more commonly affected. Results in bow-legs
What are the risk factors for OA?
- increasing age
- gender
- obesity
- joint injury
- previous deformity
- ligamentous laxity
- Post menopause
- Injuries (fractures, meniscal injuries, repetitive use (tennis elbow)
Does running result in increased risk of RA?
Moderate running=NO
Is there a genetic risk to OA
YES. But unlike RA, there is not single gene that can account for OA
What is at the top of your differential if a young person has osteoarthritis of the MCP?
Hemochromatosis
Is there a correlation btw the clinical findings and morbidity of OA?
NO. Can have little pain but lots of changes in the joints or vice versa
What are the medications that can alter the progression of OA?
None! Meds can only alleviate the pain. (NSAID, tylenol, cortisone injections, etc) However, exercise and weight loss can alter the progression of OA
What are the only effective treatments for RA?
- weight loss
- exercise
- joint replacement
