Osteoarthritis

Question 1

Define Osteoarthritis (OA)

Answer 1

heterogeneous disorder involving destruction of articular cartilage and proliferation of the contiguous bone. End stage of all types of arthritis.

Question 2

name symptoms of OA (5)

Answer 2

1) painwith use, improved with rest. 2) Stiffness - 30 min localized to involved joints 3) relative preservation of function 4) rarely significant symptoms before age 40. 5) Lack of systemic symptoms

Question 3

signs of OA (5)

Answer 3

1) localized joint tenderness 2) bony enlargement 3) Crepitance 4) restricted movement 5) variable swelling and/or instability

Question 4

specific patterns of deformity in OA (5)

Answer 4

1) Heberden’s and Bouchard’s nodes @ DIP and PIP respectively 2) squaring of the 1st carpometacarpal joint 3) Genu Varus (bow legged) 4) Hallux Valgus (bunion on big toe) 5) cervical and lumbar spine spondylosis (degenerative change)

Question 5

Synovial fluid analysis in OA

Answer 5

Type I fluid (200-2000 WBCs), 25% PMN, normal viscosity, Neg crystal exam, normal glucose

Question 6

6 radiographic evaluation findings

Answer 6

1) loss of cartilage space 2) Cony sclerosis and eburnation 2) cystic changes in the interphalangeal joints 3) osteophyte formation 5) altered shape of bone 6) joint effusion - non-inflammatory

Question 7

5 specific x-ray changes

Answer 7

1) “Gullwing” interphalangeal joints. 2) medial compartment disease of the knee 3) Horizontal osteophyes of the spine 4) Decreased joint space superiourly with relative medial preservation of hip 5) Hallux Valgus without other metatarsal disease

Question 8

T or F: OA is the most common arthropathy

Answer 8

TRUE

Question 9

Risk factors for OA

Answer 9

increasing age, weightbearing joints at risk, women >45 years, Trauma, Obesity, Genetics, but no increased risk with sports

Question 10

What joints are most affected in OA?

Answer 10

weight bearing and heavily used joints

Question 11

What joints tend to be spared from OA?

Answer 11

ankle, wrist, shoulder, and elbow (unless previous trama or disease)

Question 12

What is the main focus of pathology in OA?

Answer 12

Cartilage and chondrocytes

Question 13

What do chondrocytes do?

Answer 13

synthesize constuctive materials such as collagen and proteoglycans as well as products that degrade these materials

Question 14

What degrades collagen and proteoglycans?

Answer 14

Matrix metalloproteinases (MMPs)

Question 15

What can injury to chondrocytes cause?

Answer 15

increased production of MMPs and decreased repair of cartilage from failed proteoglycan and collagen production

Question 16

Loss of proteoglycan content and aggregation causes what in OA?

Answer 16

loss of hydrophilicity, decreased elasticity, disruption of collagen fibers, loss of collagen, and futher damage to cartilage.

Question 17

What do chondrogytes do to compensate for all this loss?

Answer 17

initially proliferate making hypercellular cartilage with decreaed matrix, then die off as disease progresses

Question 18

What cytokines and inflammatory agents cause MMP release?

Answer 18

IL-1, TNF alpha, NO (also cause chondrocyte apoptosis), and prostaglandins

Question 19

What inhibitory cytokines are implimented in decreased damage and anabolic mechanisms?

Answer 19

IL-10, TGF-beta, IGF-I

Question 20

As a general rule, what can you say about proinflammatory and damages associated cytokines and OA?

Answer 20

They make it worse

Question 21

T or F: Adipokines have no role in OA

Answer 21

FALSE, they may explain the risk of hand OA in the obese

Question 22

genetic abnomalities that can lead to familial OA and chondroplasia

Answer 22

abnormal type II collagen and type IX collagen

Question 23

T or F: OA is primarily a disease of the cartilage, not synovium

Answer 23

TRUE

Question 24

T or F: joint fluid in OA in generally non-inflammatory

Answer 24

TRUE! WBC counts are 200/2000/uL

Question 25

What do current treatments of OA aim to do?

Answer 25

control pain and improve function through analgesics, anti-inflammatory drugs, physical therapy, and surgery.

Question 26

how can you increase the cartilage matrix?

Answer 26

Growth factors to grow cartilage and cartilage transplants

Question 27

How can you prevent further damage to cartilage?

Answer 27

Inhibitors of cytokines and inflammatory mediators