Osteoarthritis

Question 1

Heberdens Nodes and Bouchard’s Nodes

Answer 1

2 most common types of nodes in OA
Heberden’s Node - Bony bumps on the finger joint closest to the fingernail
Bouchard’s Nodes - Bony bumps on the middle joint of the finger
Bony bumps also common at the base of the thumb but do not have a nickname

Question 2

Risk Factors

Answer 2

hx of joint injury
obesity
hx of immobilization
prolonged stress on joints

Question 3

Signs and Symptoms

Answer 3

Pain involving one or only a few joints, with joint pain being symmetric
Morning joint stiffness resolving within 30 minutes or can occur with moderate activity
Prolonged joint stiffness and joint enlargement noted with disease progression
Crepitation and grating of joint is a late manifestation
Inflammation may be present but usually mild
Limited ROM may follow with flexion contractures or mechanical obstructions

Question 4

Etiology

Answer 4

“Osteoarthrosis” is degenerative changes of the peri-articular tissues
It is a combination of mechanical, cellular and biochemical processes
Healthy cartilage is destroyed through internal remodeling, maintenance of the tissue and loss of cartilage leading to cartilaginous degradation and joint destruction Secondary causes include:
Calcium deposits, Endocrine/Metabolic, Genetic
Neuropathy, Post traumatic, infection

Question 5

Dx

Answer 5

A clinical diagnosis is made with a detailed history and physical exam
Diagnostic studies may or may not be helpful but may aid in ruling out various differential diagnosis
Studies can include ESR, RF and synovial fluid analysis
CBC- in OA the white count is usually < 500
Renal & hepatic function studies prior to medication selection
X-rays can determine evidence of disease & destruction, may exclude other causes of joint pain : OA presence include joint space narrowing, osteophyte formation, pseudocyst and increased density

Question 6

Tx

Answer 6

Goal is to minimize symptoms and improve function
Combination therapy are better for symptom control
Pharmacologic- NSAIDs, Cox 2s, acetaminophen (1 gram QID), Synvisc (lubricating) injections to the joint, steroids and intra-articular steroid joint injections (3-4 times a yr)
Surgical intervention to decrease pain and restore joint function
Non- prescription- glucosamine, Capsaicin cream, Aspercreme, exercise, Vitamin D, rehabilitation, activity modification, heat and Ice, electrical stimulation
Prevention- Weight loss, exercise (mild to moderate activity does not predispose, nor does running)