Osteoarthritis Flashcards
Are mildly inflammatory joint disorders more or less common than inflammatory joint disorders?
more common
What are 2 types of mildly inflammatory joint disorders?
osteoarthritis, fibromyalgia
What are 3 types of inflammatory joint disorders?
gout/pseudogout, RA, and Spondyloarthropathies
Spondyloarthropathies may include what 4 conditions?
1) psoriatic arthritis,
2) AS,
3) reactive arthritis,
4) enteropathic arthritis
Concept of Joint Failure: Arises via a disease process that involves the entire joint.
List 5 components that are involved.
(1) subchondral bone.
(2) ligaments.
(3) capsule.
(4) synovial membrane.
(5) periarticular muscles.
What ultimately degenerates with joint failure?
articular cartilage
What is osteoarthritis
A progressive disorder of the joints caused by gradual loss of cartilage and resulting in the development of bony spurs and cysts at the margins of the joints.
Epidemiology of Osteoarthritis
MC joint disorder worldwide
leading causes of disability in the elderly
>65 is MC age
List 5 common locations of osteoarthritis:
(1) Cervical spine.
(2) Lumbar spine.
(3) Hands= #1
(4) Hips.
(5) Knees.
What term describes degenerative arthritis of neck and back?
Spondolysis
What are 3 functions of cartilage?
(1) Protection.
(2) Shock Absorption.
(3) Range Of Motion.
Breakdown of cartilage in order of progression includes what 3 steps?
(1) Fibrillation.
(2) Focal and diffuse erosions of the cartilage.
(3) Thinning and complete denudation of cartilage.
Pathogenesis of OA
the result of local mechanical factors acting within the context of systemic susceptibility
Pathogenesis of OA: Systemic factors that increase vulnerability of the join includes what 5 things?
(1) age,
(2) gender,
(3) bone density,
(4) nutritional factors,
(5) genetic predisposition.
Pathogenesis of OA: In persons vulnerable to the development of OA local mechanical factors that facilitate the progression of OS include what 4 things?
(1) malalignment.
(2) muscle weakness.
(3) meniscal damage.
(4) bone marrow lesions.
Process of OA
bone suffers micro fractures and proliferates in an attempt to heal. The proliferative new bone interferes with function and causes pain. As the cartilage degrades new bone formation occurs.
What cells maintain the health and function of cartilage, and proliferate and migrate as the osteoarthritis process progresses?
Chondrocytes
What are the 4 osteoarthritis risk factors and what sites do they increase the risk of developing OA?
(1) Age = all sites.
(2) Gender = knee and hand in women, hip in men.
(3) Genetic predisposition = all sites.
(4) Obesity = all sites.
What are the 10 Risk Factors for Knee OA?
(1) Age.
(2) Female.
(3) Genetic susceptibility.
(4) Heavy physical activity.
(5) High bone mineral density.
(6) Joint laxity.
(7) Muscle weakness.
(8) Obesity.
(9) Occupational activities (repetitive kneeling, squatting, stair climbing).
(10) Previous injury/surgery.
Legg Calve Perthes disease definition?
occurs in 3-8 year olds, osteonecrosis of the femoral capital epiphysis.
Osteoarthritis can also develop from malalignment risk factors.
What are 4 examples?
(1) scoliosis.
(2) pelvic obliquity.
(3) leg length discrepancy.
(4) varus or valgus deformity at the knee.
What are 3 congenital or acquired osteoarthritis in childhood examples?
5) Legg Calve Perthes disease.
(6) Congenital hip dysplasia.
(7) Slipped capital femoral epiphysis.
Congenital hip dysplasia definition?
Born with the acetabulum not forming completely and is shallow and this leads to subluxation and OA develops early.
Slipped capital femoral epiphysis definition?
Just before the femoral epiphysis closes the femoral head subluxes and the presentation is in adolescence or early adulthood.
(1) Increased BMI leads to increased prevalence of OA in what 3 locations?
Knee
Hip
Hand
What will reduce the chance of developing OA
5kg weight loss will reduce the chances of getting OA by 50%
What are 5 symptoms of OA
(1) PAIN With Increasing Use.
(2) Stiffness <15-30minutes.
(3) Limited Range Of Motion.
(4) Swelling.
(5) Crepitus.
What is a diarthrodial joint?
A joint with the ability to move in several directions.
What are 6 potential sources of pain in a diarthrodial joint?
(1) Synovial membrane.
(2) Joint capsule.
(3) Ligaments.
(4) Muscle spasm.
(5) Periosteum.
(6) Subchondral bone.
What is avascular and aneural?
cartilage
OA Physical Examination Signs: 7
(1) Tenderness over the joint line.
(2) Crepitus with movement of the joint.
(3) Bony enlargement of the joint.
(4) Reduced range of motion.
(5) Joint swelling.
(6) Joint deformity.
(7) Instability/laxity of the joint.
What labs are specific for OA
NONE!
What are 4 x-ray findings to look for in making a diagnosis of OA?
(1) joint space narrowing,
(2) bony sclerosis,
(3) osteophytes,
(4) subchondral cyst formation (cyst formation is an overlap with RA).
What is the role of MRI or CT in making an OA diagnosis?
Reserved for cases without clear diagnosis or with strongly suspected acute tissue injury.
Osteoarthritis Differential DX: 4 common considerations?
(1) Rheumatoid arthritis.
(2) Psoriatic arthritis.
(3) Spondyloarthritis (ankylosing spondylitis, psoriatic arthritis, arthritis associated with IBD, reactive arthritis).
(4) Sarcoidosis.
What are the 4 MC causes of direct osteonecrosis (dead bone)?
Fracture, dislocation, radiation, chemotherapy.
MC place is the femoral head
What are 3 indirect causes of osteonecrosis?
Steroids, alcohol, idiopathic.
Charcot’s neuroarthropathy Definition?
Denervation of joints and loss of pain sensation.
What would the cause and findings be for Charcot’s neuroarthropathy?
(2) Extensive new bone formation around the joint.
(3) Presently diabetic peripheal neuropathy is the most common associated disease state.
PVNS (pigmented villonodular synovitis).
(1) Definition?
(2) Most commonly affects which joint?
(3) Diagnostic test?
(1) Characterized by inflammation and deposition of hemosiderin.
(2) 80% of the time it is the knee.
(3) MRI will show this type of synovial proliferation.
Synovial chondromatosis.
(1) Definition?
(2) MC affects what joint?
(3) Gender preference?
(4) Age of onset?
(1) Cartilage nests occur and overgrow and are extruded from the cartilage and form loose bodies.
(2) at least 50% of the time affects the knee.
(3) Men more than women.
(4) 30 and 40s.
Osteoarthritis hands Physical findings: (5)
(1) No heat or redness.
(2) No MCPj or wrist involvement.
(3) Squaring of thumb or loss of thenar muscle.
(4) Heberden’s nodes.
(5) Bouchard’s nodes.
Heberden’s nodes definition.
small hard nodules, usually at the distal interphalangeal joints of the fingers, formed by calcific spurs of the articular cartilage and associated with osteoarthritis
Bouchard’s nodes definition.
cartilaginous and bony enlargements of the proximal interphalangeal joints of the fingers in degenerative joint disease, like OA.
What are 3 x-ray findings that might be seen in patient with OA of the hip?
(1) Boney Proliferation At the joint Margin.
(2) Asymmetric Joint space loss.
(3) Subchondral boney Sclerosis.
Avascular Necrosis (AVN) Hip.
__(1)__% of the cases of AVN leading to death of cellular elements of the hip bone have no obvious cause.
(2-6) List 5 things associated with AVN.
(1) 50%.
(2) Steroid use.
(3) SLE with or without steroids.
(4) Alcoholism.
(5) Hemoglobinopathies (sickle cell).
(6) Gaucher’s disease.
Osteoarthritis Treatment: Physical measures.
(1) Physical measures are all designed to do what?
(2) List 6 points of possible intervention.
(1) PROTECT CARTILAGE.
(2) Physical therapy.
(3) Muscle toning.
(4) Quadricep strengthening.
(5) Exercise bike.
(6) Eliptical (less impact).
(7) Walking program (flat, level, well lit).
Osteoarthritis Treatment: Supportive devices. (7)
(1) Canes,
(2) walkers,
(3) shoes,
(4) grab bars,
(5) toilet extenders,
(6) seat lift chairs,
(7) Parking permits.
Osteoarthritis Treatment:Topical agents.
(1) What are 4 topical agent options for OA treatment?
(1) Capsaicin (affects substance P).
(2) camphor-methyl salicylate-menthol.
(3) Bio-Freeze.
(4) Diclofenac (Voltaren gel 1%™, Flector patch™, Pennsaid lotion™).
(1) Inducible enzymes which when activated produce prostaglandins from sites of inflammation only (synoviocytes, macrophages). WHAT ENZYMES?
(2) Constitutive prostaglandins - normal “housekeepers” of stomach, kidney. WHAT ENZYMES?
(1) COX 2 enzymes.
(2) COX 1 enzymes.
What are the NSAID Black Box Warnings?
(1) CARDIOVASCULAR RISK: increased risk of serious cardiovascular thrombotic events including MYOCARDIAL INFARCTION and STROKE.
(2) GASTROINTESTINAL RISK: increased risk of serious GI adverse events including BLEEDING, ULCERATION, and PERFORATION of the stomach or intestines, which can be fatal. These events can occur at any time during use and WITHOUT WARNING symptoms. ELDERLY patients are at GREATER RISK for serious gastrointestinal events.
List 6 OA analgesic options and there regulation status?
(1) Acetaminophen (OTC).
(2) Tramadol (Rx; non-schedule).
(3) Codeine (III or IV).
(4) Hydrocodone (II).
(5) Oxycodone (II).
(6) Morphine (II).
Osteoarthritis Treatment Procedures:
Joint aspirations can be __(1)__ or __(2)__.
Joint injections: (3-5) What are 3 injection options?
(1) Diagnostic.
(2) Therapeutic.
(3) Steroids (Kenalog™, Depomedrol™, Aristospan™)
(4) Anesthetics (Marcaine™, Lidocaine™).
(5) Hyaluronic acid (viscosupplementation).
Knee & Hip Osteoarthritis: 3 Indications for Total Joint Replacement.
(1) Night pain unresponsive to anti-inflammatory drugs.
(2) Major inability or difficulty to perform ADL’s.
(3) Unacceptable reduction in the ability to walk or work.
