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Musculoskeletal/Rheum > Osteoarthritis > Flashcards

Osteoarthritis Flashcards

1
Q

What is a huge hint that a patient has post-traumatic osteoarthritis?

A

Past trauma in joint

UNILATERAL

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2
Q

What does the cartilage in osteoarthritis look like?

A

cartilage with surface irregularities (clefts and cloning of chondrocytes)–> end stage has marked thinning and new osteophyte growth at edges

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3
Q

What is a characteristic physical examination finding in osteoarthritis?

A

fine grinding of the joint (crepitus)

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4
Q

What are the characteristics of normal synovial fluid?

A

Leukocyte count <25% PMNs

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5
Q

What are characteristics in the synovial fluid in osteoarthritic knee?

A

Leukocyte count 200-2000/mm^3 with 25% PMNs

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6
Q

What are the characteristic of synovial fluid in infection?

A

Leukocyte count >100,000/mm^3 with >85% PMNs

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7
Q

What joints are typically involved in primary osteoarthritis?

A

cervical spine (C3-C7), lumbar spine, hip joints, knee joints, DIPs, PIPs, thumb, 1st MPT joint of foot, 1st carpal-metacarpal joint (thumb) ONLY

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8
Q

What areas are involved in RA but not osteoarthritis?

A

wrist, elbows, shoulders, jaw

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9
Q

What are Heberden nodes?

A

osteophytes at DIPs (usually in women)

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10
Q

What are Bouchard’s nodes?

A

osteophytes at PIPs (less common in osteoarthritis)

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11
Q

What is the first joint affected in the hand in osteoarthritis?

A

carpometacarpal joint of the thumb

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12
Q

What are the symptoms of a patients with hip joint osteoarthritis?

A

deep groin pain the radiates into the medial thigh and pain with internal and external rotation

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13
Q

What is a differential diagnosis for hip joint pain due to osteoarthritis?

A

trochanteric bursitis

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14
Q

What causes cartilage breakdown in osteoarthritis?

A

mechanical forces are exerted on the cartilage over time (or due to injury) can cause cartilage to make molecules (Plasmin–> stimulates MMPs) that degrade cartilage

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15
Q

What is the major type of collagen in cartilage of joints?

A

type II collagen

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16
Q

What breaks down type II collagen?

A

collagenease 1

17
Q

How are chondrocytes involved in the process of osteoarthritis?

A

receive signals from mechanical forces to produce NO and IL-1 to tell other chondrocytes to produce NO, IL-1, TNF-alpha, and PGE2

18
Q

What does PGE2 cause?

A

pain and neutrophil chemotaxis

19
Q

How rapidly does the process of chemokine release occur in osteoarthritis?

A

slow release (so degree of inflammation is not that high)

20
Q

What do osteoarthritis joints feel like?

A

NOT warm (as you would see with infection or RA joint)

21
Q

How does having an underlying trauma alter the process of osteoarthritis?

A

speeds up the process

22
Q

How do you treat osteoarthritis?

A

Tylenol, NSAIDs, intra-articular steroids

23
Q

What are secondary causes of osteoarthritis?

A
  • previous trauma/overuse
  • consider neuromuscular disease (diabetes or other neuropathies)
  • Metabolic disorders (CPPD or pseudogout)
24
Q

If you have arthritis in joints that are NOT typical for osteoarthritis, what should you do?

A

Check for secondary causes (diabetic neuropathy, trauma, hemochromatosis, hyperparathyroidism, hypothyroidism, neuropathic joint (syphilis, diabetes), hypomagnesemia, aging, etc.)

25
Q

What can hyperparathyroidism cause in the joints?

A

Calcium Pyrophosphate Crystal Deposition disease

26
Q

What is hemochromatosis?

A

body absorbs too much iron

27
Q

What are some symptoms of osteoarthritis?

A
  • pain related to use
  • decreased range of motion
  • joint instability
  • bony enlargement
  • crepitus
  • restricted movement
  • variable swelling and/or instability
28
Q

How does osteoarthritis pain differ from RA pain?

A
  • pain gets WORSE during the day (opposite of RA)

- minimal morning stiffness and after inactivity (opposite of RA)

29
Q

What are the risk factors for osteoarthritis?

A
  • Over age 70, 75% of people have it
  • Female sex
  • Obesity
  • Hereditary
  • Trauma
  • Neuromuscular dysfunction
  • Metabolic disorders
30
Q

What are lab tests that will help with diagnosing osteoarthritis?

A
  • H&P
  • X-ray
  • Cartilage degradation products in serum and joint fluid
  • NO increased ESR and CRP
31
Q

How do you manage osteoarthritis?

A
  • Decrease pain to increase function
  • Progressive exercise (increase function, endurance, strength, and reduce fall risk)
  • Patient education (weight loss, heat/cold modalities)
32
Q

What drugs can you use to treat osteoarthritis?

A

Nonopioid analgesics, topical agnets, intra-articular agnets, opiod analgesics, NSAIDs, unconvential therapies

33
Q

What is first line therpay for osteoarthtisis?

A

Acetaminophen (take around maximum safe dose- 4 g/day)

Has pain relief relative to NSIDs but less toxicity.

34
Q

When/where do you use intra-articular steroids?

A
  • early (every 2 months)

- usually in knees

35
Q

What are hyaluronate injections?

A

Series of injections (3 over 6 month periods) that give symptom relief and improved function but are expensive. Give them to delay knee replacement.

ONLY IN KNEE.

36
Q

What are third line therapies for arthritis?

A

Arthroscopy
Osteotomy
Total joint replacement

Musculoskeletal/Rheum (12 decks)

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