Osteoarthritis Flashcards
outline the managment stages of OA
analgesia
lifestyle changes
surgery
what is passive insufficiency
inability of muscle to lengthen adequate for movement
tension injuries result in
avulsion fractures
what are Heberden’s nodes
bony osteophytes on the DIP joint
what are the risk factors for OA
injury congenital malformation hypermobility obesity family history
compression injuries lead to
vertebral fractures (esp in osteoporosis)
oral analgesics used in the treatment of OA
regular paracetamol
NSAIDs (with PPI, cardiac effects and renal failure in the elderly)
opioids
list the radiographic signs of OA
joint space narrowing
osteophyte formation
subchondral bone sclerosis
formation of subchondral cysts
list the 3 S’s of muscle action
swing - pivot at joint
shunt - holds joint surfaces together
spin - produces rotation, supination or pronation
injury caused by shear force
ligament rupture
2 functions of ligaments`
resist tensile forces
proprioception
how do ligaments differ from tendons
richer nervous supply and vascular supply
torsion injuries result in
spiral fractures
what are the functions of fibrocartilage/menisci
distributes load
minimise friction
what causes reduced joint space
loss of articular cartilage (focal cartilage destruction)
3 functions of tendons
transmit tensile forces
store energy
resist compression and shear
what is the first line pharmacological treatment for OA
topical NSAIDS
what is active insufficiency
inability of muscle to contract enough to produce movement
what type of collagen is contained in tendons and ligaments
Col I
what si the function of hyaline cartilage
absorb shock
minimise friction
investigations of OA
radiograph
inflammatory markers (to exclude RA)
aspiration of synovial fluid (should be clear)
how many joints are affected in oligoarthritis
2-4 joints
how many joints are affected in poly arthritis
more than 4
what are the symptoms of inflammatory joint disease
early morning stiffness/worse after rest systemic: - malaise -weightloss - fatigue -fever redness of overlying skin joint effusion and synovial thickening
what are the differences between articular and periarticular pain
articular:
- pain all around the joint
- exacerbated by movements in all directions
- active and passive movement is equally affected
- joint line tenderness
- swelling in the confines of joint capsule
periarticular
- localised pain in certain directions of movement
- passive movement easier than active
- localised tenderness away from jointline
what are the symptoms of non-inflammatory disease
pain better with rest worse with activity no systemic symptoms no synovial thickening may be effusion
what is early morning stiffness
marked stiffness in the morning and after rest lasting at least 30 mins
joint disease pattern off…
60yo male presents with 1yr history of pain and swelling of both knees
symptoms improve with rest and has difficulty walking more than 1 mile
chronic non-inflammatory oligoarthritis
joint disease pattern of…
30yo female with 3/12 history of progressive pain, stiffness and swelling in the small joints of hands, knees and shoulders
She has early morning stiffneess and improves with activity
chronic inflammatory polyarthritis
joint disease pattern of
50yo male with 1/52 history of pain redness and swelling in left halux
pain disrupts sleep
unable to weight bear in the morning
acute monoarthritis
joint disease pattern of…
18yo male 6/12 lower back pain which radiates to back of thighs
pain disturbs sleep at night
experiences back stiffness for 2 hours in the morning
symptoms improve by lunchtime, but feels fatigued
chronic inflammatory axial disease
name 2 examples of acute inflammatory monoarthritis
septic arthritis crystal disease (gout/pseudo gout)
investigations for suspected septic arthritis
blood cultures CXR urine culture inspection of the skin ENT exam CRP
name a chronic monoarthritis
psoriatic arthritis (coudl also be low grade infections - mycobacterium or fungal)
name 4 inflammatory oligoarthritis
psoriatic arthrits - +/- sacroilitis + psoriasis
enteropathic arthritis - IBD
ankylosing spnodnylitis - sacroilitis +/- spinal inflammation
reactive arthritis 1-3 wks post infections (gastro, GU, strep throat)
clinical features associated with inflammatory oligoarthritis
psoriasis uveitis iBD sacroiliitis HLA-B27 enthesitis dactylitis (pub shed)
name 4 examples of chronic polyarthritis
RA - symmetrical involvement of MCP PIP and MTPs
connective tissue disorders (SLEs, Sjorgren’s)
Psoriatic arthritis
Chronic polyarticular gout
what are the risk factors for septic arthritis
prosthetic joints
endocarditis
immunosuppression
what are the treatments for septic arthritis
aspiration/washout
IV abx for 1/52, then oral 4/52
outline some of the changes in cartilage which occur in arthritis
- loss of polyanionic proteoglycans (aggrecan, decor, billycan, fibromodulin)
- increased proteoglycan catabolism
- chondrocyte cluster formation
- breakdown of collagen meshwork
- surface fibrillation (MMPs and physical destruction)
outline some of the biochemical changes in cartilage caused by ageing
slowing of cell metabolism
crosslinking
reduced col IX synthesis
changes in aggrecan (shorter CS and more KS)
accumulation of degradation products of cartilage matrix
