Osteoarthritis

Question 1

outline the managment stages of OA

Answer 1

analgesia
lifestyle changes
surgery

Question 2

what is passive insufficiency

Answer 2

inability of muscle to lengthen adequate for movement

Question 3

tension injuries result in

Answer 3

avulsion fractures

Question 4

what are Heberden’s nodes

Answer 4

bony osteophytes on the DIP joint

Question 5

what are the risk factors for OA

Answer 5

injury
congenital malformation
hypermobility
obesity
family history

Question 6

compression injuries lead to

Answer 6

vertebral fractures (esp in osteoporosis)

Question 7

oral analgesics used in the treatment of OA

Answer 7

regular paracetamol
NSAIDs (with PPI, cardiac effects and renal failure in the elderly)
opioids

Question 8

list the radiographic signs of OA

Answer 8

joint space narrowing
osteophyte formation
subchondral bone sclerosis
formation of subchondral cysts

Question 9

list the 3 S’s of muscle action

Answer 9

swing - pivot at joint
shunt - holds joint surfaces together
spin - produces rotation, supination or pronation

Question 10

injury caused by shear force

Answer 10

ligament rupture

Question 11

2 functions of ligaments`

Answer 11

resist tensile forces

proprioception

Question 12

how do ligaments differ from tendons

Answer 12

richer nervous supply and vascular supply

Question 13

torsion injuries result in

Answer 13

spiral fractures

Question 14

what are the functions of fibrocartilage/menisci

Answer 14

distributes load

minimise friction

Question 15

what causes reduced joint space

Answer 15

loss of articular cartilage (focal cartilage destruction)

Question 16

3 functions of tendons

Answer 16

transmit tensile forces
store energy
resist compression and shear

Question 17

what is the first line pharmacological treatment for OA

Answer 17

topical NSAIDS

Question 18

what is active insufficiency

Answer 18

inability of muscle to contract enough to produce movement

Question 19

what type of collagen is contained in tendons and ligaments

Answer 19

Col I

Question 20

what si the function of hyaline cartilage

Answer 20

absorb shock

minimise friction

Question 21

investigations of OA

Answer 21

radiograph
inflammatory markers (to exclude RA)
aspiration of synovial fluid (should be clear)

Question 22

how many joints are affected in oligoarthritis

Answer 22

2-4 joints

Question 23

how many joints are affected in poly arthritis

Answer 23

more than 4

Question 24

what are the symptoms of inflammatory joint disease

Answer 24

early morning stiffness/worse after rest
systemic:
- malaise
-weightloss
- fatigue
-fever
redness of overlying skin
joint effusion and synovial thickening

Question 25

what are the differences between articular and periarticular pain

Answer 25

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

Question 26

what are the symptoms of non-inflammatory disease

Answer 26

``` pain better with rest worse with activity no systemic symptoms no synovial thickening may be effusion ```

Question 27

what is early morning stiffness

Answer 27

marked stiffness in the morning and after rest lasting at least 30 mins

Question 28

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

Answer 28

chronic non-inflammatory oligoarthritis

Question 29

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

Answer 29

chronic inflammatory polyarthritis

Question 30

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

Answer 30

acute monoarthritis

Question 31

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

Answer 31

chronic inflammatory axial disease

Question 32

name 2 examples of acute inflammatory monoarthritis

Answer 32

``` septic arthritis crystal disease (gout/pseudo gout) ```

Question 33

investigations for suspected septic arthritis

Answer 33

``` blood cultures CXR urine culture inspection of the skin ENT exam CRP ```

Question 34

name a chronic monoarthritis

Answer 34

psoriatic arthritis (coudl also be low grade infections - mycobacterium or fungal)

Question 35

name 4 inflammatory oligoarthritis

Answer 35

psoriatic arthrits - +/- sacroilitis + psoriasis enteropathic arthritis - IBD ankylosing spnodnylitis - sacroilitis +/- spinal inflammation reactive arthritis 1-3 wks post infections (gastro, GU, strep throat)

Question 36

clinical features associated with inflammatory oligoarthritis

Answer 36

``` psoriasis uveitis iBD sacroiliitis HLA-B27 enthesitis dactylitis (pub shed) ```

Question 37

name 4 examples of chronic polyarthritis

Answer 37

RA - symmetrical involvement of MCP PIP and MTPs connective tissue disorders (SLEs, Sjorgren's) Psoriatic arthritis Chronic polyarticular gout

Question 38

what are the risk factors for septic arthritis

Answer 38

prosthetic joints endocarditis immunosuppression

Question 39

what are the treatments for septic arthritis

Answer 39

aspiration/washout | IV abx for 1/52, then oral 4/52

Question 40

outline some of the changes in cartilage which occur in arthritis

Answer 40

- loss of polyanionic proteoglycans (aggrecan, decor, billycan, fibromodulin) - increased proteoglycan catabolism - chondrocyte cluster formation - breakdown of collagen meshwork - surface fibrillation (MMPs and physical destruction)

Question 41

outline some of the biochemical changes in cartilage caused by ageing

Answer 41

slowing of cell metabolism crosslinking reduced col IX synthesis changes in aggrecan (shorter CS and more KS) accumulation of degradation products of cartilage matrix