OSTEOARTHRITIS Flashcards
Define osteoarthritis.
Degenerative disease of the articular cartilage and subchondral bone.
What are the five subtypes of osteoarthritis?
Nodal generalized Erosive inflammatory Large joint Crystal associated ...
What are the causes of primary osteoarthritis?
Congenital misalignment of bone
Mechanical injury in the joint
Obesity (perhaps metabolic reasons rather than just increased weight)
Loss of strength in muscles supporting a joint
Impairment of peripheral nerves, leading to sudden or uncoordinated movements.
Genetics have been found to be a factor
Post-menopause
What are the causes of primary osteoarthritis?
Congenital misalignment of bone
Mechanical injury in the joint
Excessive weight
Loss of strength in muscles supporting a joint
Impairment of peripheral nerves, leading to sudden or uncoordinated movements.
Genetics have been found to be a factor
Post-menopause
What is complete loss of the articular cartilage described as?
Eburnation
What is it called when synovial fluid makes its way into the bone?
Subchondral pseudocyst
What are the different stages of the degeneration?
Fibrillation
Chondrocyte clusters
Thinning of cartilage
Eburnation
Is osteoarthritis an inflammatory disease?
No (despite its name)
What are the causes of secondary osteoarthritis?
Alkaptonuria - genetic disorder where the body cannot process phenylalanine and tyrosine.
Congenital disorders of joints
Diabetes
Ehlers-Danlos Syndrome
Hemochromatosis
Wilson’s disease - accumulation of copper in tissues
Perthes’ disease - childhood hip disorder where blood flow to the ball of the femur is disrupted.
Lyme disease - tick borne disease involving bacteria Borrelia
Costochondritis
Gout
Rheumatoid arthritis
Marfan’s syndrome - connective tissue disorder
Septic arthritis
Obesity (more than just excess body weight, metabolic effects are also a factor)
What is the process of damage to cartilage called?
Ochronosis
What is the pathophysiology of osteoarthritis?
Collagen matrix becomes more disorganised
Decrease in proteoglycan content within cartilage but outweighed by breakdown of collagen fibres. This leads to a net increase in water content.
Without protective features of proteoglycans, collagen fibres further degrade, leading to more damage.
How would a patient with suspected osteoarthritis present? (Name 3 symptoms)
Joint pain
Loss of ability
Crepitus
Pain worse in cold weather
On examination, what might you find in a patient with suspected osteoarthritis?
Crepitus upon moving the joint Heberden's nodes Bouchard's nodes Bunions Joint effusion in the knee
What is crepitus?
Crackling noise when moving affected joint.
Which joints are most commonly affected in patients with osteoarthritis?
Hands Feet Spine Hips Knees
What are Heberden’s nodes?
Osteophytes in the DIP
What are Bouchard’s nodes?
Osteophytes in the PIP
How can might you distinguish between osteoarthritis and rheumatoid upon examining a patient’s hands?
Rheumatoid arthritis does not affect the DIP, therefore no Heberden’s nodes will form. Other rheumatoid arthritis signs such as ulnar deviation are also not seen in osteoarthritis.
Are Bouchard’s nodes seen in rheumatoid arthritis?
Yes. They are seen in both osteoarthritis and rheumatoid arthritis.
What might you see on a radiograph of a joint from a patient with osteoarthritis?
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
What are the management options for someone diagnosed with osteoarthritis?
Weight loss Exercise Paracetamol NSAIDs Cox-2 selective inhibitors (celecoxib) Oral opioids (tramadol) Topical NSAIDs (diclofenac) Joint replacement
What makes up cartilage?
Made up of chondrocytes which produce large amounts of extracellular matrix.
What is the extracellular matrix that makes up cartilage made of?
Collagen fibres
Proteoglycan
Elsatin fibres
What are the three types of cartilage and what is the main component of the extracellular matrix in each one?
Elastic cartilage - elastin
Hyaline cartilage - collagen type II
Fibrocartilage - collagen type I and II
What is the name of the cells from which chondrocytes are derived?
Chondroblasts
