Osteoarthritis Flashcards
Osteoarthritis - gen info
most common arthropathy - involves cartilage
non-inflammatory
path and findings the same regardless of jt involved
OA - multifactoral etiology
progressive deterioration and loss of articular cartilage
-> loss of normal jt structure and function
Primary - aging (60)/ genetic (nodal OA)
Secondary - disorders that damage joint surfaces
trauma
2 principle mechanisms of OA
damage to normal articular cartilage by physical forces
chondrocytes react - degradative enzymes,
inadequate repair response
fundamental defective cartilage fails under normal jt loading - Type II collagen gene defect (Ochronosis)
Describe Type II collage gene defect
ochronotic cartilage - pigmented and defective
OA - pathologic characteristics
altered chondrocyte fxn loss of cartilage subchondral bone thickening- sclerosis remodeling of bone - marginal spurs(osteophytes) cystic changes insubchondral bone mild reactive synovitis
OA risk factors - systemic
age, obesity, genetics, gender(M>W), menopause?
OA risk factors - local
muscle strength, joint proprioception, repetitive use, configuration of joint(extra pressure in areas), trauma
OA common presentations
C-spine, L spine, 1st CMC, PIP, DIP!!!, Hip, Knee, 1st MTP
osteoarthritis - locations
hands - nodal
heberdens nodes - dip
bouchards nodes - pip
1st CMC jt - base of thumb
Knees - most common location med/lat/pat-fem
Hips
spine
feet 1st MTP
OA symptoms
insidious onset joint pain w/ movement limitation of motion/ decreased fxn minimal stiffness after rest referred pain no acute flares not systemic
Why OA painful - no nerves in cartilage
synovitis jt capsul/ligament stretching periosteal irritation from osteophytes trabecular microfractures muscle spasm intraosseous hypertension
OA physical exam
bony changes in jt shape crepitus malalignment/instability limited ROM Jt line tenderness cool effusions - no inflammaiton no pannus/tcells spasm or atrophy of adjacent muscles
OA x ray findings
cartilage loss/ joint space narrowing
subchondral sclerosis
osteophytes at jt margins
subchondral cysts
Types of OA
generalized nodal spondylosis erosive inflammatory - rare from overuse diffuse idiopathic skeletal hyperostosis (DISH chondromalacia patellae - young girls
findings with inflammatory osteoarthritis
fuzzy cartialge on arthoscopy
inflamed heberdens nodes
findings with erosive OA
big cysts/holes
spondylolysis - wearing through pars interarticularis at L5/S1
spondylolystheisis - spondylolis with translation
what is a syndesmophyte
body growth inside of cartilage- often intervertebral joints
what is spondylitis
inflammation of vertebrae (ankylosing spondylitis)
What causes DISH?
compulsive osteoblasts
entheses are the point of origin
non inflammatory
DISH symptoms
up flowing osteophytes
in c-spine - causes dysphagia
Right sided candle wax ossification (opp in situs inversus)
Environmental factors of DISH
fluoride
synthetic retinoids
obesity
IGF-1
best place to look for DISH
thoracic spine
flowing anterior osteophytes on the anterior of the thoracic vertebrae
downward pointing spurs in C-spine
calcification of the post long ligament
upward pointing lumbar osteophytes
ligamentous calcification at the entheses (whiskering)
foot and ankle entheses calcification
Chondromalacia of the patella
young girls with wide Q angle
patella tracks incorrectly
shredded cartilage on scope
goals of management of OA
no cure pain control improve function enhance health related quality of life avoid rx-related side effects pharmacologic treatment
ways to mange OA
education viscosupplementation
weight reduction intra articular steroids
nutriceuticals conditioning
topical agents phys/occupational therapy
analgesics - non-opiods and opioids
NSAIDS surgery
SMOADS - structure modifying anti-OA drugs
What are SMOADS
MMP inhibitors residronate doxycycline glucosamine condroitin
What to use for refractory inflammatory OA
cholchicine
What to consider when inflammatory OA doesn’t respond
thing calcium pyrophosphate joint crystals
Essentials of OA diagnosis
commonly secondary to other articlular disease
degeneerative disorder w/o systemic manifestations
pain relieved by rest, little morning stiffness
minimal inflammation
X: ray findings narrowed joint space, osteophytes, increased density of sub chondral bone, bone cysts
