Osteoarthritis Flashcards
What is Osteoarthritis ?
Articular cartilage failure
Subchondral sclerosis
loss of joint space
Subchondral cyst formation
What happens in OA?
Loss of matrix
release of cytokines including IL-1 and TNF
Release of metalloproteinases and prostaglandins by chondrocytes
What accompanies fibrillation of the cartilage surface?
Attempts of repair and osteophyte formation
What is a clinical presentation of OA?
Pain, typically on activity and relieved by rest.
stiffness usually in the morning (lasts less than 30 mins)
Inactivity gelling
What is found on examination with OA?
Crepitus
Bony enlargements due to osteophytes
Joint tenderness
Joint effusion
What joints are involved with OA?
Hands Dip, PIP, and 1st CMC joints knee Hip Spine
What kind of deformities are found in the knee?
Genu varus (away from midline) Valgus (to the midline)
What else can occur in the knee with OA?
Bakers cyst
Where is pain felt in OA of the hip?
In the groin and radiating to the knee.
May be radiating from the lower back
What can occur at the lumbar spine?
Spinal stenosis caused by osteophytes when encroached on spinal canal
What radiological signs can show OA?
Loss of joint space
Subchondral sclerosis
Subchondral cysts
Osteophytes
In OA, what grading scale is uses?
The Kellgren-Lawrence Radiographic scale of OA
How is OA managed?
Physiotherapy
Common sense e.g. weight loss
What drugs can be used to treat OA?
Analgesia
NSAID’s
Pain modulators
What can be done in surgery to help with OA?
Arthroscopic washout, loose body, soft tissue trimming
Joint replacement
What is Gout?
Inflammation in the joint triggered by uric acid crystals
What is chronic tophaceous gout?
Chronic joint pain, often associated with diuretics.
High serum uric acid
Tophi, may get acute attacks
What investigations may you do for suspected gout?
Serum uric acid levels Inflammatory markers polarised microscopy of synovial fluid X-rays Renal checks
What are treatments for Gout?
NSAIDs
Colchicine
Steroids
What prophylaxis treatment can you give?
Allopurinol
Febuxostat
What does chondrocalcinosis affect?
Fibrocartilage in the knees, wrists and ankles
What is chondrocalcinosis, aka CPPD?
Calcium Pyrophosphate Deposition Disease
What causes CPPD?
Pseudogout, calcium pyrophosphate crystals
What are treatments for CPPD?
NSAIDs
Colchone
Steroids
Rehydration
Hydroxyapatite is also known as what?
Milwaukee shoulder
What is Hydroxyapatite?
Hydroxyapatite crystals in or around the joint
What is released in Hydroxyapatite?
Collagenases, serine proteinases and IL-1
What is the treatment for Hydroxyapatite?
NSAIDs
Intra-articular steroid injection
Physiotherapy
Partial or total arthroplasty.
What is Anti-Jo 1 associated with?
Polymyositis
