Osteoarthritis Flashcards
what is OA a consequence of?
complex interplay of many factors, mainly wear & tear of a joint
what is OA?
arthritis in weight baring joints
what happens to the joint in OA?
- articular cartilage thinning or loss
- subchondral sclerosis
- loss of joint space
- subchondral cyst formation
- osteophyte formation
what is the pathogenesis of OA?
- loss of matrix of cartilage due to increase in protease:inhibitor ratio
- release of cytokines including IL1, TNF & mixed metalloproteinases
- release of prostaglandins by the chondrocytes
- fibrillation of cartilage surface
- attempted repair with osteophyte formation
what are the normal constituents of cartilage?
chondrocytes
extracellular matrix - collagen type 2, proteoglycans & water
what would happen if all of the chondrocytes in cartilage were to die?
no more ECM would be produced at all
what are the types of OA?
- idiopathic
- secondary
- generalised
where will idiopathic OA be found?
will be localised
- hands
- feet
- keen
- hip
- spine
what could secondary OA be due to?
- previous injury
- RA
- genetic elements
- acromegaly
- calcium crystal deposition disease
how can generalised OA be diagnosed?
by the involvement of 3+ joints
name some risk factors for OA?
- age
- female more common
- obesity
- occupation
- sports
- previous injury
- muscle weakness
- proprioceptive deficits
- genetic elements
- underlying disease
what symptoms would you expect to see in OA?
- pain
- stiffness, worse in the morning but lasting less than 30 mins
describe the pain in OA
typically worse on activity and relieved by rest. May progress to be present with less activity and at rest or at night.
what would you expect to find on examination
crepitus
bony enlargements due to osteophytes
joint tenderness
joint effusion
what would likely happen to the hands
DIP, PIP & 1st CMC joints
bony enlargements at DIPS
squaring of thumb
heberdens nodes
bony enlargement at DIPJs
bouchards nodes
bony enlargement at PIPJs
what would you likely see at the knees
osteophytes effusions crepitus reduced ROM genu varus/valgus deformities bakers cyst
what likely happen at the hip
pain may be felt in groin or radiating to the knee
pain in the hip could be from lower back
hip ROM reduced
what would likely happen in the cervical spine
pain
restricted ROM
osteophytes may impinged nerve roots
what could happen in the lumbar spine
osteophytes can cause spinal stenosis if they impinge on the spinal canal
what would you see on an X-ray of a joint affected by OA?
L - loss of joint space
O - osteophytes
S -subchondral sclerosis
S - subchondral cysts
what grading scale can be used in OA?
Kellgren-lawrence radiographic grading scale (0-4)
what is Kellgren-Lawrence grade 0
no radiographic findings of OA
