Osteoarthritis

Question 1

Radiologic findings in OA

Answer 1

Presence of osteophytes (marginal spurs), joint space narrowing due to T2 collagen loss, and subchondral sclerosis

Question 2

Characteristic location of osteophytes

Answer 2

DIP (Heberden) and PIP (Bouchard)

Question 3

Define etiology of OA

Answer 3

Progressive deterioration & loss of articular cartilage, leading to loss of normal joint structure & function.
Primary - aging or idiopathic, genetic (nodal OA)
Secondary - due to disorders that damage joint surfaces

Question 4

What is the pathophysiology behind the Etiology #1 of OA - Damage to normal articular cartilage by physical forces

Answer 4

chondrocytes react and release degradative enzymes and inadequate repair response

Question 5

What is the pathophysiology behind the Etiology #2 of OA - fundamental defective cartilage fails under normal joint loading

Answer 5

type 2 collagen gene defect

Question 6

Describe sx of OA

Answer 6

 Insidious onset
 Joint pain associated with movement
 Limitation of motion/ function
 Minimal stiffness after rest
 Referred pain
 Acute flares suggest another diagnosis
 Systemic symptoms are rare

Question 7

common locations of OA

Answer 7

Cervical spine
Lumbar spine
1st CMC
PIP
DIP
Hip (more genetically variable) 
Knee
1st MTP

Question 8

Physical Signs of OA

Answer 8

 Bony changes in joint shape
 Crepitus
 Malalignment/Instability
 Limited ROM
 Joint line tenderness
 **Cool effusions (***not hot, warm, effusions - OA is non-inflammatory.  Not much pain, just decreased motion.)
 Spasm or atrophy of adjacent muscles

Question 9

Describe cartilage - thickened or thinned - in OA

Answer 9

thinned

Question 10

What happens to subchondral bone in OA?

Answer 10

thickening/sclerossis

Question 11

What happens to chondrocytes

Answer 11

altered function

Question 12

Describe pain with rest/exercise in OA

Answer 12

Pain relieved by rest, morning stiffness brief, articular inflammation minimal.

Question 13

**Describe XR findings

Answer 13

**narrowed joint space, cartilage loss, osteophytes at joint margins, increased density of subchondral
bone, bone cysts

Question 14

Diagnostic tests for OA

Answer 14

none. XR is best.

Question 15

Describe nodal osteoarthritis

Answer 15

Hands -
•Heberden’s Nodes: DIP
•Bouchard’s Nodes: PIP
•1st CMC Joint: base of thumb

Question 16

Describe the most common location of OA

Answer 16

knee

Question 17

What is this?
 exuberant osteophytosis of spine/spans > 3-4 vertebral segments (outside the joint)
 preservation of disc spaces
 ligamentous calcification
 >50 yoa
 M>F
 associated with DM
 Complication: ant. cervical osteophytes - dysphagia

Answer 17

Diffuse idiopathic skeletal hyperostosis (FISH)

“flowing osteophytes” in cervical/thoracic spine

Question 18

tx of OA

Answer 18

no cure.  WL and NSAIDs
pain control, enhance health related QoL - wt loss
-SURGERY
-intraarticular steroids
-Physical therapy, conditioning
-glucosamine

Question 19

q’s on test

Answer 19

5

Question 20

what are syndesmophytes?

Answer 20

chondrocytes gone crazy