Osteoarthritis

Question 1

Primary vs. secondary OA

Answer 1

Pirmary - genetic, metabolic, biomechfactors

Secondary - pre-existing joint damage

Question 2

Initial primary OA

Answer 2

Focal damage to articular cartilage

Loosens the colagen netowrk which weaknes ECM and stimulates chondrocytes

Chondrocytes produce proinflam cytokines and proteases which cause further matrix degen and chondrocyte death

Extensive degeneration occurs

Result is thinning of cartilage and lack of chondrocytes (can’t repair)

Question 3

Extraarticular structures and OA

Answer 3

Proinflam cytokines and proteases from articular cartilage will degenerate ECM and lead to meniscal and ligament tears

Capsule and synovium become inflamed and thickened and release even more factors

OSteoblasts produce new subchondral bone through collagen so get sclerosis and osteophytes

Osteoclasts in center can cause bone erosions

Question 4

Causes of OA

Answer 4

Single most clear is age

Most over 50 have evidence

Women more, esp in hands and knees

Mutations in colagen

Question 5

Anatomic and joint load and OA

Answer 5

Varus or valgus increase risk

Obesity increases hip and knee

Joint injury can result in changes within 1-0 years

Participation in sports with koint lodaing

Question 6

OA Chart of causes

Answer 6

Vulnerable joint - older, female, genetic

Mech - misalignment, muscle weakbness, comporomised integrity

Joint loading - obesity, macrotrauam, microtrauam

Question 7

Epidemiology of OA

Answer 7

Most over 50 have some form…only 10% present with sx

Question 8

CM of OA

Answer 8

Primarily pain with activity, stiffness with rest, bone enlargement, and reduced ROM

Generally worse later in day and with increased activity

Morning stiffness common but limited to less than 30 minutes

Question 9

Most common locations

Answer 9

First carpometacarpal joint

First metatarsophalangeal joint
Cervical and lumbar facet joints
Knees, hips 
Interphalangeal joints (distal)

Question 10

Exam of osteoarthritis

Answer 10

Bondy swelling

DIP - Heberden’s
PIP - Bouchards

May have tenderness or crepitus

Question 11

Dz of OA

Answer 11

Over 45 y/o with activity related pain locazlized to commonly affecrted joints with morning stiffness less than 30 minutes

Should do other testing to rule out other things

Question 12

Radio OA

Answer 12

Loss of joint space
Osteophytes
Scelrosis
Subchondral bone cytsts

Question 13

Nonpharm managmeent of OA

Answer 13

COmibination of aerobic and muscle strengthening exercises

Weight loss

Orthotics or braces

Question 14

Pharm therapy

Answer 14

Can’t change course

Topical capsaicin or NSAID gels

Oral NSAIDs

Question 15

Severe OA

Answer 15

Total joint failure so knee or hip joint replacement are highly effective managements