Osteoarthritis Flashcards
What is osteoarthritis (OA)?
the failure of articular cartilage and subsequent degenerative changes in subchondral bone, bony joint margins, synovium, and para-articular fibrous and muscular structures
What are the two principle changes associated with Osteoarthritis (OA)?
1) Progressive focal degeneration of articular cartilage with subsequent degeneration of surrounding soft tissue
2) Formation of new bone in the floor of the cartilage lesion at the joint margins (osteophytes).
What is the quality of pain and pain in relation to activity in OA?
Quality of pain: described as a deep ache
Pain in relation to activity: initially, pain occurs with joint use and is relieved with rest. As the disease progresses, pain occurs even without use.
When does stiffness occur in OA?
there is stiffness with initial use of the joint but it gets better unlike inflammatory arthritis.
What are Heberden nodes?
bony swellings located in the distal interphalangeal joints
What is found on the physical exam of OA?
Joint margin tenderness, fine crepitance (crackling sound made when bones rub against each other, similar to the sound of hair rubbing between your fingers), limits to motion, and enlargement of the joint due to proliferation of cartilage and bone
Does radiographic or physical examination evidence of severity reliably predict a patient’s symptoms?
No
What is primary OA?
cartilage failure an unknown cause that would predispose to osteoarthritis. It almost never affects the shoulders, elbows, ankles, metacarpophalangeal joints, or ulnar side of the wrist
What is generalized OA?
affects distal and proximal IP joints, first carpometacarpal joints, hips, knees, and spine.
What is isolated nodal OA?
affects only distal IP joints.
What is isolated hip OA?
more common in men than women
What is erosive OA?
only distal and proximal IP joints.
What is diffuse idiopathic skeletal hyperostosis?
also known as Forestier disease, occurs in men over 50, is a variant of primary osteoarthritis
What are the joints involved and the usual population affected by generalized OA?
It affects distal and proximal IP joints, first carpometacarpal joints, hips, knees, and spine of middle aged postmenopausal women
What are the joints involved, time of onset, and clinical presentation of erosive OA?
Joints involved: only distal and proximal IP joints.
Onset: symptoms begin about the time of menopause
Clinical presentation: Episodes of local inflammation, mucous cyst formation at the distal IP joint.
What are the clinical findings of erosive OA?
Bony erosions and collapse of the subchondral plate (only seen with erosive OA, not any other primary OA) with osteophytes
What is the affected population in diffuse idiopathic skeletal hyperostosis (DISH).
men over 50 years old
What is found on radiographs in DISH?
exuberant, flowing osteophytosis that connects 4 or more vertebrae with preservation of the disk space
What is the differential Dx to DISH?
distinguished from typical osteoarthritis of the spine with degenerative disk disease and from ankylosing spondylitis
What is the clinical presentation to DISH?
calcification of the pelvic ligaments, exuberant osteophytosis at the site of peripheral osteoarthritis, well-calcified bony sports at the calcaneus, and heteotropic bone formation after total join arthroplasty