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RB Y2 MSK 02 - Rheumatology > Osteoarthritis > Flashcards

Osteoarthritis Flashcards

1
Q

define

A

most common type of arthritis.

progressive degenerative condition affecting joints due to an imbalance of cartialge breakdown and repair, with gradual thinning of cartilage, loss of joint space and formation of osteophytes

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2
Q

osteophytes

A

bony spurs

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3
Q

inflammation?

A

there may be inflammation alongisde it, which can lead to flare ups periodically

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4
Q

risk factors

A
  • environmental factors, hobbies and occupation may have an influence
  • joints with abnormal alignment eg hypermobility, genu, fracture malunion
  • previous injuries
  • women
  • age
  • obesity
  • familial factors
  • genetics
  • RA, gout, acromegaly
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5
Q

what can previous injuries cause

A

secondary OA

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6
Q

describe the pattern of joint involvement

A

usually asymmetrical and affects weight bearing or active joints

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7
Q

pathogenesis

A
  • A combination of muscle weakness and ligament imbalance leads to uneven load at joint.
  • Joint microtrauma causes release of cytokines (including IL-1 and TNF and metalloproteinases) – catabolic factors for cartilage ECM. This causes inflammation of the synovium and abnormal bone remodeling.
  • Cartilage consists of predominantly collagen type II fibres linked by covalent bonds, conferring tensile strength
  • There is loss of matrix. Fibrillation (softening and development of vertical clefts) of the cartilage surface (progressive loss by abrasion) and attempted repair with osteophyte formation then occurs.
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8
Q

describe a joint with mild arthritis

A

osteophytes

roughened, thinning cartilage

mild, thickened inflamed synovium

thickened stretched capsule

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9
Q

describe a joint with severe OA

A
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10
Q

what is the onset like

A

gradual

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11
Q

clinical features

A

mechanical pain

crepitus on movemenet

stiffness, inactivity gelling

bony swellings and deformity of joints

effusions and soft tissue swelling

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12
Q

mechanical pain

A

worse with activity and at the end of the day

relieved by rest

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13
Q

what can OA lead to

A

loss of function and mobility

joint deformity

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14
Q

commonly affected joints

A
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15
Q

what features are seen in the hands

A
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16
Q

what are the 2 most common sites for OA

A
  1. DIP
  2. base of thumb
17
Q

what does OA in the base of the thumb lead to, and what particular movement makes pain worse

A
  • subluxation of CMC joint
  • worse on pinching movement
  • thumb may ‘square’
18
Q

what may there be on the hands with associated OA

A

dorsal ganglion cyst may be present

19
Q

what is seen whe OA affects the knee

A

genu varum or valgum can predispose

osteophytes, effusions, crepitus and restriction of movement

bakers cyst

20
Q

genu varum and valgum

A

due to abnormalitites in the medial and lateral menisci respectively.

varum - medial OA

valgus - lateral OA

21
Q

bakers cyst

A

fluid filled swelling in popliteal fossa

also seen in RA

22
Q

effects of OA in the hip

A

restriction of movement

pain may be felt in groin or radiate to knee

23
Q

where may pain felt in the hip e from

A

lower back

24
Q

OA in the spine

A

osteophytes can impinge on nerve root causing weakness and pins and needles

pain and restriction

spinal stenosis

25
Q

diagnosis

A

history and examination are key

bloods - inflammatory markers usually normal

x ray

26
Q

x ray features

A

loss of joint space

osteophytes

sclerosis

subchondral cysts

27
Q

what treatment is available for elbow OA

A
  • elbow replacement
  • However, these are not good for young/active people and are limited to 5kg or 1kg repeatedly.
28
Q

non pharmacological management

A
  • Education
  • Physiotherapy
  • Weight loss
  • Footwear
  • Aids e.g. walking stick
29
Q

first line analgesia

A

paracetamol and topical NSAIDs (for knees and hands)

30
Q

2nd line analgesia

A
  • oral NSAIDs/COX-2 inhibitors, opioids, capsaicin cream and intra-articular corticosteroids (short term relief)
31
Q

what is NICE views on the use of viscosupplementation, hyaluronic acid injection, glucosamine or chondroitin.

A

they do not support it

32
Q

surgical management

A

fusion, replacement or total excision

33
Q

what surgery is available for varus knee

A
  • osteotomy for isoated early medial OA compartment
  • However, this has lower satisfaction rates than TKR, variable duration of effect, and can affect results of later TKR
  • Is good in heavy manual workers. The results for valgus knee are less well established.

RB Y2 MSK 02 - Rheumatology (33 decks)

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