Osteoarthritis

Question 1

what is the cause and process of OA ?

Answer 1

• not part of normal aging
• involves biomechanical,bichemical and cellular processes
• release of enzymes and abnormal biomechan forces cause fibrillation and damage of articular cartilage leading to cartilage loss
  (inflam mediators destruct jt cartilage and bone regrowth does not happen right)
• effects weight bearing jts, knee, hip hand,
• CMC and PIP and DIP with sparing of thumb in OA
• ** RA usually MCP and PIP

Question 2

are there risk factors for OA? are any modifiable

Answer 2

Yes there are

• many that we can impact as PT’s
• age; sex; genetics; obesity; physical inactivity; injury; joint stress
• • repeat loading; deep bending esp men

Question 3

What are teh differences in bone b/w general aging and OA

Answer 3

Aging:
- dec .bone turn over & density
- dec water in cartilage
- fibrillation at WB sites, not progressive (not across jt)
- normal metabo no inflam
- decreased lean muscle mass (Type II firbers - rapid movt )
VS
OA
- Incr bone turn over & local density
- incre water in cartilage
- fibrillation focal & progressive (across jt)
- incre metabolism & inflam enz
- dec lean muscle mass (type I fibres - cont. activities) (decreased endurance, tired easily)

Question 4

How do you normally diagnois OA and what are the main features?

Answer 4

1) joint space narrowing (Destruction)
2) subchondral sclerosis (destructive)
(incr. periarticular bone density)
3) subchondral cyst formation (destructive)
4) osteophytosis (attempted repair - attempted repair but bone not layed down right)

Question 5

What grading sysemt is use for OA

Answer 5

Kellgren Lawrence
Grade 0 - no radiographic features
Grade 2 -minmal: definite osteophyte, unimpaired jt space.
Grade 4 - severe, jt space greatly impaired, w. sclerosis of subchondral bone

Question 6

What are the characteristics of stiffness and P in OA?

Answer 6

40% damaged have P

• initially P after using Jt
• better with rest
• PAIN: bone, soft tissue, inflame, muscle spasm
• *Gelling = stiffness after inactivity

Question 7

WHat is the first line Rx for OA

know this well

Answer 7

Exs
Weight loss
acetaminophen

Question 8

What are some physical activity guidelines for ppl with OA

Answer 8

• 30min mod int most days OR 30min high int, 3/d/wk

* bouts of 10min

Question 9

What is a modifiable risk factor for OA

Answer 9

quadriceps activity = delay OA

the stronger the quad the lower the risk

Question 10

What are the most common forces acting in the knee and to what compartment?

Answer 10

• adduction moments - medial compartment

* *Knee adduction moment predicts progression of OA **

Question 11

What is key to Rx exs for this group?

Answer 11

Adherence you need to maintain it to see and have improvements ***

Question 12

Does a cane help pl with OA?

Answer 12

Yes it does but it does increase energy expenditure so keep in mind
- need to get them using cane inside first for shorter distances first then wrk in outdoors

Question 13

What ext aids can pt with OA get that could decrease their pain?

Answer 13

custom knee brace > neoprene > nothing

lateral wedge shoes or neutral wedge

Question 14

What is an additional mod risk factor?

Answer 14

Weight loss

- BMI effects even none weight bearing jts

Question 15

An overweight pt comes to your clinic your best recommendations for them are?

Answer 15

• exs (aerobic and strength) program with diet modification
• BMI >27 (acetaminophen)
• initial aim to loose 10% BW (1pd = 4 pd reduction /load/step)
• 10% would give 28% decrease in P ; 20% is key
• adherence is KEY !!!
• glucosamine sulfate does nothing but is also not bad could keep taking