1. Joint space narrowing 2. Subchondral bone sclerosis 3. Subchondral cysts 4. Osteophytes

1. Morning stiffness is brief (< 1 hour) 2. May develop after prolonged inactivity (“gelling”)

Osteoarthritis Flashcards by Jacqui Joseph

define osteoarthritis

degeneration of articular cartilage and reactive remodeling of subchondral bone and periarticular tissues

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what areas does OA effect?

most joint structures including cartilage, bone, muscle, synovium, and the joint capsule

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what is the “more appropriate” term for osteoarthritis? why?

degenerative process (-osis) and not an inflammatory one (-itis). DJD (degenerative joint disease) will be a better term.

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most common arthritis in older patients?

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pathognomonic finding for OA

breakdown of the cartilage of the joint.

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approach to txt for OA?

conservative and base on life-style changes until pain and/or disability requires a surgical approach when feasible.

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when do men and women get OA?

Before age 45, more common in men

After age 55, more common in women (maybe b/c of bone protective-effects of estrogen)

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OA: Xray evidence correlates poorly with what?

symptom severity

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primary OA

idiopathic + limited to a few joints

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secondary OA

caused by ...
acute or chronic trauma 
bone disorders 
congenital/development d/o 
metabolic/endocrine d/o
inflammatory arthritis

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what are the OA risk factors? (6)

AGE (biggest one)
obesity
joint malalignment (varus)- bowlegged
high bone density (odd but true!)
repetative impact loading
family history

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Women with osteoporosis and hip fracture have _____ risk of OA

decreased

possibly b/c they tend to weight less.
soft bone protects cartilage better than dense bone (absorbs impact)

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4 OA joint changes

Joint space narrowing
Subchondral bone sclerosis
Subchondral cysts
Osteophytes

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clinical manifestations of OA

pain
stiffness
swelling
deformity/ loss of function
crepitus
erythema + warmth

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what makes OA pain worse?

activity (improves with rest)

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stiffness in OA ?

Morning stiffness is brief (< 1 hour)

2. May develop after prolonged inactivity (“gelling”)

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what is “gelling”?

stiffness after prolonged inactivity

what is swelling from in OA?

bony enlargement

what three joints are generally NOT involved in OA? (unless there was injury)

Wrists
Metacarpophalangeal joints
Elbows, shoulder, and ankles

OA of the hands: two most commonly affected joints (and what are they named?)

Most commonly affected joints are DIP (Heberden nodes) and PIP (Bouchard nodes)
*findings are frequently familial

OA nodes vs RA nodes

OA- nodes are hard, RA- more hard/rubbery

knee OA happens medially or laterally more?

medially more than laterally

position for knee Xray ?

standing

what is a baker cyst?

Popliteal cyst-like expansion : Due to inflammation of the joint
Not really a cyst – actually a herniation of the bursal sac through the posterior muscles

symptoms of a baker cyst

asymptomatic or feel stiff and “funny” preventing full knee extension – usually not painful, nor OA…

txt of baker cyst

Txt; isolate the knee, takes time to go away

OA of the hip: where does the pain start and radiate?

Pain may be in groin radiating anteriorly to thigh or distally in knee Positive Trendelenburg’s sign

what is a positive trendelenburg's sign?

pelvis will sag on the side opposite to the abnormality when the normal knee is flexed

OA of the cervical and lumbar spine is referred to as _______

spondylosis

OA of the spine: 3 sites effected

1. Intervertebral disc spaces: Protrusion of the nucleus pulposus with cord compression may occur 2. Posterior spinal facet joints - areas of greatest flexibility - cervical + lumbar 3. spinal canal stenosis (from osteophytes) - apophyseal joints

what is Spondylolisthesis?

slippage of one vertebral body on another if severe

OA on the foot? - what is the characteristic finding?

Charcot foot deformity - secondary from neuropathic DM ulcer

Legg-Calve-Perthes Disease: who gets it? what is it?

secondary OA: boys age 2-12 arthritis of the hipds: temporary loss of blood supply to the hip resulting in necrosis of the femoral head (avascular necrosis), results in intense inflammation resulting in arthritic changes

OA synovial fluid

Synovial fluid: WBC < 2,000 cells/mm3 ( normal)

Dx of OA

Xray: to confirm Dx CT/MRI: Appropriate if symptoms suggest disc herniation, nerve impingement, or spinal stenosis ( if you need to see facet joints)

does Xray correlate with symptoms?

NO, Can have changes without pain | Insensitive especially in early OA

txt goal of OA?

no cure + no therapy known to prevent or retard the degenerative process Treatment focuses on relieving symptoms and improving function

OA non pharm txt (6)

``` Patient education Weight loss Diet Increase calcium, vitamins C and D Physical and occupational therapy Exercise ```

exercised for OA?

refer to PT! | strengthen quads, walking, low impact

pharm txt for OA: analgesic/anti-inflamm

``` NSAIDs... to reduce the ADRs... low dose w/ PPI *cox 2 specific (celecoxib) *acetaminophen (for liver issues) *topical capsaicin (decr. substance P ) ```

two types of surgery for OA

1. Total joint replacement – last resort and most definitive Almost all patients experience significant pain relief Function still usually limited 2. Arthroscopic debridement Poor evidential support

vitamin D to prevent OA?

low vit. D assoc. with incr. risk, but supplementation not clearly helpful