Osteoarthritis Flashcards
define osteoarthritis
degeneration of articular cartilage and reactive remodeling of subchondral bone and periarticular tissues
what areas does OA effect?
most joint structures including cartilage, bone, muscle, synovium, and the joint capsule
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.
most common arthritis in older patients?
OA
pathognomonic finding for OA
breakdown of the cartilage of the joint.
approach to txt for OA?
conservative and base on life-style changes until pain and/or disability requires a surgical approach when feasible.
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)
OA: Xray evidence correlates poorly with what?
symptom severity
primary OA
idiopathic + limited to a few joints
secondary OA
caused by ... acute or chronic trauma bone disorders congenital/development d/o metabolic/endocrine d/o inflammatory arthritis
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
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)
4 OA joint changes
- Joint space narrowing
- Subchondral bone sclerosis
- Subchondral cysts
- Osteophytes
clinical manifestations of OA
- pain
- stiffness
- swelling
- deformity/ loss of function
- crepitus
- erythema + warmth
what makes OA pain worse?
activity (improves with rest)
stiffness in OA ?
- Morning stiffness is brief (< 1 hour)
2. May develop after prolonged inactivity (“gelling”)
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
- Intervertebral disc spaces: Protrusion of the nucleus pulposus with cord compression may occur
- Posterior spinal facet joints - areas of greatest flexibility - cervical + lumbar
- 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
- Total joint replacement – last resort and most definitive
Almost all patients experience significant pain relief
Function still usually limited - Arthroscopic debridement
Poor evidential support
vitamin D to prevent OA?
low vit. D assoc. with incr. risk, but supplementation not clearly helpful
