Osteoarthritis

Question 1

OA affects women more than men (T/F)

Answer 1

T

Question 2

___ of hip/knee replacements are for OA

Answer 2

95%

Question 3

____ of people who have arthritis have OA

Answer 3

3/4

Question 4

economic burden of OA is

Answer 4

2.9B

Question 5

OA is the strongest determinant of ______

Answer 5

walking difficulty –> leads to risk for CV evets + diabetes

Question 6

what is inflammatory arthritis defined by?

Answer 6

of leukocyes in affected joint tissues and synovial fluid

Question 7

is cellular inflammation prominent in OA?

Answer 7

no; normally low leukocytes

Question 8

where does pain in OA arise from?

Answer 8

muscles and ligaments around joint

Question 9

OA is a purely degenerative disease

Answer 9

F; pathogenesis of OA includes biomechanical factors, proinflammatory mediators and proteases

Question 10

pathogenesis of OA

Answer 10

altered joint loading (obesity, structural deformity, injury) or systemic factors (age, sex, genetics, proinflammatory cytokines from fat) –> matrix destruction/aberrant repair response/mechanical failure –> joint destruction

Question 11

role of articular cartilage in joint

Answer 11

provide smooth, low-friction surface that allows for normal gliding motion of joint

Question 12

role of subchondral bone, ligaments, meniscus and muscle

Answer 12

absorb load on join

Question 13

role of hyaluronic acid

Answer 13

viscosity and with lubricin, protect joint surface

Question 14

role of collagen fibers

Answer 14

provide tensile strength and restrain hydrophillic proteoglycans that provide resiliency

Question 15

molecular pathogenesis of OA

Answer 15

degradation of proteoglycans by MMPs (MMP13 collagenase)
collagen structure altered
chondrocytes unable to repair

Question 16

pathology of OA

Answer 16

fissuring of cartilage

increased thickening of bone (subchondral)

Question 17

clinical presentation of OA

Answer 17

pain triggered by activity
morning stiffness < 30 min
activity makes pain worse, rest makes it better

Question 18

describe PE for OA

Answer 18

heigh + weight - BMI 
stress pain on ROM
swelling, redness 
knee alignment on standing
joint laxity

Question 19

what joints are involved in OA?

Answer 19

DIP joints 
PIP joints
base of thumb 
neck 
lower back 
big toe 
hips 
knees

Question 20

how to Dx OA?

Answer 20

adults aged 45+ diagnosed clinically if activity related joint pain + morning joint stiffness < 30 min
XR: weight bearing, AP and lateral knee
no MRI

Question 21

what XR changes are seen on OA?

Answer 21

joint space narrowing
osteophyte formation
subchondral sclerosis
bone cysts

Question 22

_____ is a primary modifiable factor for OA

Answer 22

obesity

Question 23

non Rx management of OA

Answer 23

weight loss of 5% BW
physical activity
assistive devices (walking aids, shock absorbing shoes, knee brace)

Question 24

what is GLA:D

Answer 24

education and exercise program for knee and hip OA

Question 25

Rx management of OA

Answer 25

topical NSAIDs for hand/knee (diclofenac)
oral NSAIDs, COX2 inhibitors
acetaminophen (minimal effect)
duloxetine (SNRI)
opioids (tramadol); not recommended
intra-articular corticosteroid injection (short term)

Question 26

PRP is indicated for OA pain relief

Answer 26

F

Question 27

is stem cell transplant approved by Health Canada for treatment of OA?

Answer 27

no

Question 28

indications for joint replacement surgery for OA

Answer 28

patient willingness

negative impact QOL

Question 29

T/F?
OA is part of normal aging and nothing can be done
weight bearing activities make OA worse

Answer 29

F, F

Question 30

is arthroscopic debridement and lavage indicated for OA?

Answer 30

no