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MSK LCRS > Osteoarthritis > Flashcards

Osteoarthritis Flashcards

1
Q

What is osteoarthritis?

A

Chronic, progressive failure of articular cartilage

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2
Q

Which joints are typically affected in osteoarthritis?

A 
Hand (esp pinch grip)
-DIP
-PIP
-First CMC
Spine
Hips 
Knees (weight bearing joints)
Lower limb
-First MTP
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3
Q

What do you call the growth of new bone at joints?

A

Osteophytes

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4
Q

What do you call osteophytes at DIP?

A

Heberden’s nodes

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5
Q

What do you call osteophytes at PIP?

A

Bouchard’s nodes

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6
Q

Describe the symptoms of osteoarthritis

A

Joint pain worse with activity, better at rest

Joint stiffness after immobility e.g. in the morning

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7
Q

What signs can be associated with osteoarthritis?

A 
Joint crepitus (creaking)
Joint instability
Joint enlargement (nodes)
Limitation of motion
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8
Q

Which phenomenon describes stiffness after immobility?

A

Gel phenomenon (gelling)

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9
Q

Describe the radiographic features of osteoarthritis

A

Narrowing of joint space
Hardening of bone under cartilage (subchondral bony sclerosis)
Osteophytes
Subchondral cysts (fluid filled sacks under cartilage)

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10
Q

List two things you see in rheumatoid arthritis, which would not be seen in osteoarthritis

A

Osteopenia

Bony erosions

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11
Q

List two things seen in osteoarthritis but not in rheumatoid arthritis

A

Subchondral sclerosis

Osteophytes

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12
Q

List a radiographic change seen in both rheumatoid arthritis and osteoarthritis and explain the difference

A

Joint space narrowing
In RA this is a secondary damage due to synovitis
In osteoarthritis it is a primary abnormality

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13
Q

Why does osteoarthritis develop?

A

Excessive loading on joints

Abnormal joint components

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14
Q

Describe the cartilage changes seen in osteoarthritis

A

Reduced proteoglycan
Reduced collagen
Chondrocyte changes e.g. apoptosis

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15
Q

Describe the composition of articular cartilage

A

Type 2 collagen
Chondrocytes
Proteoglycan monomers

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16
Q

Give an example of intracellular proteoglycan

A

Serglycin

17
Q

Give an example of cell-surface associated proteoglycan

A

Betablcan

Syndecan

18
Q

Give five examples of proteoglycan secreted into ECM

A 
Aggrecan
Decorin
Fibromodulin
Lumican
Biglycan
19
Q

What are GAGs?

A

Glycosaminoglycans i.e. repeating polymers of disaccharides

20
Q

Give five examples of GAGs

A 
Chondroitin sulphate 
Heparan sulphate
Keratan sulphate
Dermatan sulphate
Heparin
21
Q

What is the major proteoglycan in articular cartilage?

A

Aggrecan

22
Q

What is the ONLY non-sulphated GAG?

A

Hyaluronic acid

23
Q

What is the role of hyaluronic acid?

A

Maintains synovial fluid viscosity

24
Q

How do the chemical properties of GAG enable their weight-bearing properties?

A

Negatively charged GAG attracts water, therefore can expand and shrink as load is placed onto the cartilage

25
Q

What are the monomers in the following GAG: chondroitin sulphate

A

Glucoronic acid

N acetyl galactosamine

26
Q

What are the monomers in the following GAG: keratan sulphate

A

Galactose

N acetyl galactosamine

27
Q

What are the monomers in the following GAG: hyaluronic acid

A

Glucoronic acid

N acetyl galactosamine

28
Q

How do you manage osteoarthritis?

A

Education
Physical therapy (physiotherapy, hydrotherapy)
Occupational therapy
Weight loss where appropriate
Exercise
Analgesia (paracetamol, NSAIDs, intra-articular corticosteroid injection)
Joint replacement

29
Q

What other approaches to osteoarthritis exist, but are NOT approved of in the UK?

A

Glucosamine and chondroitin sulphate supplements

Intra articular injections of hyaluronic acid

30
Q

What could future therapies for osteoarthritis look like?

A

Aggrecanase inhibitors
Cytokine inhibitors
Stimulate the repair of matrix/stop matrix breakdown

31
Q

What type of collagen is in the synovium and in the articular cartilage?

A

Synovium - Type 1

Articular cartilage - Type 2

32
Q

Which joints are commonly spared in osteoarthritis?

A 
MCP
Wrist
Elbow
Shoulder
Ankle 
Tarsal joints

MSK LCRS (8 decks)

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