Osteoarthritis

Question 1

which sex is affected more by OA?

which locations are most likely to lead to disability? Which location is most commonly affected by OA?

Answer 1

women are more affected.

• knee OA most likely to lead to disability
• hand OA most common disease

3/4 of people who have arthritis have OA

Question 2

function of articular cartilage

Answer 2

• provides a smooth, low-friction surface that allows for the normal gliding motion of the joint.

Question 3

which components absorbs load on the joint

Answer 3

subchondral bone, ligaments, meniscus and muscle

Question 4

function of hyaluronic acid

Answer 4

provides viscosity and in the presence of a large mucinous protein caleld lubricin, protects the joint surface including the superficial zone chondrocytes from shear stresses

Question 5

function of collagen fibers

Answer 5

provides the tensile strength and forms a network that restrains the very hydrophilic proteoglycans that provide resiliency

Question 7

Pathogenesis of osteoarthritis

Answer 7

MMP proteases (specifically MMP13 collagenase) degrades proteoglycans and causes chondrocytes to not be able to repair.

cause fissuring, cartilage losses, subchondral bone thickening (causes boney nodule/protrusions)

Question 8

Xray changes in OA

Answer 8

Joint space narrowing

bone cysts

osteophyteformation– new bone growth,

subchondral sclerosis

Question 9

What x ray components would be indicative of osteoarthritis

Question 10

Clinical presentation of OA

Answer 10

Pain is triggered by activity initially (sports, repetitive activity), and constant aching pain with intermittent bouts of sharp and severe pain.

• MORNING STIFFNESS lasting LESS than 30 minutes (if its more, it’s probably an inflammatory issue like RA)
• activity makes pain worse and rest makes it better.

Question 11

What parts of the PE would indicate OA?

Answer 11

• overweight/BMI high
• active joints like hands and knees are “swollen’ with bony prominences
• knees may be malaligned (knock kneed valgus), there might be some joint laxity

Question 12

A person with knock knees has __ position of knees

Answer 12

Valgus

Question 13

Common joints that are affected by OA

Answer 13

Small bones of the hand, knees very common, a little bit of back and cervical area and some acetabulum/hip joint

Question 14

How can you diagnose OA without an X-RAY?

Answer 14

Adults aged 45+ years are diagnosed with osteoarthritis clinically without an X-ray if they have activity-related joint pain and morning joint stiffness <30 minutes

• MRI not indicated

Question 15

First, second, and third line therapies for OA

Answer 15

1. Weight management, education, therapeutic exercise
2. NSAIDs, opioids, non-prescription drugs, maybe physiotherapy
3. Surgery

Question 16

Types of assistive devices that may help people struggling with OA

Answer 16

Walking aids (cane, walker)

shock absorbing shoes

knee brace

Question 17

Types of NSAIDS that can be used for OA

Answer 17

1. Topical NSAIDS : knee OA diclofenac
2. Oral NSAIDS and COX-2 inhibitors
3. Acetaminophen (not an NSAID) but can provide a bit of pain relief and improvement in function for hip/knee

Question 18

specific SNRI that can help with OA

Answer 18

Duloxetine

Question 19

Types of opioids used for OA

Answer 19

Tramadol

• other opioids have a small effect on pain of physical function with more side effects

Question 20

T/F neuropathic pain modulators like gabapentin can help with OA management in hip, knee, and hand

Answer 20

False.capsaicin, glucosamine, chondroitin, and gabapentin are not recommended

Question 21

Overall, what’s the best therapy for OA

Answer 21

GLA:D. Exercise and education program for OA. GLA:D improved pain intensity and quality of life. Fewer patients took painkillers following the treatment.

Question 22

T/F OA is a part of normal aging and nothing can be done

Answer 22

False.

Also, weight bearing activities do not make OA worse and you still should exercise if you have pain. (To an extent– do recommended GLA:D and physiotherapy exercises)

Question 23

Inflammatory arthritis like RA was defined by a higher number of leukocytes in the affected joint tissues and synovial fluid. This was referred to as cellular inflammation.

• is cellular inflammation prominent in OA too?

Answer 23

It is not. Cellular inflammation is not prominent in OA, where the number of leukocytes in the joint fluid is normally low. there IS a presence of pro inflammatory mediators (cytokines and chemokines) that are part of an innate immune response to joint injury

Question 24

T/F: Health Canada has approved the use of STEM cell transplant for treatment of OA knee

Answer 24

False.