Osteoarthritis and Treatment Flashcards
What is osteoarthritis (OA)?
A condition characterised by the progressive loss of articular cartilage and remodelling of the underlying bone, usually due to wear
Why is the occurence of osteoarthritis increasing in this world?
Greater ageing population, increasing obesity rates
What type of collagen begins to wear in OA?
What is the primary pathology of OA? What is a secondary component?
What are cytokines?
The type II collagen in the hyaline cartilage
Wear and tear primarily. Afterwards cytokines also released / involved, which causes a synovial reaction = inflammatory component
cyto = cell, kine = something that moves out of the cell = substances secreted by the cells of the immune system
What factors can cause joints to wear quicker? (hence increasing chance of OA onset at an earlier age)
Factors that increase the friction between the joints - obesity, injuries, trauma, playing sport - if there is less cartilage to absorb the shock in the joint, that increases the risk of osteoarthritis
Inflammatory diseases can increase risk of osteoarthritis in some joints
What is the difference between Type I and Type II collagen?
What is a clever way to remember it?
Type I - found in bone + fibrocartilage menisci
Type II = cartilage + fibrocartilage articular
Type one = bone
Type two = cartwolage
What occurs in osteoarthritis (OA)? What are the 3 top symptoms involving the bone?
Progressive loss of articular cartilage and remodelling of underlying bone due to response of chondrocytes in articular cartilage and the inflammatory cells in the surrounding tissues
Articular cartilage destruction due to release of enzymes that break down collagen and proteoglycans
Exposure of underlying bone then leads to subchondral sclerosis (thickening of the bone in joints), osteophytes (bone spurs) and subchondral bone cysts (sacs filled with fluid that form inside of joints)
Progressive joint space loss
What are some signs and symptoms of osteoarthritis?
Deformities: varus = feet going towards the midline, knees going away from the midline, valgus (opposite)
Joint pain
Stiffness / lack of mobility
Worsen at the end of the day with activity
Gradual onset
How to manage OA?
What are the conservative, medical and operative management strategies?
Physiotherapy, painkillers, steroids (anti-inflammatory medications), crutch / stick, surgery - hip replacement; other surgical measures
Conservative: education, weight loss, hot and cold therapy, physiotherapy
Medical: simple analgesia, topical NSAIDS, injections - steroid or local anaesthetics
Operative: realignment, arthrodesis (fusion e.g. big toe), anthroplasty (replacement e.g. hip or knee), total joint replacement, unicompartmental (damaged parts replaced)
What are the differences between OA and RA (rheumatoid arthritis)?
RA = primarily inflammation of the joints; OA = primarily wear and tear (but can progress onto inflammation)
RA = autoantibodies involved; OA = no antibodies involved
RA = because it’s a disease of the blood due to antibodies, it is usually symmetrical; OA = can be unilaeral e.g. if trauma / injury was only to one side
RA = pain, stiffness and swelling in the morning; OA = more they use it, more wear and tear, therefore pain worse towards the end of the day
RA = small joints; OA = large weight-bearing joints
RA = joint erosion; OA = joint cysts that are subchondral
What is the role of meniscus?
Why can the loss / removal of a meniscus increase onset of OA?
Made of collagen - shock absorbers and weight / pressure distributors (as bottom of the femur is flat, but the top of the tibia is round)
Loss of a shock absorber = contact pressure between bones is greater
What factors in the patient history are important to note and why?
Increasing joint pain = more intensive management measures need ot be put in place
If low impact / small injury makes pain a lot worse
Difficulty carrying out daily tasks = loss of independence
Previous history of injury = affects management plan / highlights causes
Age of the patient = eligible for surgery, walking stick / crutch, social support etc.
In a total menisectomy, what is the increase in pressure at the joint?
800%
What diagnostic test(s) would be ordered on a patient with OA?
Weight bearing X-rays
Stress the joint of the lower limb by standing when doing an x-ray - as it shows the narrowing of the joint space (unlike laying flat for an MRI or something)
To look at the ligaments more closely, then do an MRI scan
What are the key findings seen on an x-ray image / screening of an OA patient?
Joint space narrowing
Osteophyte formation = bony projections associated with degeneration of cartilage
Subchondral bone cysts = fluid filled space inside a joint below the cartilage surface
Subchondral sclerosis = hardening of the bone just below the cartilage surface
What is an example of a sequence of events that may eventually lead to development of OA in the knees?
Injury - meniscal tear - surgery / removal - increased pressure in the knee - articular cartilage wear - loss of joint space - osteoarthritis
Put the following treatments in the corresponding list:
What is hallux valgus?
What are the operative and non-operative management strategies? Fill in the flowchart:
Medical term for bunion = deformity of the big toe
