Osteoarthritis, crystal arthropathies and soft tissue rheumatism Flashcards
What is osteoarthritis?
It is a chronic disease characterised by cartilage loss and accompanying periarticular change
Knees, hands and hips are the most commonly affected joints
What is the pathophysiology of OA?
It’s a metabolically active dynamic process that involves all tissues of the joint
Pathological changes include 1. localised loss of hyaline cartilage 2. remodelling of adjacent bones with osteophytes at joint margins
It is a ‘repair process’ of synovial joints - indicated by combination of tissue loss and new tissue synthesis
*Hence this process could potentially be triggered by a variety of trauma
What are risk factors of OA?
- Genetic factors - 40-60%
- Constitutional factors - Ageing, female, obesity
- Biomechanical factors - Joint injury, reduced muscle strength, recreational/occupational usage, joint laxity, joint mal-alignment/prior joint trauma
Describe the process of OA pathology development using the words: fibrillated cartilage, degenerative cartilage loss, subchondral bone cyst/sclerosis, thickened joint capsule
What are the most often affected joints in OA?
Neck, lower back, hips, knee, base of thumb, finger joints, base of big toe
What are the clinical presentations of OA and what features would be seen upon examination?
Clinical presentation:
Pain worse with joint use
Only short morning stiffness if present at all
Inactivity gelling
Instability
Poor grip in thumb OA
Examination features:
Joint line tenderness.
Crepitus
Joint effusion (eg. Baker’s cyst)
Bony swelling (eg. Heberden’s node, Bouchard’s node, squaring of thumb base)
Deformity
Limitation of motion.
What are features of knee involvement in OA?
Osteophytes, effusions, crepitus and restriction of movement
Genu varus and valgus deformities
Baker’s cysts
What are features of hip involvement in OA?
Pain may be felt in groin or radiating to knee
Pain felt in hip may be radiating from the lower back
Hip movements restricted
What are features of spine involvement in OA?
Cervical – pain and restriction of movement.Occipital headaches may occur.
Osteophytes may impinge on nerve roots
Lumbar – osteophytes can cause spinal stenosis if they encroach on the spinal canal.
Is there a particular laboratory test for OA?
No
What are the X-ray features of OA and what are common pitfalls of X-ray imaging in OA?
Marginal osteophytes.
Joint space narrowing.
Subchondral sclerosis. (increased opacity)
Subchondral cysts. (increased lucency)
Pitfalls-
Insensitive particularly with early disease.
Correlate poorly with disease activity.
Common incidental asymptomatic finding in older people.
How to manage OA?
Non-pharmacologic:
- lifestyle management
- physio/occupational therapy
Pharmacologic:
- analgesia
- local intraarticular steroid injection
Surgical:
- joint replacements
- arthroscopic surgery removing lose body
What is gout?
a potentially disabling and erosive inflammatory arthritis caused by the deposition of monosodium urate crystals into joints and soft tissues
What are risk factors/causes of gout?
What is the pathophysiology of gout?
