Osteoarthritis/DJD

Question 1

Most common form of arthritis worldwide

Answer 1

OA

[also leading cause of pain and disability of lower extremity]

Question 2

Risk factors for OA

Answer 2

Aging
Female
Obesity
Occupational risks
Genetics
Trauma/injury

Question 3

OA is characteristically non-inflammatory and without systemic symptoms. The pain is _____ by rest, morning stiffness is brief, and it is oligoarticular

Answer 3

Relieved

Question 4

Pathophysiology of RA involves a combination of multifactorial stressors including the consequences of aging, _______ articular cartilage loss (type II), increasing thickness and _____ of subchondral bone plate, outgrowth of ______ at the joint margin, joint injury, and extracellular matrix degeneration.

Weakness of muscles bridging the joint may also play a role

Answer 4

Hyaline
Sclerosis
Osteophytes

Question 5

Clinical manifestations of OA

Answer 5

Usually weight bearing and frequently used joints

Usually >50 y/o

Insidious onset of intermittent sxs, becomes more persistent and severe over time

Pain worse with activity, relieved by rest

Crepitus, decreased ROM, effusion (cool, not hot)

Heberdens and bouchard nodes

Hip involvement manifests as groin pain

Spondylosis and spinal stenosis

Joint instability

Question 6

What are some potential findings on radiographs of OA?

Answer 6

Asymmetric joint space narrowing

Subchondral sclerosis-thickening

Osteophytes and marginal lipping

Bone cysts

Joint mice (loose particles)

Question 7

Primary OA is the most common type, no identifiable cause is recognized.

What are the most common joints affected in this type?

Answer 7

DIP
PIP
1st carpometacarpal joint
Hip and knee
Cervical spine
Lumbar spine

Question 8

Type of osteoarthritis that affects DIP and PIP joints but is more painful than typical hand OA; more common in women and shows central erosions on radiographs with “seagull” apearance in finger joints

Answer 8

Erosive OA (inflammatory OA)

[note that central erosions are erosive OA, while marginal erosions would indicate RA]

Question 9

Secondary causes of OA

Answer 9

Trauma
Joint infection
Surgical repair (ACL, meniscus, etc)
Congenital joints
Metabolic
Endocrine

Question 10

What joints are typically affected in OA secondary to hemochromatosis?

Answer 10

2nd/3rd MCP joints

Wrist

Question 11

What joints are typically affected in OA secondary to pseudogout?

Answer 11

MCP
Wrist
Knees
Hips
Shoulders

Question 12

What joints are typically affected in OA secondary to hyperparathyroidism?

Answer 12

Wrist

MCP

Question 13

Management of OA

Answer 13

There is no cure or agents approved to prevent/delay/remit the structural progression of OA

Management of pain/disability are key — requires non-pharmacologic and pharmacologic modalities

Non-pharm = education, joint protection, weight loss, proper footwear, isometric-aerobic exercise, strength training, cane

Pharm = NSAIDs, duloxetine, tramadol, acetaminophen, topical capsaicin, steroid injections, total joint replacement surgery