Osteoarthritis - Flusser

Question 1

What are the inflammatory mediators of osteoarthritis?

Answer 1

IL-1

TNF-alpha

Other cytokines

Decreased synthesis of TGF-beta and IGF

Question 2

What are the main symptoms and signs of osteoarthritis?

Answer 2

Use related pain (improves with rest)

Stiffness after inactivity and in the mornings (but less than 30 minutes)

Crepitus

No joint ankylosis (fusion)—versus rheumatoid arthritis, which causes joint ankylosis
Mechanical wear and tear → thinned, fibrillated articular cartilage
Subchondral cysts
Osteophytes (reactive bone formation) at joint margins irritate synovial lining → pain
Eventually bone rubs on bone → dense, sclerotic bone; pain

Question 3

What joints are most affected in osteoarthritis?

Answer 3

DIP (distal interphalageal joints- uncommon in RA)

PIP (proximal interphalangeal joints, more common in RA)

Hips

Knees

Spine

Foot (not ankle)

Question 4

What are the pharmacological therapies in osteoarthritis and what is their mechanism of action?

Answer 4

Diacerein: IL-1 inhibitor, analgesic, antipyretic
-Some disease modification but not a huge effect

Glucosamine: glycosaminoglycan analogue

• some disease modification but same as placebo
• In moderate to severe osteoarthritis significant