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AAA-MEDICINE (GI) > OSTEOARTHRITIS & GOUT > Flashcards

OSTEOARTHRITIS & GOUT Flashcards

1
Q

What is the most common type of arthritis?

A

Osteoarthritis (OA)

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2
Q

Which age group is most commonly affected by osteoarthritis?

A

Elderly (60 years and above)

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3
Q

Which joints are most commonly affected in osteoarthritis?

A

Cervical and lumbosacral spine. hip. knee. 1st metatarsophalangeal joint (MTP)

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4
Q

Which joints are typically spared in osteoarthritis?

A

Wrist. elbow. ankle

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5
Q

What is the characteristic cartilage loss in osteoarthritis?

A

Focal and non-uniform hyaline articular cartilage loss

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6
Q

What bony changes are seen in osteoarthritis?

A

Sclerosis of the subchondral bony plate and outgrowth of osteophytes at the joint margin

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7
Q

What type of synovitis is seen in osteoarthritis?

A

Mild synovitis

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8
Q

What muscle changes contribute to joint failure in osteoarthritis?

A

Weakness of muscles bridging the joint

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9
Q

What is the primary initial event leading to osteoarthritis?

A

Joint injury with failure of protective mechanisms

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10
Q

Which nodes are associated with osteoarthritis in the hands?

A

Heberden’s nodes (DIP) and Bouchard’s nodes (PIP)

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11
Q

Which gender is more commonly affected by osteoarthritis?

A

Women

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12
Q

What is the most potent risk factor for osteoarthritis?

A

Age

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13
Q

Why are women more prone to osteoarthritis after 60 years?

A

Loss of hormone protection

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14
Q

Which genetic polymorphism influences joint shape in osteoarthritis?

A

GDF5 polymorphism

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15
Q

Which joints have the highest heritability for osteoarthritis?

A

Hand and hip joints (50%). Knee joints (30%)

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16
Q

What joint environmental factors increase the risk for osteoarthritis?

A

Congenital dysplasia. Legg-Perthes disease. slipped capital femoral epiphysis. acetabular dysplasia

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17
Q

What major joint injuries predispose to osteoarthritis?

A

Ligament tear. joint malalignment (varus/valgus deformity)

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18
Q

What loading factor increases the risk for osteoarthritis?

A

Obesity

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19
Q

Which occupation increases the risk of hip osteoarthritis?

A

Farmers

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20
Q

Which occupation increases the risk of knee and spine osteoarthritis?

A

Miners

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21
Q

Which occupations involve high risk of knee osteoarthritis?

A

Jobs requiring knee bending and heavy lifting

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22
Q

Which sports are exceptions and do not increase osteoarthritis risk despite high impact?

A

Jogging. walking

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23
Q

What is the hallmark pathology of osteoarthritis on X-ray?

A

Osteophytes

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24
Q

What is the role of chondrocytes in osteoarthritis?

A

They produce matrix molecules (collagen type 2

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25
Q

What growth factor stimulates bone invasion in osteoarthritis?

A

Vascular Endothelial Growth Factor (VEGF)

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26
Q

Which inflammatory mediators are involved in osteoarthritis pathogenesis?

A

Interleukins (IL). Tumor Necrosis Factor (TNF). Transforming Growth Factor (TGF)

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27
Q

What is the primary complaint of patients with osteoarthritis?

A

Pain

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28
Q

When does pain occur in early-stage osteoarthritis?

A

During or after joint use and gradually resolves

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29
Q

When does pain become continuous in osteoarthritis?

A

Later stages with loss of cartilage integrity and neurovascular invasion

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30
Q

How long does morning stiffness last in osteoarthritis?

A

Less than 30 minutes

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31
Q

How does morning stiffness in osteoarthritis differ from rheumatoid arthritis?

A

Osteoarthritis: <30 minutes; Rheumatoid arthritis: >1 hour

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32
Q

What mechanical symptoms are seen in osteoarthritis?

A

Knee buckling. catching. locking

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33
Q

What is the expected white blood cell (WBC) count in synovial fluid of osteoarthritis patients?

A

<1000 WBC/uL

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34
Q

Which imaging modality is not routinely used but reveals the extent of osteoarthritis pathology?

A

MRI

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35
Q

What are the goals of osteoarthritis treatment?

A

Alleviate pain and minimize loss of physical function

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36
Q

What is the mainstay non-pharmacologic management of osteoarthritis?

A

Alter load across the painful joint and improve joint protector function

37
Q

What exercise is recommended for obese women with knee osteoarthritis?

A

Swimming (to offload the joint)

38
Q

What assistive device helps redistribute joint load in osteoarthritis?

A

Brace. splint. cane or crutch

39
Q

What medication is first-line for osteoarthritis pain management?

A

Acetaminophen

40
Q

Which class of drugs is used when acetaminophen is insufficient for osteoarthritis pain?

A

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

41
Q

What medication is used for severe osteoarthritis pain?

42
Q

Which SNRI can be used for osteoarthritis pain and depression?

A

Duloxetine

43
Q

What intra-articular injection provides lubrication in osteoarthritis?

A

Hyaluronic acid

44
Q

What intra-articular injection is used to reduce inflammation in osteoarthritis?

A

Glucocorticoids

45
Q

What dietary supplements may help improve osteoarthritis symptoms?

A

Glucosamine

46
Q

What surgical procedures are considered for severe osteoarthritis?

A

Arthroscopic debridement. arthroplasty. chondrocyte transplantation

47
Q

What bony abnormality on X-ray is a hallmark of osteoarthritis?

A

Osteophytes

48
Q

What is the function of joint protectors like muscles and tendons?

A

Absorb and distribute joint impact forces

49
Q

What type of joint injury leads to focal stress and osteoarthritis?

A

Joint malalignment (varus/valgus)

50
Q

What is the primary pathology in osteoarthritis cartilage?

A

Proteoglycan depletion and collagen matrix damage

51
Q

What stimulates osteoblast and osteoclast activation in osteoarthritis?

A

Growth factors and cytokines

52
Q

Which imaging modality correlates poorly with osteoarthritis symptoms?

53
Q

What drug class should be avoided in severe osteoarthritis unless necessary?

54
Q

Which joint condition in osteoarthritis is associated with cartilage ulceration?

A

Advanced osteoarthritis

55
Q

What are the two most affected hand joints in osteoarthritis?

A

Distal interphalangeal joint (DIP). Proximal interphalangeal joint (PIP)

56
Q

What non-pharmacologic intervention corrects malalignment in osteoarthritis?

A

Bracing. splinting or corrective surgery

57
Q

What is the main difference in pathogenesis between rheumatoid arthritis and osteoarthritis?

A

Osteoarthritis: cartilage degradation; Rheumatoid arthritis: autoimmune inflammation

58
Q

Which joint movement stimulates mechanoreceptor sensory afferents in osteoarthritis?

A

Joint movement with load-bearing

59
Q

Why is proprioception impaired in osteoarthritis?

A

Joint malalignment and muscle weakness

60
Q

What physical therapy goal improves osteoarthritis prognosis?

A

Strengthening muscles that bridge the joint

61
Q

What is the role of acetaminophen in osteoarthritis management?

A

First-line pain relief

62
Q

Which medication class can slow down the progression of osteoarthritis?

A

None; current treatments focus on symptom management

63
Q

What is the most common crystal arthropathy?

64
Q

What is the main crystal deposit in gout?

A

Monosodium urate

65
Q

What is the classic presentation of acute gout?

A

Sudden onset of severe pain. redness and swelling in a joint. typically the first metatarsophalangeal joint (big toe)

66
Q

Which joint is most commonly affected in gout?

A

First metatarsophalangeal joint (big toe)

67
Q

What is the primary cause of hyperuricemia in gout?

A

Underexcretion of uric acid

68
Q

What enzyme deficiency can lead to increased uric acid production?

A

Hypoxanthine-guanine phosphoribosyltransferase (HGPRT) deficiency

69
Q

What condition is associated with HGPRT deficiency?

A

Lesch-Nyhan syndrome

70
Q

What are common triggers for acute gout attacks?

71
Q

What are examples of high-purine foods that can trigger gout?

A

Red meat. seafood. alcohol (especially beer)

72
Q

What is the characteristic finding on joint aspiration in gout?

A

Negatively birefringent needle-shaped crystals

73
Q

What is the serum uric acid level usually like during an acute gout attack?

A

Can be normal or elevated

74
Q

What is the first-line treatment for acute gout?

A

Nonsteroidal anti-inflammatory drugs (NSAIDs)

75
Q

What are alternative treatments for acute gout if NSAIDs are contraindicated?

A

Colchicine or corticosteroids

76
Q

What is the mechanism of action of colchicine?

A

Inhibits microtubule polymerization. reducing neutrophil migration and inflammation

77
Q

What lifestyle modifications are recommended for gout prevention?

A

Weight loss. low-purine diet. increased hydration. reduced alcohol intake

78
Q

What medication is used for long-term urate-lowering therapy in gout?

A

Allopurinol or febuxostat

79
Q

What is the mechanism of action of allopurinol?

A

Inhibits xanthine oxidase. reducing uric acid production

80
Q

What is the mechanism of action of febuxostat?

A

Selective xanthine oxidase inhibitor. reducing uric acid production

81
Q

What is the mechanism of action of probenecid?

A

Increases renal excretion of uric acid

82
Q

What is the most common adverse effect of allopurinol?

A

Hypersensitivity reaction (rash. Stevens-Johnson syndrome)

83
Q

What condition presents similarly to gout but with calcium pyrophosphate crystals?

A

Pseudogout (calcium pyrophosphate deposition disease)

84
Q

What is the characteristic finding on joint aspiration in pseudogout?

A

Positively birefringent. rhomboid-shaped crystals

85
Q

Which joints are commonly affected in pseudogout?

86
Q

What is the first-line treatment for pseudogout?

A

Nonsteroidal anti-inflammatory drugs (NSAIDs)

87
Q

What radiographic finding is associated with pseudogout?

A

Chondrocalcinosis (calcification of cartilage)

88
Q

What is the main risk factor for pseudogout?

A

Aging. hyperparathyroidism. hemochromatosis

89
Q

Which crystal deposition disease is associated with hemochromatosis?

A

Pseudogout (calcium pyrophosphate deposition disease)

AAA-MEDICINE (GI) (5 decks)

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