Osteoarthritis Lecture - Week 6 Flashcards
What joints are most commonly affected?
- Knees
- Hips
- Hands
What fails with osteoarthritis?
- Articular cartilage failure with secondary components of inflammation
What factors can cause osteoarthritis?
- Genetics
- Metabolic
- Biochemcial
- Biomechanical
Pathology and disease process of OA
- Chondrocytes fail to repair damaged articular cartilage —> unstable matrix
- Progressive cartilage loss, penetrating to subchondral bone —> inflammatory response
- Macrochanges
What is a type III chondral injury considered?
Full thickness
Macro changes of OA
- Progressive cartilage loss
- Subchondral bone reaction/remodeling (sclerosis)
- Osteophyte formation
- Synovial inflammation
What happens with chondrocytes during OA?
- Chondrocytes are injured, metabolism decreases which leads to decreased proteoglycans
- Increased proteases that increase chondrocyte death, decreased ECM production
- Decreased water content - cartilage becomes stiff and brittle
What are the types of OA?
- Primary (idiopathic)
- Secondary
Primary (idiopathic)
- Localized or generalized forms
- Localized OA most commonly affects one joint (hands, hips, spine, knees, feet)
- Generalized OA - three or more joint sites
Secondary OA
- Post traumatic
- Congenital or developmental disorders
- Calcium pyrophosphate dihydrate deposition disease (CPPD)
- Other bone and joint disorder
- Other diseases
Etiology of OA - multi factorial
- Aging
- Obesity
- Joint injury: trauma or repetitive microtrauma
- Chronic low grade joint inflammation
- Heredity/genetics
What are the commonly affected joints of OA?
- Cervical and lumbar spine
- Hand: 1st CMC, PIPs, DIPs
- Hip
- Knee
- Foot: 1st MTP, subtalar joint
Risk factors of OA
- Age (50+)
- Sex (male <45, female >45)
- Family history
- Occupation
- Past injuries, congenital/developmental conditions
- Obesity (loss of mobility exacerbates this)
Physical examination clinical signs of OA
- Crepitus
- Bony enlargement
- Decreased ROM
- Malalignment or deformity
- TTP
- Mild, localized joint effusion
- Impaired muscle performance, balance, gait and transfers
Clinical symptoms of OA
- Local joint disease
- Unilateral/asymmetrical
- More common as older
- Morning pain/stiffness <30 min
- No constitutional symptoms
- Hand joints
- X rays
X ray evaluation of OA
- Reduced joint space
- Osteophyte formation
- Subchondral sclerosis
- Subchondral cysts
Clinical Symptoms of RA
- Systemic autoimmune
- Symmetrical
- Can occur at any age
- Morning pain/stiffness >30 min
- Constitutional symptoms
- Small joints of hand
OA Management
- Pharmacological approaches (oral, topical, intraarticular)
- Physical, psychosocial and mind-body approaches
- Surgical
Self - efficacy and self- management of OA
- Understand condition
- Stress reduction and coping strategies
- Addressing insomnia
- Enhance fitness level
Weight loss management for OA
> 5% weight loss clinical changes -
- Increased efficacy with exercise program
Joint protection and energy conservation strategies for OA
- Monitor activities and stop when discomfort or fatigue develops
- Alternative activities, balance work and rest
- Maintain ROM and strength
- Avoid deforming positions
- Use stronger and larger muscles when possible
Braces and Assistive devices for OA
- When ambulation or joint stability is significantly impacted
- Cane (strong)
- Tibiofemoral brace for unloading (strong)
- Patella (conditional)
Hand assistive devices/brace for OA
- Orthosis for 1st CMC (strong)
- Other fingers (conditional)
What other adaptive equipment for OA
- Raise commode
- Grab bars
- Shower chairs
Exercise for OA
- Mobility - ROM and stretching
- Strengthening - resistance training
- Neuromuscular balance training
- Aerobic conditioning
- Aquatic exercise
- Tai Chi
