Osteoarthritis (OA) Flashcards
Joints that are commonly affected by OA (6)
Cervical spine Lumbosacral spine Hip Knee Hand First metatarsal phalangeal joint (big toe)
Spared joints of OA
wrist,
elbow
ankle
Risk Factors of OA (6)
Aging
Obesity
History of participation in
team sports
History of trauma or overuse of a joint
Heavy occupational work
Misalignment of the pelvis, hip, knee, ankle, or foot can contribute to the development of osteoarthritic changes.
Etiology of OA
Stresses applied to joints (weight bearing)
Degeneration of cartilage
- Excessive loading of healthy joint
- Normal loading of previously injured joint
Chronic disease
What is 8 steps in the patho of OA
Excess pressure on a joint gradually wears away the cartilage surface and the subchondral bone is exposed developing cysts.
Cysts move through the cartilage and destroy along the way
Chondrocytes synthesize a fluid called proteoglycans in an effort to repair the cartilage. This excess fluid causes swelling of the joint.
Localized inflammation (cytokines & mediators) degradation of cartilage.
Osteoblasts are activated →leading to bony spurs → synovial fluid thickening
Proteoglycans and cartilage degeneration can occur for years.
As OA progresses the level of proteoglycans decreases.
Loss of cartilage narrowing of the joint space.
What are osteophytes
small bony projections that develop along the rim of bone adjacent to cartilage loss.
What is an important hallmark of OA
Osteophytes
What are the symptoms of OA (7)
Deep, aching joint pain, occurring especially after exercise or weight-bearing; relieved with rest.
Joint pain during cold weather
Stiffness when arising in the morning
Crepitus of the joint during motion
Joint swelling
Altered gait
Limited range of motion
What are some physical examination findings of OA
Joint deformity
Joint tenderness
Decreased range of motion
Fingers are often involved in OA:
Swellings at the distal interphalangeal joint (DIP), called Herbeden’s nodes, and
Proximal interphalangeal joint (PIP), called Bouchard’s nodes.
3 Treatment Goals of OA
manage pain
Maintain mobility
Minimize disability
What is the focus of management of OA
pain and reduce swelling
OA treatment of mild-moderate pain (3)
Acetaminophen (Tylenol)
Topical capsaicin
NSAIDS (OTC)
OA treatment of moderate to severe pain (5)
NSAIDS (Rx strength)
NSAIDS + Colchicine
Tylenol + Tramadol
Opioids
Steroid injections
How do NSAIDs work
reducing the production of prostaglandins (prostaglandins are what promotes inflammation, pain and fever)
Caution about NSAIDs
Use the lowest effective dose possible
May effect kidney function
Risk for GI bleed
Risk increases drastically with aging
Contraindicated with peptic ulcer disease
Use caution if previous history of GI bleed or current anticoagulant therapy
4 Pharm treaments of OA
Use of medications: NSAIDs; inhibit formation of prostaglandins
Intra-articular injection of glucocorticoids
Dietary supplements such as chondroitin sulfate and glucosamine may help
Artificial joint fluid containing hyaluronic acid, such as Synvisc
2 Dietary Supplements in OA
Glucosamine Sulfate
Naturally occurring compound in body
Also a supplement
Maintains cartilage health
Decreasing amounts with age
Chondroitin Sulfate
Naturally occurring chemical in cartilage
Also a supplement
Might slow cartilage breakdown
Degenerative Disc Disease (DDD) is common cause of what and where does it most often occur
pain
motor weakness
neuropathy
Most often occurs in lumbar or cervical spine
What happens with age in degenerative discs
With age, intervertebral discs dehydrate and vertebral bone become compressed -> impinge on the entering and exiting nerves.
Dysfunction of motor and sensory spinal nerves impedes movement and sensation in the extremities.
May see weakness and paresthesia’s
Signs and symptoms in the LUMBAR of DDD
Pain in the lower back that radiates down the back of the leg (also called “sciatica”)
Pain in the buttocks or thighs
Pain that worsens when sitting, bending, lifting, or twisting
Pain that is minimized when walking, changing positions, or lying down
Numbness, tingling, or weakness in the legs
Foot drop
Signs and symptoms in the CERVIAL of DDD
Chronic neck pain that can radiate to the shoulders and down the arms
Numbness or tingling in the arm or hand
Weakness of the arm or hand
