Pathophysiology of Osteoarthritis

Question 1

What is the definition of Osteoarthritis?

Answer 1

A heterogenous group of conditions that lead to joint symptoms and signs which are associated with defective integrity of articular cartilage, in addition to related changes in the underlying bones at the joint margins

Question 2

In Osteoarthritis what can be observed?

Answer 2

1. Cartilage is lost
2. Imbalance of degradation and repair
3. All joints are NOT affected equally

Question 3

What is the most common form of arthritis?

Answer 3

OA

Question 4

What is a major cause of long term disability?

Answer 4

QA

Question 5

What are the systemic factors that are affected by OA?

Answer 5

Makes cartilage more vulnerable to repeated injury, it is less capable of repair

Question 6

What are factors influencing susceptibility to OA?

Answer 6

1. Age
2. Sex
3. Genetics
4. Obesity
5. Occupation
6. Sports

Question 7

Prevalence and Severity of disease increases with what?

Answer 7

Age

Question 8

What are the possible mechanisms of increased OA with aging?

Answer 8

1. Reduced repair
2. Ligament laxity
3. Muscle weakness
4. Neurologic slowing
5. Reduced non-calcified

Question 9

Which sex has a higher risk of OA age below 45?

Answer 9

Males

Question 10

Which sex has a higher risk of OA age above 55?

Answer 10

Female

Question 11

Which sex has a higher risk of OA in the hands and knees?

Answer 11

Women

Question 12

If your parents had OA, what is your risk for OA?

Answer 12

HIGHER and EARLIER

Question 13

Is obesity a modifiable risk factor?

Answer 13

YES

Question 14

With increased weight what increases?

Answer 14

Increased knee OA and increased risk

Question 15

How is occupation a risk factor of OA?

Answer 15

Repetitive trauma, overuse, and overloading

Question 16

What types of sports lead to OA?

Answer 16

Sport injuries, high intensity, direct impact, and repetitive impact

Question 17

Does recreational running lead to OA?

Answer 17

Not really, unless they are already predisposed to OA where running could add additional stress

Question 18

What is Primary OA?

Answer 18

Idiopathic

Question 19

What is Secondary OA?

Answer 19

Identifiable cause Present

Question 20

What is Generalized OA?

Answer 20

At least 3 local sites involved

Question 21

What are the local sites?

Answer 21

1. Hands
2. Feet
3. Knees
4. Hips
5. Spine
6. Shoulder

Question 22

What is Localized OA?

Answer 22

1 site

Question 23

What is DISH?

Answer 23

Diffuse Idiopathic Skeletal Hyperostosis: large, numerous osteophytes, affect the spine

Question 24

What is Normal Articular Cartilage?

Answer 24

Thin, vascular, neural covering of bone in joints

Question 25

What is Normal Articular Cartilage composed of?

Answer 25

1. Water 2. Type II Collagen 3. Proteoglycans

Question 26

What does collagen do?

Answer 26

Provide structure, strength, and shape

Question 27

What are proteoglycans?

Answer 27

Protein cores with linked disaccharides

Question 28

What do glycosaminoglycans do?

Answer 28

Draw in water, restricted by collagen

Question 29

What does cartilage do?

Answer 29

Provide resilience, elasticity, and lubrication to joint

Question 30

What do chrondrocytes do?

Answer 30

Control synthesis and degradation

Question 31

What is obtained from synovial fluid?

Answer 31

Nutrients

Question 32

Eventually, underlying bone is revealed leading to reactive bone changes, causing what pathologic changes?

Answer 32

1. Irregular thickening, sclerosis and remodeling of bone 2. Cysts in bone underlying cartilage 3. Marginal osteophyte formation

Question 33

What is seen in EARLY OA?

Answer 33

Decrease extracellular matrix, Increase water

Question 34

What is changes are seen in OA?

Answer 34

DECREASE chondrocytes and proteoglycan

Question 35

What happens to the degraded proteoglycans?

Answer 35

They are released into synovial fluid causing inflammatory response

Question 36

New bone growth at joint margins is classified as what?

Answer 36

Osteophytes

Question 37

What causes would classify Secondary OA?

Answer 37

1. Trauma 2. Abnormal joint stresses or mechanics 3. Genetic abnormalities of the cartilage 4. Metabolic or endocrine abnormalities 5. Crystal deposition 6. Inflammatory conditions of joints 7. Avascular necrosis 8. Neuropathic

Question 38

What are the clinical symptoms of OA?

Answer 38

1. Joint pain 2. Stiffness with inactivity

Question 39

What is joint pain described as in OA?

Answer 39

Use related, later also at rest or night pain

Question 40

What is stiffness with inactivity described as in OA?

Answer 40

Gelling, short duration

Question 41

What joints are at the Highest Risk of OA?

Answer 41

1. Distal and Proximal Interphalangeal Joints 2. 1st Carpometacarpal Joint

Question 42

What are the clinical signs of OA?

Answer 42

1. Enlargement and Deformity 2. Coarse crepitus 3. No clinical signs of inflammation 4. Restricted painful movements decreased range of motion 5. Instability

Question 43

What are the forms of enlargement and deformity?

Answer 43

1. Heberden Nodes DIP Nodules 2. Bouchard Nodes PIP Nodules

Question 44

What is a main X-Ray finding in OA?

Answer 44

Joint space narrowing due to cartilage loss