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MSK-Derm by Minnie > SM 225a - Osteoarthritis > Flashcards

SM 225a - Osteoarthritis Flashcards

1
Q

What are the risk factors for developing osteoarthritis?

A
  • Older age
  • Female gender
  • Genetic factors
  • Excess body weight (knee)
  • Certain occupations
  • Elite athletic activity
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2
Q

What laboratory studies can help to diagnose osteoarthritis?

A

Synovial fluid analysis

  • Would reveal non-inflammatory characteristics
    • <2000 WBCs
    • Clear fluid
    • may show CPPD crystals
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3
Q

Does severe inflammation make a diagnosis of osteoarthritis more or less likely?

A

Less likely

May see mild inflammation in osteoarthritis, but moderate to sever inflammation raises suspicion for other conditions (septic arthritis, crystal process, or both)

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4
Q

What are the characteristics of generalized osteoarthritis?

A
  • Affects the hands and at least 1 large joint
  • Familial predisposition
  • More common in women
  • Onset in middle age
  • Polyarticular finger interphalangeal joints affected
  • Symptoms persist for years, but settle down
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5
Q

What is the role of type II collagen in cartilagee?

A

Provides tensile strength

The tight weave of these fibrils contains aggrecan moleules

  • Aggrecan = proteoglycan + hyaluronic acid
    • Serves to retain water to give cartilage compressive stiffness
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6
Q

What is the of MRI in the management of osteoarthritis?

A

Small role in patient care; only used in specific situations

  • Arthroscopy under consideration
  • Possible avascular necrosis
  • Unusual pattern or course
    • Ex: rapidly progressive
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7
Q

Which cells phagocytize released (degraded) cartilage fragments?

What are the consequences?

A

Synovial cells

  • This can lead ot synovial inflammation due to the release of matrix metaloproteinases (MMPs) and cytokines
  • This leads to further alterations in the ECM and active chondrocytes
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8
Q

Which phase of osteoarthritis is characterized by:

  • Edema of the extracellular matrix
  • Microcracks appear on the cartilage surface
  • Focal loss of chondrocytes
    • Alternate with areas of proliferation
A

Phase 1

  • Phase 2
    • ​Deeper microcracks; vertical clefts form
    • Clusters of chondrocytes appear around the clefts and at the surface
  • Phase 3
    • ​Fissures -> cartilage fragments break off
      • ​Create osteocartilaginous loose bodies
    • Subchondral bone is exposed
    • Subchondral cysts form
    • Mild synovitis
    • Subchondral bone sclerosis
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9
Q

What are the protective measures in normal joints that protect against osteoarthritis?

A
  • The joint capsule and ligaments prevent excessive motion
    • Mechanoreceptors provide feedback if these restraints are stressed
  • Muscles and tendons decelerate the joint before impact occurs to distribute the load
  • Synovial fluid reduces the friction between cartilage surfaces
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10
Q

What are the key physical exam findings of osteoarthritis?

A
  • Bony enlargement
  • Limited motion (flexion and extension)
  • Crepitus
  • Malalignment
  • Mild inflammation
    • If severe, consider infection or crystal process
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11
Q

In osteoarthritis, which structures of the joint show pathologic changes?

A

All joint structures

  • Hyaline articular cartilage
  • Subchondral bony plate
  • Bone
  • Muscles

This leads to joint failure

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12
Q

What is the role of aggrecan in healthy cartilage?

A

Aggrecan = proteoglycan macromolecules + hyaluronic acid

  • Electrostatic repulsion of negative charges and retained water give cartilage its compressive stiffness
  • Aggrecan is contained in tightly woven type II collagen fibrils
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13
Q

What pharmacologic treatments are used to manage osteoarthritis?

A
  • Non-narcotic analgesic
    • Acetaminophen
  • Anti-inflammatory
    • NSAID
    • Selective COX-2 inhibitor
  • Local
    • Intra-articular
    • Corticosteroid
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14
Q

What changes occur in cartilage as a result of osteoarthritis?

A
  • Aggrecan is gradually depleted
    • Aggrecan = proteoglycan + hyaluronic acid; helps the joint resist compressive forces
  • Tighly woven collagen matrix unfurls; type II collagen is lost
  • Water content in cartilage increases initially
    • Proteoglycans are lost, so water replaces
  • Cartilage is vulneraple without the compressive stiffness usually maintained by aggrecan
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15
Q

When should you consider secondary osteoarthritis vs. primary arthritis?

A

Likely secondary if it is in a site that is not commonly affected by primary

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16
Q

What are the treatment goals for osteoarthritis?

A
  • Relieve symptoms
  • Maintain or improve function
  • Limit disability
  • Avoid drug toxicity
  • Modify disease course
    • Via lifestyle modification

There are no disease-modifying agents for OA

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17
Q

Which phase of osteoarthritis is characterized by:

  • ​Fissures -> cartilage fragments break off
    • ​Create osteocartilaginous loose bodies
  • Subchondral bone is exposed
  • Subchondral cysts form
  • Mild synovitis
  • Subchondral bone sclerosis
A

Phase 3

  • Phase 1
    • Edema of the extracellular matrix
    • Microcracks appear on the cartilage surface
    • Focal loss of chondrocytes
      • Alternate with areas of proliferation
  • Phase 2
    • Deeper microcracks; vertical clefts form
    • Clusters of chondrocytes appear around the clefts and at the surface
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18
Q

What are the major constituents of healthy joint cartilage?

A
  • Thin rim of tissue at the ends of opposing bones
  • Compressible stiffness = impact-absorption
  • Made from:
    • Collagen Type II Fibrils
    • Aggrecan
    • ECM proteins
    • Chondrocytes
19
Q

Describe the pathologic changes that occur in osteoarthritis

  • Cartilage:
  • Bone:
  • Synovium:
  • Capusule:
A
  • Cartilage:
    • ​Initial surface fibrillation and irregularity
    • -> Full thickness defect extending to the bone
    • -> Bare bone
  • Bone:
    • ​Thickening and stiffness of the subchondral plate
    • Osteophytes form at joint margins
  • Synovium:
    • ​May become edematous and inflamed
  • Capusule:
    • ​Edema
    • Eventually fibrosis
20
Q

Which imaging method is most valuable for assessing the prognosis of osteoarthritis

A

X-ray

MRI is usually only used for research or in special circumstances

21
Q

What are the characteristics of osteoarthritis?

A
  • Hyaline articular cartilage loss that is initially focal
  • Thickening and sclerosis of subchondral bony plates
  • Ougrowth of osteophytes at joint margins
  • Articular capsule stretching
  • Mild synovitis
  • Weakness of the muscles bridging the joint
22
Q

People with arthritis in the hip will most likely experience pain in which areas?

Which movements will be difficult for these patients?

A

Groin, deep posterolateral

Pain/difficulty getting in and out of the car, putting on shoes and socks

23
Q

Is there an increased risk in developing osteoarthritis physical activity?

A
  • Recreational activity: no increased risk
  • Non-elite athletics: no increaesd risk
  • Elite athletics: increaed risk
24
Q

What are TIMPs?

What happens if the TIMP levels in a joint are low?

A

TIMP = tissue inhibitors of MMPs

If TIMP levels in a joint are low, MMPs will run rampant; cartilage will be degraded

25
What is the role of surgical therapy in the management of osteoarthritis?
* Advanced osteoarthritis * Total joint replacement is effective * Mild/moderate osteoarthritis (if no response to conservative therapy) * Arthroscopy may fix mechanical symptoms (locking), but may not improve outcome * Role of surgery is less clear
26
Describe the pathologic changes that occur in phase 3 of osteoarthritis
* ​Fissures -\> **cartilage fragments break off** * ​Create osteocartilaginous loose bodies * Subchondral **bone is exposed** * Subchondral **cysts** form * Mild synovitis * **Subchondral bone sclerosis**
27
Describe the pathologic changes that occur in phase 2 of osteoarthritis
* Deeper microcracks; **vertical clefts form** * **Clusters of chondrocytes** appear around the clefts and at the surface
28
Which part of the foot is most commonly affected by osteoarthritis?
1st MTP joint
29
What symptoms would make you suspicious for osteoarthritis?
* Aching * If early: * Pain increases with use and is relieved by rest * If advanced: * Pain at rest and with use * Night pain, not easily relieved * Interrupted sleep = increased pain experience * Morning stiffness (lasts \<30 min) * Stiffness after inactivity * Mild swelling * Less pronounced, less persistent than RA Note: the correlation between damage and pain is strong with hip OA and weak with hand OA
30
What features help you distinguish osteoarthritis from other types of arthritis?
Osteoarthritis is... * Gradual onset * Usually only one or a few joints affected at a time * Progression is slow * Strong association with older age * Men \> 40 * Women perimenopausal or older
31
What is the role of intra-articular hyaluronic acid in the treatment of osteoarthritis?
Data is contradictory - no clear indication
32
Which phase of osteoarthritis is characterized by: * Deeper microcracks; **vertical clefts form** * **Clusters of chondrocytes** appear around the clefts and at the surface
Phase 2 * *Phase 1* * *Edema of the extracellular matrix* * *Microcracks appear on the cartilage surface* * *Focal loss of chondrocytes* * *Alternate with areas of proliferation* * *Phase 3* * *​Fissures -\> cartilage fragments break off* * *​Create osteocartilaginous loose bodies* * *Subchondral bone is exposed* * *Subchondral cysts form* * *Mild synovitis* * *Subchondral bone sclerosis*
33
Why does incidence of osteoarthritis increase with age?
Age-related decline in... * Neuromuscular joint protective mechanism * Biomechanical properties of cartilage matrix * Ability to rebound from injury * Regenerative potential of joint tissue
34
What factors are associated with progression of knee osteoarthritis?
* Excess body weight * Varus or valgus alignment * Meniscal damage
35
What is the essential element of the pathophysiology of osteoarthritis?
Hyaline articular cartilage loss that is initialy focal
36
Osteoarthritis results from attempts of the joint components to produce new tissue. What pathologic changes are seen as a result?
* Osteophytes (new bone) * Synovial hyperplasia * Capsular thickening * Initial increase in chondrocyte number and activity
37
What defines generalized osteoarthritis?
Osteoarthritis in the hands and at least 1 large joint
38
What enzymes are involved in cartilage degradation? Where do they come from?
Matrix metaloproteinases (MMPs) Released by chondrocytes and synoviocytes in response to cytokines (IL-1, TNF-alpha)
39
What occurs in phase 1 of osteoarthritis?
* **Edema** of the extracellular matrix * **Microcracks** appear on the cartilage surface * **Focal loss of chondrocytes** * Alternate with areas of proliferation
40
What are the radiographic findings of osteoarthritis?
* Focal joint space narrowing * Marginal and central osteophytes * Subchondral sclerosis and cysts * Osteochondral bodies * Bony attrition
41
What non-pharmacologic treatments are recommended for patients with osteoarthritis?
* Patient education * Self management programs * Social support * Pysical + Occupational therapy * Preserve range of motion, strength, aerobic capacity * Assistive devices * Improve amulation and ADLs * Weight loss (if overweight)
42
What is the difference between functional impairment and disability?
* Functional impairment * Impaired performance of discrete actions * Disability * Limitation of performance of _socially defined tasks expected of an individual_ (ex: cooking, shopping)
43
Which sites are most commonly affected by primary osteoarthritis?
* Hands * DIP, PIP, Base fo thumb * MCPs usually spared? * Cervical and lubar spine * Feet * Knees * Hips * 1st MTP joint
44
How does physical activity affect your cartilage and bone health?
Physical activity is good! Regular loading is required to maintain cartilage and bone health. Excess loading or joint immobilization may lead to fibrillation/thinning of cartilage

MSK-Derm by Minnie (48 decks)

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