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MSK/Derm > SM_225a: Osteoarthritis > Flashcards

SM_225a: Osteoarthritis Flashcards

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Dermatology Board Prep flashcards
1
Q

Describe osteoarthritis

A

Osteoarthritis

  • Joint failure, pathologic change in all joint structures
  • Hyaline articular cartilage loss, initially focal
  • Thickening and sclerosis of subchondral bony plate
  • Outgrowth of osteophytes at joint margins
  • Articular capsule stretching
  • Mild synovitis
  • Weakness of muscles bridging a joint
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2
Q

Describe the general schema of factors leading to osteoarthritis

A

Schema of factors leading to osteoarthritis

  • Systemic factors lead to OA susceptibility
  • OA susceptibility and local factors lead to OA disease
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3
Q

Describe risk factors for incident ostheoarthritis

A

Risk factors for incident osteoarthritis

  • Systemic: age (all joint sites), gender (all sites), genetic factors (many sites, especially hand), excess body weight (especially knee), certain occupations, elite athletic activity
  • Local risk factors: major injury (all, even atypical sites), meniscectomy (knee), developmental abnormalities (especially hip), varus alignment (knee), meniscal tear/extrusion (knee)
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4
Q

Describe why there is an increase in osteoarthritis with age

A

Increase in osteoarthritis with age due to age-related decline in

  • Neuromuscular joint protective mechanisms: muscle function, proprioception, soft tissues that stabilize joint
  • Biomechanical properties of cartilage matrix
  • Joint less able to rebound from injury
  • Reduced regenerative potential of joint tissue
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5
Q

Describe excess body weight in osteoarthritis

A

Excess body weight

  • Increases risk of incident and progressive knee OA
  • Weight in young adulthood/middle age predicts knee OA risk later in life
  • In overweight persons, weight reduction reduces risk of incident knee OA
  • Increases risk of hip OA (less than for knee)
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6
Q

Describe occupational risk factors for OA

A

Occupational risk factors for OA

  • Knee: frequent knee bending + heavy lifting, mining
  • Hip: farming
  • Elbow: jackhammer operation
  • Hand: cotton mill work
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7
Q

Describe nonoccupational physical activity as a risk factor for OA

A

Nonoccupational physical activity as a risk factor for OA

  • Recreational - no increase in risk
  • Non-elite athletic - no increase in risk, unless injury occurs
  • Elite athletic - increase in risk
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8
Q

Describe the effects of physical activity in OA

A

Effects of physical activity in OA

  • Certain amount of regular loading required for cartilage and bone health
  • Under experimental conditions, cartilage fibrillation and thinning seen in immobilized limbs and excessively loaded joints
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9
Q

Describe developmental abnormalities in OA

A

Developmental abnormalities in OA

  • Potentially any abnormality that alters joint sirface fit will increase risk of OA
  • Especially at hip: acetabular dysplasia
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10
Q

Describe the phases of OA

A

Phases of OA

  1. Phase 1: edema of extracellular matrix, microcracks on cartilage surface, focal loss of chondrocytes alternating with areas of chondrocyte proliferation
  2. Phase 2: microcracks deepen, vertical clefts form in cartilage, clusters of chondrocytes appear arround these clefs and at surface
  3. Phase 3: fissures cause cartilage fragments to break off (osteocartilaginous loose bodies), subchondral bone uncovered, subchondral cysts, mild synovitis (more focal and milder than RA), subchondral bone sclerosis
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11
Q

Describe Phase 1 of OA

A

Phase 1 of OA

  • Edema of extracellular matrix
  • Microcracks appear on cartilage surface
  • Focal loss of chondrocytes alternating with areas of chondrocyte proliferation
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12
Q

Describe Phase 2 of OA

A

Phase 2 of OA

  • Microcracks deepen
  • Vertical clefts form in cartilage
  • Clusters of chondrocytes appear around these clefts and at surface
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13
Q

Describe Phase 3 of OA

A

Phase 3 of OA

  • Fissures cause cartilage fragments to break off: osteocartilaginous loose bodies
  • Subchondral bone uncovered
  • Subchondral cysts
  • Mild synovitis: more focal and milder than RA
  • Subchondral bone sclerosis
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14
Q

Describe the joints most commonly affected in OA

A

Joints most commonly affected in OA

  • Primary: hands, cervical and lumbar spine, feet, knees
  • Hips: superolateral or inferomedial narrowing
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15
Q

Describe the sites most commonly affected by primary OA

A

Sites most commonly affected by primary OA

  • Hands (DIP, PIP, first CMC)
  • Cervical and lumbar spine
  • Feet (1st MTP)
  • Knees: only tibiofemoral or only patellofemoral but not both, medial or lateral tibiofemoral compartment but not both
  • Hips: superolateral or inferomedial narrowing
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16
Q

Joint involvement in OA can be _____, _____, or _____

A

Joint involvement in OA can be monoarticular, oligoarticular, or polyarticular

17
Q

When hips are affected by OA, there is _____

A

When hips are affected by OA, there is superolateral or inferomedial narrowing

18
Q

Describe the pattern of joint involvement in primary OA

A

Pattern of joint involvement in primary OA

  • Hand
  • Cervical and lumbar spine
  • Feet
  • Knees
  • Hips
19
Q

Pattern of joint involvement in generalized OA is _____ + _____

A

Pattern of joint involvement in generalized OA is hands + at least one large joint

20
Q

Secondary OA involves OA in joints ____, such as ____, ____, ____, and ____

A

Secondary OA involves OA in joints not typically affected, such as MCP, wrist, elbow, shoulder, and ankle

21
Q

Describe generalized OA

A

Generalized OA

  • Hands + at least one large joint
  • Familial predisposition
  • More common in women, onset in middle age
  • Multiple Heberden’s nodes
  • Polyarticular finger interphalangeal joint OA
  • Symptoms persist for years but settle down
  • Predisposition to OA at other sites such as knee
22
Q

Describe secondary OA

A

Secondary OA

  • Premature onset
  • Atypical site: MCP, wrist, elbow, shoulder, ankle
23
Q

Describe general clinical characteristics of OA

A

General clinical characteristics of OA

  • Onset tends to be gradual
  • Usually only one/few joints problematic at given time
  • Evolution of symptoms and structure change slow
  • Strong age association: men 40s and older, women peri-menopause and older
24
Q

Describe symptoms of OA

A

Symptoms of OA

  • Aching
  • Early OA: increases with joint use, relieved by rest
  • Advanced OA: pain at rest as well as with use, night pain, not relieved easily, sleep interference worsens pain experience
  • Pain/structure change closest relationship at hip, weakest at hand and spinal apophyseal joints
  • Morning stiffness: ≤ 30 minutes, shorter than RA
  • Stiffness after inactivity
  • Swelling: less pronounced, less persistent then RA
25
Q

Morning stiffness duration in OA is _____ than in RA

A

Morning stiffness duration in OA is shorter than in RA

26
Q

Swelling in OA is ____ persistent than in RA

A

Swelling in OA is less persistent than in RA

27
Q

In OA symptoms occur at ____

A

In OA symptoms occur at specific sites

28
Q

Describe symptoms occuring at specific sites in OA

A

Symptoms occuring at specific sites in OA

  • Knee: pain global or compartmental, pain/difficulty with stairs and sitting to standing
  • Hip: pain in groin or deep posterolateral, pain/difficulty in/out of car and with putting on shoes and socks
  • Spine: pain in region of involvement, radicular symptoms of osteophytes compressing nerve roots
29
Q

Describe physical exam findings of OA

A

OA physical exam findings

  • Bony enlargement
  • Limitation of motion: limited flexion, inability to achieve full extension
  • Crepitus
  • Malalignment
  • Mild inflammation, warmth, effusion (if moderate or severe consider joint infection or crystal process)
30
Q

______ is a warning sign and symptom of OA

A

Marked joint inflammation is a warning sign and symptom of OA

  • Flares of OA are common and may show mild joint inflammation
  • More marked warmth, swelling, or redness warrants urgent investigation for another cause: crystal, septic arthritis (damaged joints are predisposed), coexisting crystal and septic arthritis
31
Q

Describe laboratory studies in OA

A

Laboratory studies in OA

  • Blood and urine tests have no role
  • Synovial fluid analysis reveals non-inflammatory fluid characteristics: low turbidity, low WBC count (<2,000), may show calcium pyrophosphate dihydrate crystals
32
Q

Describe radiographic findings in OA

A

Radiographic findings in OA

  • Focal joint space narrowing
  • Marginal and central osteophytes
  • Subchondral sclerosis and cysts
  • Osteochondral bodies
  • Bony attrition
33
Q

Role of X-ray in OA is to _____ and _____, which helps _____ and _____

A

Role of X-ray in OA is to confirm diagnosis/rule other other conditions and assess OA severity, which helps develop a therapeutic plan and understand prognosis/expected course of OA

34
Q

Describe the role of MRI in OA

A

Role of MRI in OA

  • Large role in research but not in patient care
  • MRI in older individuals needs careful interpretation because may reveal incidental lesions
  • Low utility in OA joint b/c presence of multiple lesions does not change management
  • Useful if arthroscopy under consideration, possible AVN, or unusual pattern or course
35
Q

Describe key outcomes of OA

A

Key outcomes of OA

  • Disease progression: structural changes at joint level
  • Symptoms: pain, stifness
  • Function: impaired performance of discrete actions
  • Disability: limitation in performance of socially defined tasks expected of individual within typical environment
36
Q

Prognosis in OA is ____

A

Prognosis in OA is variable

  • Outcome varies between people and within one person from one joint to the next: whether outcome is poor or not, category of poor outcome
  • DIsease progression ≠ function decline: separate risk factors
  • Worsening not inevitable
37
Q

Describe factors associated with progression of OA in the knee

A

Factors associated with progression of OA in the knee

  • Excess body weight
  • Varus alignment (bow-legged, outward)
  • Valgus alignment (knock-kneed, inward)
  • Meniscal damage
38
Q

Describe factors associated with function decline in knee OA

A

Factors associated with function decline in knee OA

  • Pain severity
  • Excess body weight
  • Inactivity
  • Muscle weakness
  • Joint laxity
  • Low self-efficacy
  • Depression/anxiety
  • Poor social support
  • Other medical conditions
39
Q

Describe treatment in OA

A

Treatment in OA

  • Patient education: self-management programs (education, self-efficacy enhancement, coping strategies), social support
  • Physical and occupational therapy: exercise to preserve ROM/strength/aerobic capacity, assistive devices, improve ambulation and activities of daily life
  • Weight loss if overweight
  • Systemic: non-narcotic analgesic (acetominophen), anti-inflammatory (NSAIDs, selective cyclooxygenase-2 inhibitors), narcotic analgesics (advanced OA)
  • Local: intra-articular, corticosteroid, hyaluronic acid (minimal evidence)
  • Surgical: total joint replacement (advanced OA), unclear if helpful in mild/moderate OA w/o response to conservative therapy

MSK/Derm (49 decks)

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