Test 2: lecture 18 osteoarthritis

Question 1

Progressive articular cartilage degradation without adequate repair

Answer 1

osteoarthritis

Question 2

OA that develops after known trauma

Answer 2

Posttraumatic Osteoarthritis (PTOA)

Question 3

OA will do what to the joint

Answer 3

synovitis
mediscal degeneration and tear
osteophyotosis
loss of collagen
sub-condral bone sclerosis

Question 4

Synovial fluid is ultrafiltrate of plasma providing— and —

Answer 4

nutrients & lubrication

Question 5

subchondral bone is — bone deep to cartilage and will—

Answer 5

cortical

absorb force acting on the joint

Question 6

what type of cartilage in the joints

Answer 6

hyaline/articular cartilage

Question 7

articular cartilage is made by — cell types

Answer 7

chondrocytes

Question 8

why can’t articular cartilage heal well?

Answer 8

avascular and aneural
limited intrinsic repair

Question 9

ECM of articular cartilage is made of

Answer 9

95%: type 2 collagen
proteoglycans (aggrecan)
glycoproteins
hyaluronan

Question 10

ECM of articular cartilage is maintained by

Answer 10

Question 11

cartilage trauma causes increase in —

Answer 11

inflammation
ECM degradation
apoptosis
posttraumatic inflammation (IL-1β, TNF⍺, MMPs)

Question 12

what are the main catabolic cytokine

Answer 12

IL-1β, TNFα, IL-17

Question 13

what are the main degradtative enzymes

Answer 13

MMPs, ADAMTS

Question 14

joint injury causes stress activation of — and —

Answer 14

chondrocytes
synoviocytes

Question 15

MMPs will —

Answer 15

breakdown collagen fibers
(collagenases)

type of degradative enzyme

Question 16

ADAMTs will —

Answer 16

cause break down of proteoglycans (aggrecan)

“aggrecanases”

type of degradative enzyme: MMPs, ADAMTS

Question 17

what happens to sub chondral bone if articular surface is lost

Answer 17

degrades: sclerotic and eburnated

Question 18

how to diagnose OA

Answer 18

lameness exam/ pain
diagnostic analgesia
Radiography
Ultrasonography, MRI, CT, PET
Diagnostic arthroscopy

Question 19

what is a positive flexion test

Answer 19

if you hold joint in flexion, then let it go lameness will be worse

Question 20

joint distension vs joint enlargement

Answer 20

distension: from increased fluid and inflammation

enlargement: thickening of joint capsule and bony spurs (osteophyte)

Question 21

ankylosis

Answer 21

abnormal stiffening and immobility of a joint due to fusion of the bones.

Question 22

what is seen on Xray of OA

Answer 22

osteophytes
Joint space narrowing / asymmetry
Subchondral sclerosis
Subchondral lysis
Osteochondral fragments
Ankylosis

Question 23

what causes swollen joints to be painfull?

Answer 23

damage to subchondral bone

joint capsule: pressure from increased fluid, thick capsule can reduce mobility

Question 24

4 conservative treatments of OA

Answer 24

• Systemic medications
• Intra-articular injections
• Controlled exercise
• Weight loss

Question 25

4 surgical treatments of OA

Answer 25

* Resurface cartilage defects * Remove osteochondral fragments * Total joint replacement * Arthrodesis

Question 26

what are some meds that can be used for OA

Answer 26

NSAIDs steroids hyaluronic acid PSGAGs

Question 27

hyaluronic acid will --- joints.

Answer 27

lubricate and antiinflammatory * will cause joint to make more HA from type B synoviocytes * acts as anti-inflammatory: blocks PGE2 and free radicals and prevents cell migration ## Footnote injected directly into joint

Question 28

what does PSGAGs do?

Answer 28

stimulates EMC matrix synthesis (type 2 collagen and protegylcans) inhibits MMPs promotes HA synthesis (lubricate and anti-inflammatory) Anti-inflammatory: blocks PGE2 and free radicals ## Footnote Adequan

Question 29

PSGAG will inhibit?

Answer 29

MMPs (which degrade collagen fibers) inhibits PGE2 and free radicals (acts as anti-inflammatory) ## Footnote Adequan: increases HA synthesis and stimulated matrix synthesis: type 2 collagen and proteglycans

Question 30

polyacrylamide hydrogels will ---

Answer 30

lubricate joint analagesic effect on joint- incoporates into the synovial membrane (change elasticity) ## Footnote noltex, arthramid: intra-articular injection NON degradable

Question 31

--- is a non degradable intra articular injection to increase lubrication and reduce pain in joint

Answer 31

polyacrylamide hydrogel Noltrex (USA), Arthramid (Europe)

Question 32

complications of joint injections

Answer 32

**joint flare**: acute inflammatory response **Joint infection**: septic arthritis- needs aggressive treatment

Question 33

Autologous conditioned serum is used for ---

Answer 33

block IL-1 made from self and acts as anti-inflammatory **interleukin-1 antagonist protein (IRAP)**

Question 34

--- is a competitive antagonism of IL-1 made from incubate autologous blood

Answer 34

Autologous conditioned serum **(ACS)** interleukin-1 antagonist protein (IRAP)

Question 35

what is PRP

Answer 35

platelet rich plasma plateletes have high concentration of growth factors : PDGF, TGF-β, FGF, VEGF will promote healing, cell proliferation, matrix synthesis and angiogenesis

Question 36

what will platelet rich plasma do?

Answer 36

will promote healing, cell proliferation, matrix synthesis and angiogenesis Platelets contain high concentration of growth factors * PDGF, TGF-β, FGF, VEGF, EGF