The degenerative joint - osteoarthritis Flashcards
what type of joint does osteoarthritis affect?
synovial joints
what contributes to the cost of osteoarthritis?
hip replacements knee replacements lost days at work benefits treatments
what is osteoarthritis?
an age related dynamic reaction pattern of a joint in response to insult or injury
Which part of the synovial joint is most affected?
the articular cartilage
but all the tissues of the joint are involved
does osteoarthritis have an inflammatory component?
yes and it is a metabolically active and dynamic process mediated by pro-inflammatory cytokines eg IL-1, TNF alpha and NO
What are the main pathological features seen in osteoarthritis?
loss of cartilage
disordered bone repair
what are the risk factors for osteoarthritis?
age gender - female genetics obesity occupation local trauma inflammatory arthritis eg RA abnormal biomechanics of the joint eg joint hypermobility, congenital hip dysplasia and neuropathic conditions
Explain how age contributes to developing osteoarthritis
cumulative effect of trauma
decline in neuromuscular function
How does obesity contribute to OA?
NOT due to mechanical factors
obesity is a low grade inflammatory stage and results in the release of IL-1 and TNF and adipokines - cytokines secreted by adipose tissue eg lectin and adiponectin
how does occupation contribute to OA?
manual labour associated with OA of the hands
repeated use of the joints
what are the symptoms of OA?
pain, though not always present
functional impairment- can’t walk, ADLs affected
what are the signs of OA?
alteration in gait joint swelling limited range of motion crepitus (grating, crackling or popping sounds and sensations experienced under the skin and joints) tenderness deformities
What contributes to the joint swelling in OA?
bony enlargement
effusion
synovitis (if inflammatory)
VIP EXAM
what are the radiological features of OA?
joint space narrowing osteophyte formation subchondral sclerosis subchondral cysts abnormalities of bone contour
What are Heberden’s nodes?
hard or bony swellings that can develop in the distal interphalangeal joints (DIP)
What are Bouchard’s nodes?
hard or bony swellings that can develop in the proximal interphalangeal joints
Which joints in the hand can OA affect?
DIP
PIP
CMC (eg base of thumb)
what is the course of OA of the hand?
relapsing, remitting
Which form of OA has a strong genetic component?
nodal form
Which is the commonest compartment of the knee to get OA?
medial
What are the three compartments of the knee?
medial
lateral
patellofemoral
What is the course of OA of the knee?
evolution is slow
once the OA is established, it remains stable for years
How does erosive/inflammatory OA present?
pain and swelling of the small joints of the hand
pain worse on exertion but also worse after prolonged rest
morning stiffness lasting longer than usual for degenerative eg 1 hour
bony swelling of the joints but also additional soft tissue swelling
tenderness of the joints
What therapy can be used for erosive/inflammatory OA in addition to usual OA therapy?
DMARDs Disease-modifying anti-rheumatic drugs
