Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Locomotor 2 > Treatments for OA > Flashcards

Treatments for OA Flashcards

1
Q

What are the risk factors for OA

A
  • genetic predisposition
  • hereditary factors
  • age
  • joint injury previously
  • Gender
  • joint immobilization
  • obesity
  • overuse of the joint
  • high intensity sport
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

describe the viscous cycle of OA

A
  • There is altered mechanical loading n the cartilage, bone and ligaments
  • this causes proteolytic destruction of cartilage matrix and chondrocyte death
  • this leads to remodelling of the bone osteophytes, angiogenesis, and subchondral sclerosis
  • there is abnormal synovial fluid and thus reduced viscosity
  • leaving to synovial inflammation and angiongesi
  • peripheral and central sensitisation and nociceptor activation causing pain
  • this leads to a reduced in exercise, muscle weakness which leads to altered mechanical loading of cartilage, ligaments and bone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the health outcomes of OA

A
  • Joint destruction
  • Severe pain
  • loss of joint function
  • disability
  • social isolation
  • depression
  • reduced quality of life
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is OA

A

OA is a metabolically active repair process and causes localised loss of cartilage and remodelling of adjacent bone
- results in varying degrees of functional limitation and a reduction in quality of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the areas that are commonly affected by osteoarthritis

A
  • knees
  • Hips
  • Small hand joints
  • knees and hips as they are weight bearing joints
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

describe characteristics of OA

A
  • not always caused by ageing

- not always progressive (some people get it worse than others)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the Clinical symptoms of OA

A
  • Joint pain (with use)
  • morning stiffness lasting less than 30 minutes
  • joint instability or buckling
  • Loss of function
  • Crepitus (creaking or cracking of the joint - marker that cartilage is lost or it is cracked) on motion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the clinical signs of OA

A
  • Bony enlargement at affected joints
  • limited range of motion
  • muscle atrophy/weakness
  • Mal-alignment and or joint deformity
  • crepitus on motion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is crepitus a marker for

A

creaking or cracking of the joint - marker that cartilage is lost or it is cracked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How should you educate someone with OA

A
  • offer accurate verbal and written information
  • patient centred
  • individualised self management strategies agreed between patient and healthcare professionals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are some lifestyle changes that people with OA can make

A

Exercise – swimming

Weight loss if obese

Use of suitable footwear

Walking at an appropriate speed and pacing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

describe the OA pyramid of treatment

A
  • every one is given information and advice
  • everyone is given self help ideas such as lifestyle changes
  • then you have NSAIDs, physiotherapy, occupational therapy
  • advanced - non surgical interventions, injections
  • surgery - total joint replacement or partial joint replacement
  • surgery joint preserving
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the non pharmacological care that can be given to patients with OA

A

Exercise – core treatment

  • Local muscle strengthening
  • General aerobic fitness
  • Weight loss

Transcutaneous electrical nerve stimulation (TENS) as an adjunct for pain relief

Aids and devices

  • Orthopaedic insoles
  • Walking stick

lifestyle changes

diet

Thermotherapy
- use of local heat or cold

Nutriceuticals

  • increase intake of omega 3 rich foods
  • Chondroitin sulphate and glucosamine supplements – no longer recommended that they should be recommended or approved
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is better then changing just exercise

A

Exercise and diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

arthritis prevalence increased with

A

body weight - the more obese you are the higher the chance you have of getting OA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the oral analgesics that can be used for OA treatment

A
  • paracetamol and/or topical NSAID
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what happens when paracetamol and topic NSAIDS are not ineffective

A
  • give oral NSAID or COX-2 inhibitor
  • used at lowest effective dose for shortest possible period
  • start with NSAID then go onto the COX-2 inhibitor such as celecoxib
  • Co-prescribe with PPI due to the gastric problems caused
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

name an example of a COX -2 inhibitor

A

celecoxib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what happens when the oral NSAID and COX-2 inhibitor is not effective

A
  • give intra-articular injections = corticosteroid injections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

where does the topical NSAID go

A

concentrated into the synovial fluid so it gets into the joint where the pain is

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

when do you refer patients for surgery in OA

A
  • referred when the patent wakes during the night because of the pain
  • this shows that they pain stiffness and reduced function have a substantial impact on quality of life
22
Q

Name some surgery options for OA

A

Arthroscopic lavage – not used, soemtiems they do it to have a look inside

Arthroscopic lavage plus debridement – normally lavage plus now

Microfracture

Mosiacplasty (osteochondral transplant)

Chondrocyte grafts

Joint replacement

23
Q

what happens in a Arthroscopic lavage plus debridement

A
  • After they have done an MRI, CT or X ray they still need to look in the joint and see how badly affected the articular cartilage is as these imaging techniques will not tell you this
  • then they washout the synovial fluid - put back artificial synovial fluid until it re-establishes
  • and debride the surface at the same time - this involves getting rid of any of the loose or damaged edges of the cartilage
24
Q

describe the benefits

Arthroscopic lavage plus debridement

A

80-90% of patients who had debridement and washout, pain free at 1 year compared to 14% of patient who just had washout

25
Q

What happens in a Arthroscopic washout and debridement plus microfracture

A
  • this is when you drill into the subchondral bone
  • this bone contains the red bone marrow which contains bone marrow pluripotent stem cells
  • this stimulates repair of the articular cartilage - the new cells make fibrocartilage
  • cartilages recovers within 4-6 months
26
Q

who has the best result for Arthroscopic washout and debridement plus microfracture

A

Peopleunder age 40 with a recent cartilage injury have the best results

People that are not overweight also have better results

27
Q

What is viscosuplementation

A
  • Returns higher molecular weight hyaluronans and increases viscosity
  • this is because in OA you have a low concentration and low molecular weight of hyaluronic acid
  • thereby injecting hyaluronic acid back in you can have up to 6 moths pain relief almost straight away
28
Q

what are the advantages of viscosuplementation

A

Works well at all stages of OA

Improves patient assessed pain

Well tolerated

Long term effectiveness

29
Q

what are the disadvantages of

viscosuplementation

A

Severe OA may not respond as well

Some local adverse effects at injection site

30
Q

What happens to the hyaluronic acid in OA

A
  • this is because in OA you have a low concentration and low molecular weight of hyaluronic acid
31
Q

what happens in chondrocyte grafting

A
  • take chondrocytes from elsewhere
  • periosteum is stitched around the defect
  • long tube injects the chondrocytes underneath the periosteum and over a period of a couple months they differentiate and make ECM and repair the defect
32
Q

what are the source of chondrocyte that can be used in chondrocyte grafting

A

Rib costochondral process

Non damaged part of joint

Also cartilage implants from young individuals available

33
Q

what is a microfracutre chondral allograft transplant

A
  • bone marrow stimulated technique
  • creates fibrocartilage
  • less durable and resilient
34
Q

What is an autologous chondrocyte implantation

A

Take a bit of aluminum foil and push it into the defect to form a mould

Take the chondrocyte into the mould

More hyaline like cartilage forms

But can hypertrophy and unreliable biological potential of implanted cells

35
Q

what is a mosiacplasty (osteochondral grafting)

A

Take undamaged cartilage from less weight bearing regions plus the underlying bone and move to OA region

36
Q

describe the benefit of mosiacplasty (osteochondral grafting)

A

At 1 year up to 88% of patients had good to excellent clinical outcomes
95% had returned to normal level of sport and work activity at 3 years

37
Q

What is osteotomy

A

An osteotomy is a surgical operation whereby a bone is cut to shorten or lengthen it or to change its alignment

38
Q

what re the two types of osteotomy

A

Closing
- Can either take a wedge out

Open
- add material

39
Q

what compartment in the knee is commonly used in osteotomy

A

For the knee often the medial compartment affected

40
Q

describe what used to happen in a conventional hip replacement

A

Large incision (20-30cm)

Cuts muscles, ligaments and tendons to access the joint

41
Q

Describe what happens in a minimal invasive hip replacement

A

Incision 10cm or less

Therefore less damage to surrounding structures

42
Q

what are the two types of hip replacement

A

Cemented

non cemented/hybrid

43
Q

What increases the risk of having a knee replacement

A
  • obesity

- knee injury

44
Q

How long do joint replacements last

A

15-20 years

- average is 25 years

45
Q

what is the most common reason for having a joint replacement

A

aseptic loosening - due to the biomatierals that are used for the hip replacement creating bits of plastic and metal that the bodies own immune system works against therefore you end up with inflammatory

46
Q

what are other reasons for having a joint replacements

A
  • aseptic loosening
  • instability
  • infection
  • pain
  • peri-prosthetic fracture - can fracture the bone when putting int the metal from the joint replacement
  • component failure
47
Q

What are the drug treatment for knee osteoarthritis

A

SYSADOA = symptomatic slow acting drugs for osteoarthritis;

IA HA = intra-articular hyaluronic acid;

NSAID = non-steroidal anti-inflammatory drug.

48
Q

What is a new treatment in osteoarthritis

A

platelets rich plasma

49
Q

what biologicals can be given for OA

A

IL1 blockage
- Statistical improvement on day 4 with 150mg

TNF inhibition

  • Adalimumab had less joint damage
  • If given early
50
Q

Name an TNF inhibitor

A

Adalimumab

51
Q

what is the problem with biologicals

A
  • cost

- problem is that low grade inflammation and varies with time

Locomotor 2 (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions