Week 10 - Osteoarthritis Flashcards
what is arthritis
- inflammation of the joint
what symptoms do all arthritis’ share (5)
- pain
- stiffness
- swelling
- redness
- decreased ROM
what is the most common joint disease in NA
- osteoarthritis
what is osteoarthritis
- slowly progressive non-inflammatory disorder of synovial/diarthrodial joints
what is OA also referred to as (3)
- “wear and tear arthritis”
- degenerative joint disease
- degenerative disk disease (if it occurs in the spine)
describe the role of inflammation in OA
- inflammation is not causative
- although it can occur later, secondary to injury & synovial irritation
what are risk factors for OA (9)
- age
- female
- obesity
- immobility
- mechanical injury
- sports
- repeated stress of joints
- genetics
- post inflammatory disorders
- bone deformities
how does mechanical injury contribute to the development of OA
- stimukates chondrocytes to release cytokines
- cytokines increase the release of proteolytic enzymes = breakdown of bone & cartilage
= loss of cartilage
= friction within the joint increases & becomes painful to move
how can immobility increase the risk of OA
- without joint movement, the synovial fluid becomes stagnant
= increased friction
what occurs in the later stages of OA
- subchondral bone (bone beneath the cartilage) responds by increasing bone production
= creation of osteophytes (bone spurs) in the synovial space
what does OA most commonly affect (4)
- knees
- hips
- lumbar & cervical vertebrae
- hands
what 2 places does OA rarely affect but can after an orthopaedic injury
- shoulder
- ankle
what are the 7 symptoms of OA
- pain (range from mild discomfort to severe disability)
- crepitus
- spasm & decreased ROM
- inflammation
- referring pain
- deformity
- stiffness
describe the initial pain associated w OA (3)
- achy
- diffuse
- stiff
what releives/worsens pain during the early stages
- relieved by rest
- worsened w activity
- consistent light activity may lessen pain due to the pumping action of synovial fluid
describe the onset of pain during the later stages of OA
- will still occur at rest
- and can disturb sleep
what else can worsen the pain associated w OA
- cold temperature
what causes worsened stiffness during OA
- rest (worse in the am)
what is crepitus
- an abnormal popping or crackling sound heard in the joints
what causes crepitus? what makes it worse?
- the breakdown of cartilage can cause bone-on-bone rub & grinding
- appearance of osteophytes make this worse
describe the spasms & decreased ROM during OA
- deep joint pain can cause painful muscle spasms which limit the joint’s ability to move
- ROM is also decreased due to structural changes in the joint
what can limit the loss of & improve ROM during OA
- light activity & pain management
what causes inflammation during OA
- synovial, tendon, or ligament irritation
what are signs of inflammation during OA (4)
- pain
- warm
- may be swollen
- but redness rarely occurs at the knee of hips
where might pain refer to during OA
may refer to:
- groin
- buttocks
- sciatic region (side of knee or thigh)
what causes referred pain during OA
- OA of the neck & lower back can cause structural damage which puts pressure on the spinal nerves
= pain radiates down the dermatome
does OA effect joints asymetrically or symetrically
asymetrically
what deformity can hip OA cause
- the leg to externally rotate & flex
what deformity can knee OA cause (2)
- varus (knees bend outwards)
- valgus (knees bend inwards)
what deformity can hand OA cause (2)
- heberden’s nodes
- bouchard’s nodes
what is heberden’s nodes
- hard bony lumps in the distal interphalangeal finger joint
what are bouchard’s notes
- hard bony lumps in the proximal interphalangeal finger joints
what are 3 ways to diagnose OA
- bone scan
- CT scan
- MRI
what are 7 treatments for OA
- analgesics
- exercise
- NSAIDs
- glucocorticoids
- hot & cold
- lubricants
what is the preferred therapy for OA? why?
- analgesics support (ex. tyenol)
- bc inflammation may not occur until later in the disease process
what is the benefit of exercise during OA (4)
- increases joint stability
- prevents muscle strophy
- pumping action may replenish synovial fluid
- promotes weight loss in an obese pt
what is the benefit to replenishing synovial fluid via exercise (2)
- reduced friction
- improved nutrient delivery
what is the benefit to weight loss r/t OA
- decreased stress on the joint in obese pts
when are NSAIDs used as treatment for OA
- only when inflammation is present
what is a common side effect of NSAIDs for OA
- GI side effects
- but newer NSAIDs reduce this problem
when are glucocorticoids used for OA therapy
- when inflammation fails to respond to NSAID therapy
how are glucocorticoids used for OA therapy
- injections directly into the joint
what are the limitations of glucocorticoid therapy for OA
- bc of adverse catabolic effects on the joint, can only be done 4 times per joint
when is heat used for OA (2)
- during the initial stages
- to reduce stiffness
when should heat not be used for OA
- during times of inflammation
when is cold used for OA
- during times of inflammation
what is a type of lubricant used during OA
- synvisc –> synthetic joint lubricant
what is the benefit of synvisc (3) how is it used
reduces:
- inflammation
- friction
- pain
- injected
describe assessment of a pt with OA (4)
- OPQRSTU
- compare contralateral joints
- assess for tenderness, swelling, reduced ROM, crepitation
- consider effect on ADLs
