Week 7 - Osteoarthritis and related conditions Flashcards
What is osteoarthritis?
A degenerative, non-inflammatory joint disease.
What is the most common articular disease worldwide?
Osteoarthritis
What parts of the joint does osteoarthritis affect?
Articular cartilage
Joint surface
Subchondral bone
Synovium
What are the primary joints affected by osteoarthritis?
Weight-bearing joints
DIP and PIP joints of hands
What are the risk factors of osteoarthritis?
Increasing age Obesity Female Trauma Infection Repetitive occupational trauma Genetic factors History of inflammatory arthritis Neuromuscular disorder Metabolic disorder
What does osteoarthritis do to the joint?
It causes focal areas of damage to the articular cartilage
Remodels the underlying bone
Osteophytes form
Mild synovitis (swelling of the synovial membrane)
How does cartilage degradation in OA occur?
- Synovial cells overproduce enzymes which break up the cartilage matrix
- Cartilage becomes softer, allowing deformation and splitting called fibrillation.
- As the degradation progresses, these splits become deeper (fissures) reaching down to the bone
- Areas of full thickness loss of cartilage develop
What is periarticular bone growth?
Bone spur caused by cartilage transforming to bone in attempts to regrow cartilage.
What are the symptoms of OA?
Pain Joint stiffness in morning joint instability joint mal-alignment decreased ROM muscle atrophy joint effusion
How is OA diagnosed?
Radiographs
What are the impacts of OA?
Pain and functioning
Activity restrictions
Psychological distress
Effects of environmental and personal factors
How is OA managed?
Patient education Heat/ice Exercise Weight loss PT OT SP Joint unloading principles Analgesics Surgical intervention as last resort
What is Paget’s Disease?
A localised disorder of bone remodelling that typically begins with excessive borne resorption followed by an increase in bone formation. This forms structurally disorganised “woven bone” which is mechanically weaker, larger, less compact, more vascular and more susceptible to fracture than normal bone.
Where are common sites for paget’s disease?
The axial skeleton
Pelvis
Long bones like tibia and fibula
What are the 3 phases of paget’s disease?
- Lytic phase
- Mixed phase
- Sclerotic phase
What is the lytic phase of paget’s disease?
Increase in bone resorption resulting in a bone turnover rate up to 20 times faster than normal
What is the mixed phase of paget’s disease?
Second phase of rapid increase in bone formation with the newly formed collagen fibres being deposited in an unorganised fashion
What is the sclerotic phase of paget’s disease?
Bone formation dominates with the new bone having a woven pattern, resulting in weaker, highly vascularised bone.
What are the cuases of paget’s disease?
Unknown, however suspected genetic and environmental contributors
Does paget’s affect more men or women?
Men, 3:2
Why is there increased morbidity in people with paget’s disease?
Bone pain, OA and fractures
Why is there increased mortality in people with paget’s disease?
Likely to suffer fracture or tumour.
What age group are most cases of paget’s reported?
Incidence increases with age, most cases reported in the 50+ age group
How does paget’s present clinically?
Usually monostotic (affects 1 bone) but can be polyostotic
Many patients are asymptomatic and are diagnosed incidentally
Most common complaint is bone pain
May also present with pathological fractures, congestive heart failure, hearing loss, sensory disturbances and weakness due to nerve root compression.
