Week 8 - Osteoathritis Flashcards

1
Q

OA

A
  • most common form of arthritis and possesses marked variability of disease expression
  • wear and tear on joints
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2
Q

Is there an inflammatory component of OA

A

Considered non-inflammatory, there is a inflammatory component

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3
Q

Primary OA

A

Where there is no discernible or identifiable aetiology

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4
Q

Secondary OA

A

Where the aetiology can be identified
- mechanical factors
- biochemical factors
- destruction of cartilage by other mechanisms
- common after bouts of septic, inflammatory and crystal arthritis

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5
Q

Cartilage breakdown

A
  • horizontal flashing
  • superficial fissuring
  • horizontal splitting
  • deep fissuring
  • increase in chondrocytes
  • increase in water content
  • progressive depletion of proteoglycans
  • increase in collagen
  • proliferation in collagen production
  • proliferation of the synovium
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6
Q

Cartilage breakdown results in

A

Loss of joint space
Osteophytes
Sclerosis of Subchondral bone
Subchondral cyst
Collapse of bone and subluxation

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7
Q

OA symptoms

A
  • joint pain
  • early in disease, pain is episodic, triggered by overreactive
  • nocturnal pain normally only occurs in the end stages of the disease
  • pain should not be ignored
  • joint gelling
  • joint instability
  • loss of function
  • muscle wasting
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8
Q

OA Investigations

A
  • radiographs
  • US
  • MRI
  • Laboratory investigations
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9
Q

X-ray allows detection of (OA)

A
  1. Osteophytosis
    2 joint space narrowing
  2. Subchondral sclerosis
  3. Subchondral cyst formation
  4. Loose osseous body
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10
Q

Osteophytosis

A

+ An Osteophyte is a bony outgrowth (spur) at the margin of the affected joint
+ frequently in an isolated finding but can present in a combination with any or all of the following 4 findings, especially in more severe cases
+ normal bone density is maintained and trabecular reorganisation occurs in the osteophyte

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11
Q

Joint space narrowing

A
  • The joint space narrowing typically is uneven
  • narrowing occurs at the focus of the applied abnormal force or at the site of cartilage or Subchondral bone abnormality
  • uniform narrowing may be seen if the entire cartilaginous surface is affected
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12
Q

Subchondral sclerosis

A
  • this finding is represented by periarticular increased bone density
  • Subchondral sclerosis is frequently found adjacent to the site of joint space narrowing
  • no correlation between Subchondral sclerosis and cartilage degeneration
  • Subchondral sclerosis does not increase as the disease progresses
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13
Q

Subchondral cyst formation

A
  • geographic, radiolucent, eccentric lesion frequently associated with the OA joint
  • characteristically has a thin, sclerotic margin
  • can be mistaken for erosion
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14
Q

Loose osseous body

A
  • the loose body appears as a bone fragment or ossicle within the joint or along it’s margins
  • related to a traumatic event
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15
Q

OA classification.

A

0: no joint space narrowing or osteophyte
1: doubtful joint space narrowing, possible osteophytes
2: definite osteophytes, possible joint space narrowing
3: moderate osteophytes, definite joint space narrowing, some sclerosis, possible bone end deformity
4: large osteophytes, marked joint space narrowing, severe sclerosis, definite bone-end deformity

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16
Q

Knee OA

A
  • important anatomical factor related to knee OA is lower extremity alignment
  • people with varus alignment are at increased risk of medial tibia-femoral OA
  • people with valgus alignment are at risk of lateral tibia-femoral OA
17
Q

Hip OA

A
  • affects older adults and poses detrimental consequences on mobility and quality of life
  • risk factors: previous hip injury, occupations involving heavy physical activity, alterations in joint shape, and family history, may increase the risk substantially
18
Q

Management

A
  • X-ray is not a routine test to consider as a means to explain clinical symptoms
  • patients with a robust diagnosis of OA on clinical grounds may have normal plain radiographs and vice verse
  • knee pain on most days of a month can precede radiographic changes of OA by several years
  • radiograph - may have a role I’m defining the prognosis of patients with symptomatic OA
  • where there is still diagnostic uncertainty regarding the cause of joint pain, advanced imaging with MRI or US may also be helpful
  • synovial fluid examination is not routinely required to support a diagnosis of OA