Osteoarthritis Flashcards
What is the most common type of arthritis?
Osteo
What joints does osteoarthritis most commonly affect?
Most commonly affects joints in your hands, knees, hips and spine.
What joint structures are involved in osteoarthritis?
The whole joint structure including cartilage, subchondral bone, ligaments, menisci, synovium and capsule is involved
What gene encodes collagen type II?
COL2A1
What is osteoarthritis the result of?
Osteoarthritis is the result of active, sometimes inflammatory but potentially reparative processes rather than the inevitable result of trauma and ageing
What are factors predisposing someone to osteoarthritis?
Obesity Heredity gender Hypermobility Osteoporosis Traum
What type of cells produce cartilage?
Chondrocytes
Die in osteoarthritis
What mechanisms have been suggested for the pathogenesis of osteoarthritis?
- Abnormal stress and loading - leading to mechanical cartilage damage play a role in secondary OA.
- Obesity - is a risk factor for developing OA of the hand and knee, but not the hip in later life
- Collagenases (MMPs)
- MMPs are secreted by chondrocytes in an inactive form
- Extracellular activation then leads to the degradation of both collagen and proteoglycans around chondrocytes.
- Tissue inhibitors and metalloproteinases
- Regulate MMPs
- Disturbance of regulation may lead to an increase in cartilage degradation
- Osteoprotegerin, RANK and RANK ligand
- control the remodelling of subchondral bone remodelling
- Their levels are significantly different in OA chondrocytes
- Aggrecanase
- production is stimulated by pro- inflammatory cytokines and aggrecan (the major proteoglycan) levels fall.
What are the symptoms of osteoarthritis?
Early OA is rarely symptomatic unless accompanied by a joint effusion, whilst advanced radiological and pathological OA is not always symptomatic
Symptoms:
- Joint pain
- Short-lived morning stiffness
- Functional limitation
What are the signs of osteoarthritis?
- Crepitus
- Restricted movement
- Bone enlargement
- Joint effusion and variable levels of inflammation
- Bony instability and muscle wasting
How is a diagnosis of osteoarthritis made?
During the physical exam, your doctor will check your affected joint for tenderness, swelling, redness and flexibility.
Imaging may support a working diagnosis:
- X-rays
- Narrowing space between bones in a joint due to loss of cartilage
- MRI can give a detailed picture of cartilage
How would you manage a patient with osteoarthritis?
There is no cure or reversal
The guiding principle is to treat the symptoms and disability, not the radiological appearances
Weight loss and exercises for strength and stability are useful
Local heat, ice packs, massage and rubefacients or local NSAID gels are all used
Paracetamol is effective and should be prescribed before NSAIDs
Intra-articular corticosteroid injections produce short-term improvement when there is a painful joint effusion
Who does nodal osteoarthritis often affect?
This mainly affects women and often starts around the time of the menopause. It usually affects the base of your thumb and the joints at the ends of your fingers, although other finger joints can also be affected.
What deformities can nodal osteoarthritis cause?
The inflammatory phase settles after some months or years, leaving painless bony swellings posterolaterally: Heberden’s nodes (DIPs) and Bouchard’s nodes (PIPs), along with stiffness and deformity
What are the two major subgroups of hip osteoarthritis?
The most common is superior-pole hip OA
Less commonly, medial cartilage loss occurs
