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MSK II > osteoarthritis > Flashcards

osteoarthritis Flashcards

1
Q

osteoarthritis general info

A 
most common arthropathy
primary pathology involves cartilage
characteristically non-inflammatory
involves active enzymatic factors
multi-factorial 
pathology and findings same regardless of joint
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2
Q

primary osteoarthritis

A

aging or idiopathic

genetic- nodal O.A.

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3
Q

secondary OA

A

due to disorders that damage joint surfaces

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4
Q

pathogenesis of OA

A
  • damage to normal articular cartilage by physical forces

- fundamental defective cartilage fails under normal joint loading

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5
Q

damage to normal articular cartilage by physical forces

A

macro or microtrauma
chondrocytes react -> release degredative enzymes
inadequate repair response

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6
Q

fundamental defective cartilage fails under normal joint loading

A 
type II collagen gene defect (orchronosis) 
ochronotic cartilage (pigmented and defective)
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7
Q

OA pathologic characteristics

A
  • altered chondrocyte fnx
  • loss of cartilage
  • subchondral bone thickening- sclerosis
  • remodeling of bone
  • marginal spurs (osteophytes)
  • cystic changes in subchondral bone
  • mild reactive synovitis
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8
Q

systemic risk factors for OA

A 
age
obesity
genetics
gender
menopause
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9
Q

local risk factors for OA

A 
mm strength
joint proprioception
repetitive use
configuration of joint
trauma
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10
Q

common osteoarthritis joints

A 
cervical and lumbar spine
1st CMC
PIP
DIP
hip
knee
1st MTP
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11
Q

uncommon OA joints

A 
shoulder
thoracic spine
elbow
wrist
MCP
ankle
subtalar
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12
Q

OA hands

A

nodal osteoarthrits
heberdens nodes: DIP
bouchards nodes: PIP
1st CMC joint: base of thumb

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13
Q

OA knees

A 
most common location
3 compartments (med/lat/pat-fem)
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14
Q

OA spine

A

spondylosis- involves disc degeneration and facet involvement
DISH

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15
Q

OA feet

A

1st MTP

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16
Q

symptoms of OA

A 
insidious onset
joint pain associated with movement
limited ROM/decreased fnx
minimal stiffness after rest
referred pain
acute flares suggest another Dx
systemic symptoms are rare
17
Q

why is OA painful

A 
cartilage is avascular and aneuritc
synovitis
joint capsule/lig stretching
periosteal irritation from osteophytes 
trabecular microfractures
mm spasm
intraosseous HTN
18
Q

OA PE

A 
boney changes in joint shape
crepitus
malalignment/instability
joint line tenderness
cool effusions (not inflammation)
spasm or atrophy of adjacent mm
19
Q

OA labs

A 
ESR, RD neg
synovial fluid- class 1
20
Q

OA images

A

cartilage loss/ joint space narrowing
subchondral sclerosis
osteophytes at joint margins
subchondral cysts

21
Q

subsets of OA

A 
generalized
nodal
spondylosis
erosive OA
inflammatory 
diffuse idiopathic skeletal hyperostosis (DISH)
chondromalacia patellae
22
Q

inflammatory OA

A

inflammed heberdens nodes

23
Q

erosive OA

A

may appear normal on x-ray

24
Q

osteophyte

A

bone spur

25
Q

syndesmophyte

A

ossification of ligament btwn transverse processes

26
Q

DISH

A 
exuberant osteophytosis of spine 
spans >3 segments
preservation of disc spaces
ligamentous calcification
>5
M>F
associated with DM
ant. cervical osteophytes- dysphagia
27
Q

DISH cuase

A

non-inflammatory
overactive osteoblasts
entheses is point of origin

28
Q

environmental risk factors for DISH

A

fluoride
synthetic retinoids
obesity
insulin like GF 1

29
Q

DISH spine

A

melted wax look on spine
downward pointing spurs in C-spine, upward in lumbar
calcification of posterior longitudinal ligament
T spine best place to look for DISH
ligamentous calcifications at entheses are characteristic

30
Q

chondrolmalacia of patella

A

women with wide hips (large Q angle) at risk

31
Q

management of OA

A 
no cure
pain control
improve fnx
enhance health and quality of life
avoid rxn related side effects
pharm
32
Q

SMOADs

A 
structure modifying anti-OA drugs
matrix metalloproteace inhibitors (MMPIs)
residronate
doxycycline 
glucosame
chondroitin
33
Q

Tx of refractile inflammatory OA

A

colchicine

MSK II (19 decks)

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