Osteoarthritis

Question 1

What is Osteoarthritis ?

Answer 1

Articular cartilage failure
Subchondral sclerosis
loss of joint space
Subchondral cyst formation

Question 2

What happens in OA?

Answer 2

Loss of matrix
release of cytokines including IL-1 and TNF
Release of metalloproteinases and prostaglandins by chondrocytes

Question 3

What accompanies fibrillation of the cartilage surface?

Answer 3

Attempts of repair and osteophyte formation

Question 4

What is a clinical presentation of OA?

Answer 4

Pain, typically on activity and relieved by rest.
stiffness usually in the morning (lasts less than 30 mins)
Inactivity gelling

Question 5

What is found on examination with OA?

Answer 5

Crepitus
Bony enlargements due to osteophytes
Joint tenderness
Joint effusion

Question 6

What joints are involved with OA?

Answer 6

Hands
Dip, PIP, and 1st CMC joints
knee
Hip
Spine

Question 7

What kind of deformities are found in the knee?

Answer 7

Genu varus (away from midline)
Valgus (to the midline)

Question 8

What else can occur in the knee with OA?

Answer 8

Bakers cyst

Question 9

Where is pain felt in OA of the hip?

Answer 9

In the groin and radiating to the knee.

May be radiating from the lower back

Question 10

What can occur at the lumbar spine?

Answer 10

Spinal stenosis caused by osteophytes when encroached on spinal canal

Question 11

What radiological signs can show OA?

Answer 11

Loss of joint space
Subchondral sclerosis
Subchondral cysts
Osteophytes

Question 12

In OA, what grading scale is uses?

Answer 12

The Kellgren-Lawrence Radiographic scale of OA

Question 13

How is OA managed?

Answer 13

Physiotherapy

Common sense e.g. weight loss

Question 14

What drugs can be used to treat OA?

Answer 14

Analgesia
NSAID’s
Pain modulators

Question 15

What can be done in surgery to help with OA?

Answer 15

Arthroscopic washout, loose body, soft tissue trimming

Joint replacement

Question 16

What is Gout?

Answer 16

Inflammation in the joint triggered by uric acid crystals

Question 17

What is chronic tophaceous gout?

Answer 17

Chronic joint pain, often associated with diuretics.
High serum uric acid
Tophi, may get acute attacks

Question 18

What investigations may you do for suspected gout?

Answer 18

Serum uric acid levels
Inflammatory markers
polarised microscopy of synovial fluid 
X-rays 
Renal checks

Question 19

What are treatments for Gout?

Answer 19

NSAIDs
Colchicine
Steroids

Question 20

What prophylaxis treatment can you give?

Answer 20

Allopurinol

Febuxostat

Question 21

What does chondrocalcinosis affect?

Answer 21

Fibrocartilage in the knees, wrists and ankles

Question 22

What is chondrocalcinosis, aka CPPD?

Answer 22

Calcium Pyrophosphate Deposition Disease

Question 23

What causes CPPD?

Answer 23

Pseudogout, calcium pyrophosphate crystals

Question 24

What are treatments for CPPD?

Answer 24

NSAIDs
Colchone
Steroids
Rehydration

Question 25

Hydroxyapatite is also known as what?

Answer 25

Milwaukee shoulder

Question 26

What is Hydroxyapatite?

Answer 26

Hydroxyapatite crystals in or around the joint

Question 27

What is released in Hydroxyapatite?

Answer 27

Collagenases, serine proteinases and IL-1

Question 28

What is the treatment for Hydroxyapatite?

Answer 28

NSAIDs
Intra-articular steroid injection
Physiotherapy
Partial or total arthroplasty.

Question 29

What is Anti-Jo 1 associated with?

Answer 29

Polymyositis