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Clin Med- P > Osteoarthritis > Flashcards

Osteoarthritis Flashcards

1
Q

define osteoarthritis

A

degeneration of articular cartilage and reactive remodeling of subchondral bone and periarticular tissues

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2
Q

what areas does OA effect?

A

most joint structures including cartilage, bone, muscle, synovium, and the joint capsule

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3
Q

what is the “more appropriate” term for osteoarthritis? why?

A

degenerative process (-osis) and not an inflammatory one (-itis). DJD (degenerative joint disease) will be a better term.

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4
Q

most common arthritis in older patients?

A

OA

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5
Q

pathognomonic finding for OA

A

breakdown of the cartilage of the joint.

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6
Q

approach to txt for OA?

A

conservative and base on life-style changes until pain and/or disability requires a surgical approach when feasible.

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7
Q

when do men and women get OA?

A

Before age 45, more common in men

After age 55, more common in women (maybe b/c of bone protective-effects of estrogen)

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8
Q

OA: Xray evidence correlates poorly with what?

A

symptom severity

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9
Q

primary OA

A

idiopathic + limited to a few joints

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10
Q

secondary OA

A 
caused by ...
acute or chronic trauma 
bone disorders 
congenital/development d/o 
metabolic/endocrine d/o
inflammatory arthritis
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11
Q

what are the OA risk factors? (6)

A
  • AGE (biggest one)
  • obesity
  • joint malalignment (varus)- bowlegged
  • high bone density (odd but true!)
  • repetative impact loading
  • family history
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12
Q

Women with osteoporosis and hip fracture have _____ risk of OA

A

decreased

  • possibly b/c they tend to weight less.
  • soft bone protects cartilage better than dense bone (absorbs impact)
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13
Q

4 OA joint changes

A
  1. Joint space narrowing
  2. Subchondral bone sclerosis
  3. Subchondral cysts
  4. Osteophytes
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14
Q

clinical manifestations of OA

A
  • pain
  • stiffness
  • swelling
  • deformity/ loss of function
  • crepitus
  • erythema + warmth
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15
Q

what makes OA pain worse?

A

activity (improves with rest)

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16
Q

stiffness in OA ?

A
  1. Morning stiffness is brief (< 1 hour)

2. May develop after prolonged inactivity (“gelling”)

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17
Q

what is “gelling”?

A

stiffness after prolonged inactivity

18
Q

what is swelling from in OA?

A

bony enlargement

19
Q

what three joints are generally NOT involved in OA? (unless there was injury)

A

Wrists
Metacarpophalangeal joints
Elbows, shoulder, and ankles

20
Q

OA of the hands: two most commonly affected joints (and what are they named?)

A

Most commonly affected joints are DIP (Heberden nodes) and PIP (Bouchard nodes)
*findings are frequently familial

21
Q

OA nodes vs RA nodes

A

OA- nodes are hard, RA- more hard/rubbery

22
Q

knee OA happens medially or laterally more?

A

medially more than laterally

23
Q

position for knee Xray ?

A

standing

24
Q

what is a baker cyst?

A

Popliteal cyst-like expansion : Due to inflammation of the joint
Not really a cyst – actually a herniation of the bursal sac through the posterior muscles

25
Q

symptoms of a baker cyst

A

asymptomatic or feel stiff and “funny” preventing full knee extension – usually not painful, nor OA…

26
Q

txt of baker cyst

A

Txt; isolate the knee, takes time to go away

27
Q

OA of the hip: where does the pain start and radiate?

A

Pain may be in groin radiating anteriorly to thigh or distally in knee
Positive Trendelenburg’s sign

28
Q

what is a positive trendelenburg’s sign?

A

pelvis will sag on the side opposite to the abnormality when the normal knee is flexed

29
Q

OA of the cervical and lumbar spine is referred to as _______

A

spondylosis

30
Q

OA of the spine: 3 sites effected

A
  1. Intervertebral disc spaces: Protrusion of the nucleus pulposus with cord compression may occur
  2. Posterior spinal facet joints - areas of greatest flexibility - cervical + lumbar
  3. spinal canal stenosis (from osteophytes) - apophyseal joints
31
Q

what is Spondylolisthesis?

A

slippage of one vertebral body on another if severe

32
Q

OA on the foot? - what is the characteristic finding?

A

Charcot foot deformity - secondary from neuropathic DM ulcer

33
Q

Legg-Calve-Perthes Disease: who gets it? what is it?

A

secondary OA: boys age 2-12
arthritis of the hipds:
temporary loss of blood supply to the hip resulting in necrosis of the femoral head (avascular necrosis), results in intense inflammation resulting in arthritic changes

34
Q

OA synovial fluid

A

Synovial fluid: WBC < 2,000 cells/mm3 ( normal)

35
Q

Dx of OA

A

Xray: to confirm Dx
CT/MRI: Appropriate if symptoms suggest disc herniation, nerve impingement, or spinal stenosis ( if you need to see facet joints)

36
Q

does Xray correlate with symptoms?

A

NO, Can have changes without pain

Insensitive especially in early OA

37
Q

txt goal of OA?

A

no cure + no therapy known to prevent or retard the degenerative process
Treatment focuses on relieving symptoms and improving function

38
Q

OA non pharm txt (6)

A 
Patient education
Weight loss
Diet
Increase calcium, vitamins C and D
Physical and occupational therapy
Exercise
39
Q

exercised for OA?

A

refer to PT!

strengthen quads, walking, low impact

40
Q

pharm txt for OA: analgesic/anti-inflamm

A 
NSAIDs... to reduce the ADRs... 
low dose w/ PPI 
*cox 2 specific (celecoxib) 
*acetaminophen (for liver issues) 
*topical capsaicin (decr. substance P )
41
Q

two types of surgery for OA

A
  1. Total joint replacement – last resort and most definitive
    Almost all patients experience significant pain relief
    Function still usually limited
  2. Arthroscopic debridement
    Poor evidential support
42
Q

vitamin D to prevent OA?

A

low vit. D assoc. with incr. risk, but supplementation not clearly helpful

Clin Med- P (124 decks)

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