Ch 3 - Rheumatology: OA

Question 1

What is Osteoarthritis (OA)?

Answer 1

Nonerosive, noninflammatory progressive d/o joints l/t deterioration of the articular cartilage and new bone formation at the joint surfaces and margins

Question 2

Which joint is MC affected with obesity?

Answer 2

Knee

Question 3

What is seen in early pathology of OA?

Answer 3

Hypercellularity of chondrocytes
Cartilage breakdown
Increased proteoglycan synthesis
Minimal inflammation

Question 4

What is seen in late pathology of OA?

Answer 4

– Hypocellularity of chondrocytes
– Inflammation 2/2 synovitis
– Osteophytes spur formation
– Subchondral bone sclerosis (eburnation)
– Cyst formation in the juxta-articular bone

Question 5

What does increased water content of OA cartilage lead to?

Answer 5

Damage of the collagen network (increased chondrocytes, collagen, and enzymes)

Question 6

Which joints are affected in primary OA?

Answer 6

Knees
MTP
DIP
CMC
Hips
Spine

Question 7

Which joints are affected in secondary OA?

Answer 7

Elbows

Shoulders

Question 8

What is the cause of primary OA?

Answer 8

Idiopathic

Question 9

What is the cause of secondary OA?

Answer 9

Chronic or acute trauma
Connective tissue disease (CTD)
Endocrine or metabolic
Infectious
Neuropathic
Crystal deposition
Bone dysplasias

Question 10

What is Diffuse idiopathic skeletal hyperostosis (DISH)?

Answer 10

Variant form of primary OA degenerative arthritis typically characterized by ossification of spinal ligaments of the thoracolumbar spine

Question 11

Where does DISH have a predilection for?

Answer 11

Right side of the thoracic spine

Question 12

What is the hallmark of DISH?

Answer 12

Ossification spanning three or more intervertebral discs

Question 13

What can be seen on imaging in DISH?

Answer 13

Ossification of the anterior longitudinal ligament, separated from vertebral body by radiolucent line

Question 14

Who is DISH most prevalent in?

Answer 14

White males >60 yo

Question 15

What other disorders are DISH associated with?

Answer 15

DM
Obesity
HTN
CAD

Question 16

What are clinical findings of DISH?

Answer 16

Morning or evening stiffness

Question 17

When can dysphagia be seen in DISH?

Answer 17

With cervical involvement

Question 18

What is DISH not associated with?

Answer 18

Sacroiliitis
Apophyseal joint ankylosis
HLA-B27 positivity
Distinguishes from ankylosing spondylitis

Question 19

What are symptoms of OA?

Answer 19

– Dull aching pain inc w/ activity, relieved by rest
– Later pain occurs at rest
– Joint stiffness for <30 min; worse as the day goes on
– Joint giving away
– Crepitus on ROM

Question 20

What is Articular gelling?

Answer 20

Stiffness after immobility lasting short periods and dissipating after brief period of movement

Question 21

What are Heberden’s nodes?

Answer 21

osteophytosis (bone spur formation) at the DIP joints

Question 22

What are Bouchard’s nodes?

Answer 22

osteophytosis at the PIP joints

Question 23

Which CMC joint is typically affected in OA?

Answer 23

First CMC joint

Question 24

Which compartment of the knee is narrowed in OA?

Answer 24

Medial compartment

Question 25

Which compartment of the hip is narrowed in OA?

Answer 25

Superior lateral compartment

Question 26

Which MTP joint is affected in OA?

Answer 26

First MTP joint

Question 27

What are radiographic findings of OA?

Answer 27

• Asymmetric narrowing of the joint space
• Subchondral bony sclerosis
• Osteophyte formation
• Osseous cysts
• Loose bodies

Question 28

What is Subchondral bony sclerosis?

Answer 28

New bone formation (white appearance, eburnation)

Question 29

What is not seen on radiographs in OA?

Answer 29

Not associated with osteoporosis/osteopenia (no bone washout)

Question 30

Which joints are involved in OA in the spine?

Answer 30

Luschka’s (uncovertebral) joints—uncinate process on the superior/lateral aspect of the cervical vertebral bodies (C3 to C7), making them concave

Question 31

What medications are used for treatment of OA?

Answer 31

– Acetaminophen (initial treatment)
– NSAIDs (used for pain once inflammation ensues)
– Narcotics—rare
– Oral steroids are contraindicated