DJD

Question 1

(T/F) Normal joint motion is pain-free, follows a prescribed range of motion, and is virtually frictionless.

Answer 1

(T)

Question 2

(T/F) Normal joint motion is controlled by muscles and tendons and is repeatable.

Answer 2

(T)

Question 3

In what two locations of the body are menisci used in joints?

Answer 3

(The stifle and the TMJ)

Question 4

The term osteoarthritis is a term that represents a group of disorders that are characterized by what three things?

Answer 4

(Deterioration of articular cartilage, changes in the subchondral bone, and changes in soft tissue of joints)

Question 5

(T/F) Natural repair processes of articular cartilage by adjacent tissues are incapable of producing tissue with morphological, biochemical and biomechanical properties of articular cartilage.

Answer 5

(T, cartilage defect → fibrous tissue → fibrocartilage (not the same as original cartilage))

Question 6

The chondrocyte response to biomaterial failure as a result of trauma is to degrade a repair what they can but that results in what pathology?

Answer 6

(Chronic synovitis)

Question 7

A joint will form enthesophytes and osteophytes to try to fuse a joint that is causing pain due to injury but that only works in high/low (choose) motion joints.

Answer 7

(Low)

Question 8

What histopathologies occur in the synovial membrane in osteoarthritis?

Answer 8

(Synovial lining hyperplasia, villous hyperplasia, inflammatory cell infiltration of subintima, and fibrosis)

Question 9

If a synovial insult or injury occurs, synoviocytes will release what substances?

Answer 9

(Lysosomal enzymes, PGE2, free radicals, and cytokines)

Question 10

What are the sources of pain associated with synovial insults/injuries?

Answer 10

(There are pain receptors in the capsule itself so triggering of those leads to pain but also the increase in intraosseous pressure leads to pain)

Question 11

Why is articular cartilage that is undergoing degradation discolored?

Answer 11

(Because of the loss of proteoglycan, instead of nice pale white it will start to turn yellow)

Question 12

What types of strength that articular cartilage provides a joint are reduced when that cartilage is degraded?

Answer 12

(Compressive and tensile strength)

Question 13

What is the main purpose of chondrocytes in the joint?

Answer 13

(Controlling the turnover over the extracellular matrix of articular cartilage)

Question 14

The turnover of the extracellular matrix of articular cartilage by chondrocytes is controlled by what?

Answer 14

(The local environment so cytokines present and mechanical stimuli)

Question 15

Pair the following cytokines to the metabolic pathway they trigger when present in the joint:

IGF and TGF

A - Anabolic
B - Catabolic
C - Regulation of catabolism

Answer 15

(A)

Question 16

Pair the following cytokines to the metabolic pathway they trigger when present in the joint:

IL-1, TNF-a, IL-17 and prostaglandins

A - Anabolic
B - Catabolic
C - Regulation of catabolism

Answer 16

(B)

Question 17

Pair the following cytokines to the metabolic pathway they trigger when present in the joint:

IL-10, IL-4, IL-6, IL-13

A - Anabolic
B - Catabolic
C - Regulation of catabolism

Answer 17

(C)

Question 18

How does subchondral bone adapt to repetitive cyclic loading?

Answer 18

(By becoming thicker)

Question 19

What subchondral bone changes are seen in relation to osteoarthritis?

Answer 19

(Subchondral bone sclerosis, subchondral cystic lesions (d/t vascular infiltration or focal osteonecrosis), and periarticular osteophyte formation)

Question 20

What are the two essential clinical features of osteoarthritis that are the main reason it is treated?

Answer 20

(Pain and loss of function)

Question 21

What are nonsteroidal anti-inflammatory options for treatment of inflammation secondary to trauma or degraded cartilage products in osteoarthritis?

Answer 21

(Phenylbutazone, flunixin meglumine, firocoxib, diclofenac sodium, acetaminophen)

Question 22

What is the purpose of Adequan (an IM injectable polysulfated glycosaminoglycan)?

Answer 22

(Stimulates synoviocytes to produce hyaluronic acid, stimulates chondrocytes to produce proteoglycans and collagen, and inhibits metalloproteases)

Question 23

Why is pain relief associated with corticosteroid intra-articular injections both an advantage and a disadvantage?

Answer 23

(Pain relief is an advantage but also a disadvantage because it can hides big issues like fractures)

Question 24

How does intra-articular corticosteroid usage improve cartilage nutrition?

Answer 24

(By controlling severity of synovitis → enables return of normal synovial fluid properties and improves fluid exchange within the joint)

Question 25

What is an important differential diagnosis for post-injection flare symptoms (heat, pain, swelling, and lameness that occurs 8-24 hours post-injection of corticosteroids)?

Answer 25

(Joint infection)

Question 26

What is thought to enhance the positive effects of corticosteroid intra-articular injections so they are often combined (though this has not been studied)?

Answer 26

(Hyaluronic acid)

Question 27

What is the primary adverse effect of IA polysulfated glycosaminoglycans that IA HAs do not have?

Answer 27

(Increased chance of infection → increased minimum inhibitory concentration of abx effective in vitro against S. aureus, don’t use with steroids)

Question 28

What does IRAP stand for?

Answer 28

(Interleukin-1 receptor antagonist → competes with IL-1 for binding and IL-1 is one of the main actors for bad OA)

Question 29

The primary goal of arthroscopic techniques for repairing cartilage is enhancement of what the body is already doing to repair the tissue either by increasing the quantity or quality of the repair tissue, how is that accomplished?

Answer 29

(Local manipulation or cell/tissue transplantation)

Question 30

What are the advantages and disadvantages of a chondroplasty for partial thickness defects?

Answer 30

(Advantages → removal of loose tissue and reduction of further exfoliation which will prevent further synovitis, disadvantage → no long term improvement)

Question 31

Is a partial or full thickness defect in articular cartilage going to induce an improved healing response?

Answer 31

(Full thickness, will trigger extrinsic repair which entails mesenchymal tissue inflow from subchondral bone, partial thickness defects only trigger an intrinsic repair)

Question 32

What arthroscopic surgical technique can be utilized to aid extrinsic repair efforts?

Answer 32

(Making microfractures in the subchondral bone → better quality of fibrocartilage healing, increased type II collagen)

Question 33

If you can make sure that your surgical approach to arthrodesis is very stable, it can decrease the time the horse needs to be in a cast, why is that a good thing?

Answer 33

(Less chance of secondary issues due to casting such as wounds/pressure sores and a shorter hospital stay)