Lecture 25

Question 1

Mechanisms

Answer 1

active process where cells in joint tissues repond to external stimuli and drives structural pathologies. External signals can be mechanical or biological and can affect different tissues. As they communicate with each other, all tissues are impacted and cascade begins.

Question 2

Modifiable risk factors

Answer 2

Obesity and joint injury can activate multiple signalling pathways that drives joint OA and pain onset/progression.

Question 3

Pathology vs pain

Answer 3

targeting one tissue does not treat pathology in another. Disability and physical problems are clinical issues that may or may not be correlated with pain. Pain is not correlated with structural disease and treatments may not help with pain. Also, different types of pain have different molecular drivers and treatment targets. No structurally modifying drugs approved that reverse, halt or slow OA. Now, key targets is symptom management and decrease risk factors

Question 4

symptom and risk factor management

Answer 4

Holistic evaluation of patients and conditions. Focus on clinical not imaging diagnosis to develop plan based of patient needs and wants. Some patients should also not have treatments

Question 5

comorbidities

Answer 5

accompanied by heart disease, hypertension, depression and diabetes, increase management complexity. Treatment of OA mustn’t worsen comorbidity. Topical and oral non-steroidal anti inflammatory drugs are recommended as 1st line of treatment, decrease paracetamol due to marginal efficacy, intra-ventricular corticosteroids are used in some cases (not repeated). Some are actively recommended against due to efficacy.

Question 6

Biological targeted therapies

Answer 6

No strong random clinical trial evidence suggesting a beneficial effect over placebo despite preclinical evidence for involvement of pathways in OA. More studies needed.

Question 7

surgical therapies

Answer 7

Only joint alignment surgery esp. high tibial osteotomy and arthroplasty have evidence for efficacy, Anterior cruciate ligament repair while increase joint stability do not alter long-term OA risk supporting that factors beyond mechanics along play a role in post-traumatic OA pathophysiology.

Question 8

random ass statistics

Answer 8

50% patients dont have pain and functional status well assessed

2/3 patients not offered non-drug effective treatments

2/3 patients receive inappropriate drug regaments