OA

Question 1

T/F OA is a “wear and tear” arthritis

Answer 1

F

Question 2

T/F OA is a “whole joint disease”

Answer 2

T

Question 3

What are the components of the joint affected in OA

Answer 3

Cartilage
Synovial Membrane
Ligaments
Bone

Question 4

Is the synovial membrane as affected in OA as it is in RA

Answer 4

no more affected in RA

Question 5

What is OA characterized by

Answer 5

cell stress and extracellular matrix degradation

Question 6

What initiates OA

Answer 6

micro and macro injury that activates maladaptive repair responses including pro-inflammatory pathways of innate immunity

Release of inflammatory enzymes + abnormal biomechanical forces -> damage of cartilage -> cartilage loss

Question 7

What occurs to bone in OA

Answer 7

Increase in bone turnover and localized density - osteophytes

Question 8

OA risk factors?

Answer 8

• Age
• Sex
• Genetic
• Obesity
• Physical inactivity
• Injury
• Joint stress

Question 9

Knee OA prevalence

Answer 9

• African american > Caucasians
• Medial compartment: Caucasian>chinese (men
• lateral compartment: Chinese>Caucasian (men)

Question 10

Hip OA prevalence

Answer 10

Caucasian > Chinese

Question 11

Hand OA prevalence

Answer 11

Asymptomatic: Caucasian>Mexican americans>african americans

- Caucasian>Chinese

Question 12

What occurs to bone turnover and localized density in OA vs normal aging

Answer 12

Increases in OA

Decreases in normal aging

Question 13

What occurs to water content in cartilage in OA vs. normal aging

Answer 13

Increased in OA

Decrease in NA

Question 14

What occurs to fibrillation in OA vs. normal aging

Answer 14

In OA: focal + progressive (will see it crossing joint line
In NA: at WB sites & not progressive

Question 15

What occurs to metabolism and inflammatory enzymes in OA vs. normal aging

Answer 15

In OA: Increased

In NA: normal metabolism and no inflammation

Question 16

What occurs to lean muscle mass in OA vs. normal aging

Answer 16

OA: Decrease (type I fibres)
NA: Decrease Type II fibres (fast)

Question 17

What is the clinical pattern of OA in the knee

Answer 17

mostly bilateral; tibio-femoral?patella-femoral

Question 18

What is the clinical pattern of OA in the hip

Answer 18

UNilateral> bilateral

Question 19

What is the clinical pattern of OA in the spine

Answer 19

Facet joint OA

Question 20

What is the clinical pattern of OA in the hand

Answer 20

PIP, DIP, CMC joints

This is unlike RA - which normally occurs in the MCP and rarely occurs in the CMC joint

Question 21

What is OA in the PIP called

Answer 21

Bouchard’s Node

Question 22

What is OA in the DIP called

Answer 22

heberden’s Node

Question 23

How does OA get diagnosed?

Answer 23

1. Radiographic OA
2. Symptomatic OA
3. MRI- Defined OA

Question 24

What grading system is used for diagnosis of OA via radiography

Answer 24

Kellgren-Lawrence Grading System

Question 25

What are the main features you would see in Xray of someone with OA

Answer 25

- Loss of joint space - Osteophytes - Subchondral scelerosis - Subchondral cyst formation

Question 26

What are subchondral sclerosis caused by

Answer 26

Increased periarticular bone density

Question 27

What is the first characteristic of OA you would see on an xray (what is the first clincal sign to occur)

Answer 27

- Osteophytes

Question 28

What causes subchondral cyst formation

Answer 28

Typically cyst formation

Question 29

Using the Kellgren-Lawrence Grading system, what are the grades? At what grade do you begin to see changes on xray

Answer 29

0 - No radiographic features 1 - Doubtful: minute osteophyte, doubtful significance 2 - Minimal: Definite osteophyte, unimpaired joint space 3 - Moderate: Moderate decrease in joint space (pain) 4 - Severe; Joint space greatly impaired, sclerosis of subchondral bone (pain and all other Loss syndromes)

Question 30

Clinical Feature of OA

Answer 30

- Pain after using the joint - Relieved by rest - Morning stiff less than 30mins - Stiffness after a period of inactivity - Only 40% of patients with joint damage experience pain

Question 31

Why may there be no pain in OA

Answer 31

Cartilage likes pressure and compression - unless soft tissue structures are being put on strain there is often limited pain, other causes of pain can be bone being exposed (very painful!!) or inflammation

Question 32

what needs to occur for symptomatic diagnosis of OA

Answer 32

Yes to all 4 questions: Constant or intermittent discomfort or pain... - at any time on most days of the month? - In the past year? - Worse with activity? - Relieved with rest? One or more of 3 signs: - Effusion. Flexion contracture. Gait abnormality

Question 33

___% of people with knee pain had MRI-detected OA that was not evident on xray

Answer 33

55%

Question 34

MRI is very useful to catch OA early, how does it do this?

Answer 34

- Picks up on bone marrow edema (bone bruise) which are found in acute traumatic injuries

Question 35

Is there an association between weather and OA

Answer 35

- The climate is not the cause or the cure but warmth does relieve symptoms - changes in barometric pressure and ambient temperature may affect OA

Question 36

What is the first line of treatment for oa

Answer 36

- Exercise - Weight loss - Acetaminophen

Question 37

70% of knee joint loading is in the _____ compartment when walking - bringing the leg into the ___ position

Answer 37

medial | varus

Question 38

relationship between quad strength and hip/knee OA

Answer 38

in women only - lower risk with greater quad strength

Question 39

Is obesity related to risk of OA in WB or non-WB joints

Answer 39

Both - because fat tissues can increase the levels of inflammatory enzymes in the body

Question 40

Is BMI or waste circumference used to determine risk of OA

Answer 40

BMI

Question 41

If you lose 1 lb of weight you lose _____lb of knee joint load per step

Answer 41

4 lb

Question 42

Best to start diet or exercise program first?

Answer 42

both at same time

Question 43

Which diet is best : atkins, ornish, weight watchers, zone diets

Answer 43

all reduce weight but with poor adherence - need to choose one which person will stick to!