OA & Charcots Lec

Question 1

3 major subheadings of Arthritis

Answer 1

• Hypertrophic: Osteoarthritis, Charcot’s deformity, Neurotrophic osteoarthropathy
• Erosive: Rheumatoid Arthritis, AS, Gout
• Infectious: Osteomyelitis, Septic arthritis

Question 2

What are the 3 types of OA?

Answer 2

Primary (idiopathic), Secondary (identifiable stress/trauma) and erosive (variant occurring in the hands involving inflammation)

Question 3

Most common sites for OA presentation?

Answer 3

o Dips more common than Pips (RA)
o 1st metacarpal-trapezium
o 1st metacarpal phalangeal 
o Spine
o  Hips, knees and AC

Question 4

What are the first few trivial signs of OA?

Answer 4

• Gradual onset: intermittent signs and symptoms
• Stiffens with rest and improves with activity
• Decreased ROM
• Complications: spinal stenosis, nerve entrapment, vertebral artery impingements

Question 5

What is another name for the bare area of a synovial joint?

Answer 5

Enthoseal site (Enthesopathy) where the synovial capsule connects to the bone

Question 6

What are the 8 Radiographic Hallmarks of OA?

Answer 6

1. Asymmetrical distribution (unilateral presentation)
2. Non-uniform or asymmetrical loss of joint space
3. Osteophytes
4. Subchondral Sclerosis- eburnation
5. Subchondral Cysts- Geodes
6. Intra-articular loose bodies (joint mice)
7. Articular deformity
8. Joint subluxation: instability

Question 7

Describe the Vacuum Phenomenon.

Answer 7

Denotes degeneration in the spinal DJD but NOT in other joints. Represents collections of nitrogen gas in nuclear and annular fissures and presents as area of linear radiolucency. Thought to originate from adjacent extracellular fluid. In movements of the spine that produce a lowered pressure in the disc, such as in extension.

Question 8

Whats the difference between a claw and a traction osteophytic growth?

Answer 8

• Traction: occur in early phase of disc degen, typically originate about 2mm from ant vertebral margin
• Claw: Derived from reactive spur once shear forces have reduced to more compressive loads

Question 9

Describe a Normal Variant?

Answer 9

An abnormality in ossification or mineralisation of a bone

Question 10

What vessels pass through the posterior ponticle?

Answer 10

The vertebral artery and the exiting nerve root

Question 11

In a CAT scan and MRI, what is the descriptor when bone appears brightest?

Answer 11

Homogeneously white, meaning that its not a bone window or a MRI water-study (T2)

Question 12

What are DD’s for hypertrophic arthridities?

Answer 12

• OA

- Charcot joint (neurotrophic)

Question 13

What are DD’s for erosive arthridities?

Answer 13

• RA
• Pseuriatic
• Gout
• AS

Question 14

What are DD’s for infective arthridities?

Answer 14

• Osteomyelitis

- Septic Arthritis

Question 15

Difference between OA and RA joint space?

Answer 15

OA= unilateral joint space loss 
RA= symmetrical joint space loss as well as demineralisation

Question 16

What is Charcot’s Deformity secondary to?

Answer 16

Secondary to impaired or absent, sensory or proprioceptive function in a joint

Question 17

What are the classic 6 D’s for a Charcot joint?

Answer 17

Distention of joint
Density of subchondral sclerosis
Debris within the joint (joint mice)
Dislocation due to chronic and severe instability
Disorganisation of joints
Destruction of bone