Osteoarthritis Flashcards
(34 cards)
- MOST COMMON TYPE OF ARTHRITIS
- LEADING CAUSE OF DISABILITY IN THE ELDERLY
- PREVALENCE RISES STRIKINGLY WITH AGE, BEING UNCOMMON IN ADULTS AGEDD <40 Y.O, HIGHLY PREVALENT TO AGES >60
Osteoarthritis
Usually spared joints in Osteoarthritis are the:
- wrist
- elbow
- ankle
Symptomatic OA of the knee (pain on most days of a recent month plus x-ray evidence of OA in that knee) occurs in 12% of persons age ___ in the United States and 6% of all adults age___
- > 60
- > 30
- is joint failure, a disease in which all structures of the joint have undergone
pathologic change, often in concert. - the pathologic sine qua non of disease is hyaline articular cartilage loss, present in a focal and, initially, nonuniform manner
- increasing thickness and sclerosis of the subchondral bony plate, by outgrowth of
osteophytes at the joint margin, by stretching of the articular capsule, by variable degrees of synovitis, and by weakness of muscles bridging the joint
OA
Joint protectors include:
- joint capsule and ligaments
- muscle
- sensory afferents
-underlying bone
- reduces friction between
articulating cartilage surfaces - hyaluronic acid and lubricin
Synovial fluid
bridge the joint are key joint protectors.
Muscles and tendons
Risk factors for osteoarthritis
- Previous damage (e.g..
meniscectomy) - Bridging muscle weakness
- increasing bone density
- Malalignment
- Proprioceptive deficiencies
- Increase age
- female gender
- racial/ethnic factors
- genetic susceptibility
- nutritional factors
- obesity
- injurious physical activities
rarely inherited and is more often a consequence of aging
“generalized OA”
confer a high risk of OA
polymorphism within the growth differentiation factor 5 (GDF5) gene
distortions of hip joint anatomy in children that often lead to
- congenital dysplasia
- Legg-Perthes disease
- slipped capital femoral epiphysis
recedes the development of disease and is not just a
consequence of the inactivity present in those with disease
- it Is a stronger risk factors for disease in women and men
- have more severe symptoms from the disease
Obesity
two categories of repetitive joint use:
- occupational use
- leisure time physical activities
SOURCES OF PAIN IN OSTEOARTHRITIS
- cartilage is aneural, cartilage loss in a joint is not accompanied by pain
- pain arises from structures outside the cartilage
pain is episodic, triggered often by overactive use of a diseased joint
Early in disease
Stiffness of the affected joint may be prominent, but morning stiffness is usually brief about
<30 min
CLINICAL FEATURES OF OA
- In knees, buckling may occur, in part, from weakness of muscles crossing the joint
- buckling, catching or catching could also signify internal derangement, like an anterior cruciate ligament or meniscal tear
- for hip pain, it can be detected by loss of internal rotation on passive movement, and pain isolated to an area lateral to the hip joint usually reflects the presence of trochanteric bursitis
Test for OA if signs and symptoms suggests inflammatory arthritis
Blood tests
more helpful diagnostically than an X-RAY
Exam of the synovial fluid
If the synovial fluid white count is ____, inflammatory arthritis or gout or
pseudogout is likely, the latter two being also identified by the presence of crystals.
> 1000/pL
goals of the treatment of OA:
- alleviate pain
- minimize loss of physical function
Patients with mild and intermittent symptoms may need only
reassurance or nonpharmacologic treatments.
Patients with ongoing, disabling pain are likely to need
both nonpharmacotherapy
and pharmacotherapy
NONPHARMACOTHERAPY
Ways of lessening focal load across the joint include:
- avoiding painful activities as these are usually activities that overload the joint:
- improving the strength and conditioning of muscles
that bridge the joint, so as to optimize their function - unloading the joint, either by redistributing load within the joint with a brace or a splint or by unloading the joint during weight bearing with a cane or a crutch
