Osteoarthritis

Question 1

• 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

Answer 1

Osteoarthritis

Question 2

Usually spared joints in Osteoarthritis are the:

Answer 2

• wrist
• elbow
• ankle

Question 3

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___

Answer 3

• > 60
• > 30

Question 4

• 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

Answer 4

OA

Question 5

Joint protectors include:

Answer 5

• joint capsule and ligaments
• muscle
• sensory afferents
  -underlying bone

Question 6

• reduces friction between
  articulating cartilage surfaces
• hyaluronic acid and lubricin

Answer 6

Synovial fluid

Question 7

bridge the joint are key joint protectors.

Answer 7

Muscles and tendons

Question 8

Risk factors for osteoarthritis

Answer 8

• 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

Question 9

rarely inherited and is more often a consequence of aging

Answer 9

“generalized OA”

Question 10

confer a high risk of OA

Answer 10

polymorphism within the growth differentiation factor 5 (GDF5) gene

Question 11

distortions of hip joint anatomy in children that often lead to

Answer 11

• congenital dysplasia
• Legg-Perthes disease
• slipped capital femoral epiphysis

Question 12

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

Answer 12

Obesity

Question 13

two categories of repetitive joint use:

Answer 13

• occupational use
• leisure time physical activities

Question 14

SOURCES OF PAIN IN OSTEOARTHRITIS

Answer 14

• cartilage is aneural, cartilage loss in a joint is not accompanied by pain
• pain arises from structures outside the cartilage

Question 15

pain is episodic, triggered often by overactive use of a diseased joint

Answer 15

Early in disease

Question 16

Stiffness of the affected joint may be prominent, but morning stiffness is usually brief about

Answer 16

<30 min

Question 17

CLINICAL FEATURES OF OA

Answer 17

• 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

Question 18

Test for OA if signs and symptoms suggests inflammatory arthritis

Answer 18

Blood tests

Question 19

more helpful diagnostically than an X-RAY

Answer 19

Exam of the synovial fluid

Question 20

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.

Answer 20

> 1000/pL

Question 21

goals of the treatment of OA:

Answer 21

• alleviate pain
• minimize loss of physical function

Question 22

Patients with mild and intermittent symptoms may need only

Answer 22

reassurance or nonpharmacologic treatments.

Question 23

Patients with ongoing, disabling pain are likely to need

Answer 23

both nonpharmacotherapy
and pharmacotherapy

Question 24

NONPHARMACOTHERAPY
Ways of lessening focal load across the joint include:

Answer 24

1. avoiding painful activities as these are usually activities that overload the joint:
2. improving the strength and conditioning of muscles
   that bridge the joint, so as to optimize their function
3. 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

Question 25

Why Tx of Exercise in OA needed?

Answer 25

• First, there is a decline in strength with age.
• Second, with limited mobility comes disuse muscle atrophy.
• Third, patients with painful knee or hip OA alter their gait so as to lessen loading
  across the affected joint, and this further diminishes muscle use
• Fourth, “arthrogenous
  a inhibition” may occur, whereby contraction of muscles bridging the joint is inhibited by a nerve afferent feedback loop emanating in a swollen and stretched joint capsule

Question 26

Trials in Knee and hip OA have shown that exercise

Answer 26

lessens pain and improves physical function

Question 27

TREATMENT:

Correction of Malalignment

Answer 27

• either surgically or with bracing, may relieve pain in persons whose knees are malaligned
• Fitted braces that straighten varus knees by putting valgus stress across the knee can be effective
• Using a patellar brace to realign the patella, or tape to pull the patella back into the trochlear sulcus or reduce its tilt, has been shown, when compared to control in clinical trials, to lessen patellofemoral pain

Question 28

Most effective exercise regimens consist

Answer 28

aerobic
and/or resistance training

Question 29

PHARMALOGICAL TX FOR OA

Answer 29

ORAL NSAIDs and COX-2 inhibtors

Question 30

• produce 30% greater improvement in pain than high-dose acetaminophen
• should be administered topically or taken orally on an “as needed” basis
  because side effects are less frequent with low intermittent doses.

Answer 30

NSAIDS

Question 31

The American Heart Association has identified ___ as putting patients at high risk, although low doses of celecoxib (S200 mg/d of celecoxib) are not associated with an elevation of risk

Answer 31

rofecoxib and all other COX-2
inhibitors

Question 32

only conventional NSAID that appears safe from a
cardiovascular perspective, but it does have Gl toxicity

Answer 32

Naproxen

Question 33

Recent guidelines recommend against the use for OA

Answer 33

glucosamine or chondroitin

Question 34

Surgery when the px w/ knee or hip OA has failed nonsurgical tx modalities w/ limitations of pain or function that compromise the quality of life, the px w/ reasonable expectations and readiness for surgery should be refereed for

Answer 34

total knee or arthroplasty