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443-SRH and MSK > Osteoarthritis > Flashcards

Osteoarthritis Flashcards

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1
Q

what is osteoarthritis?

A

a degenerative joint disease that is painful and often disablint as a chronic disease

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2
Q

what joints does OA affect

A

any= knee, hip, neck, spine, ankle, etc

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3
Q

what is the primary issue causing OA

A

loss of articular cartilage

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4
Q

T or F: OA only affects the articular cartilage

A

F- is a disease of the entire joint, but the primary issue is loss of articular cartilage

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5
Q

what is the most common chronic joint disase

A

OA`

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6
Q

by 65yrs of age, 80% of the population has some _______ of OA

A

radiographic evidence

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7
Q

what are the 3 parts that are affected in OA pathology

A

cartilage
synovium
bone

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8
Q

describe what happens to the cartilage in OA

A

initial cartilage swelling and matrix synthesis, unbalanced cycle of articular cartilage destruction/ repair followed by gradual cartilage loss (degradation >repair)

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9
Q

describe what happens to the synovium in OA

A

synovial inflammation and cytokine release = breakdown and more inflammation, ligament stretching and further fibrotic thickening/ encapsulation

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10
Q

describe what happens to the bone in OA

A

may see endochondral bony growths- osteophytes
early periarticular bone turnover
late subchondral plate sclerosis

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11
Q

list 3 causes of Oa

A

obesity
occupation, sports, trauma
genetic factors

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12
Q

what is the most important preventable RF for OA

A

obesity

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13
Q

obesity is a predictor of
1. shoulder OA
2. rapidly progressing OA
3. needing a prosthetic joint replacement
4. heberden’s nodes

A

3

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14
Q

what is the relationship between quad muscles and OA

A

quad weakness = joint looseness and more likely to see ligament injury
usually quad would help stabilzie the joint

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15
Q

what are some genetic factors for OA

A

heberden’s nodes, bouchard’s nodes, F>M

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16
Q

what is primary OA? what are the types

A

Primary OA: more common, no identifiable cause
Types: localized, generalized, erosive

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17
Q

what is secondary OA?

A

Secondary OA: known association with underlying cause
Ex- post trauma, genetic, obesity

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18
Q

what is the clinical presentation of OA

A

Progressive development (usually over years) of pain, joint stiffness, loss of movement/ function

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19
Q

waht differentiates RA and OA

A

OA pain usually confined to affected joints (asymmetric), while RA pain is usually symmetric and multi joint

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20
Q

OA pain tends to worsen with

A

exercise, AM inactivity

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21
Q

OA pain tends to improve with

A

rest

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22
Q

what is the gold standard imaging for OA

A

x ray

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23
Q

what are the hallmarks of OA seen on xray

A

joint space narrowing + osteophyte formation (most common), subchondral cysts, boney sclerosis

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24
Q

what are the clinical and radiographic criteria for knee OA

A

Pain in knees most days AND
Osteophytes on xray AND
One of the following
>50yrs
Morning stiffness <30min
Crepitus on motion

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25
what are the clinical criteria only for knee OA
Pain in the knee most days and at least 3 of the following >50yrs Morning stiffness <30min Crepitus on motion Bony enlargement Bony tenderness No palpable warmth
26
what are the clinical and radiographic criteria of hip OA
Pain in the hip most days + at least 2 of the following ESR <20 mm/h Femoral or acetabular osteophytes on xray Joint space narrowing on xray
27
what is the primary nonpharm tx for OA
exercise and weight loss
28
list 3 nonpharm tx for OA
PT/OT exercise taichi activity mod + pt education GL:D canada
29
what is GLA:D canada
8 wk education nand exercise program for those with knee or hip OA: includes 2 education sessions + 12 supervised exercise sessions (2x/wk) Assoc with improvement in pain and function, licensed through Canadian orthopedic foundation
30
how much weight loss is recommended for OA if pt is obese
~10%, but even 4% is disease modifying
31
when might surgery be used for OA? how effective is it?
for severe pain/ disability that can not be treated with meds 20-25% see no improvement in pain
32
name the 5 classes of oral meds for OA
acetaminophen, NSAIDs, glucosamine and chondroitin, opioid analgesics, antidepressants
33
topical tx for OA
topical NSAIDs, capsacin, other topical rubefacients
34
what are the 2 intraarticular injections for OA
corticosteroids viscosupplementation/ hyaluronic acid
35
name the 3 first line options for OA
acetaminophen, NSAIDs, topical NSAIDs
36
how long is an adequate trial of acetaminophen
2-3wks
37
acetaminophen appears more effective than placebo for ______ OA pain (small improvement at _______), effect size may be small, less eff than NSAIDs
knee or hip 2 wks
38
acetaminophen improves function in pts with ____ or ______ OA
hip or knee
39
NSAIDs is associated with improvement in pain, function, and stiffness at 3mths in ________ OA
knee
40
what characteristics of OA do NSAIDs improve? what kind of OA?
pain, function, stiffness of knee OA
41
which NSAIDs are better than APAP for pain
naproxen, ibuprofen, diclo
42
which NSAIDs are better than APAP for function and stiffness
naproxen, ibuprofen, diclo, celecoxib
43
ACR 2019 recommends considering topicals ______ (before/after) PO NSAIDs
before
44
what are some non NSAID topicals that may help OA pain
Methyl salicylate, trolamine salicylate, capsaicin, menthol (rubefacient)
45
ACR 2019: ________for capsaicin in knee OA, _________for hand OA (may touch eye = irritate)
conditional rec conditional rec against
46
is capsacin recommended for hand OA
conditional recommended against- may irritate eyes
47
duloxetine class
SNRI
48
duloxetine is _______ for knee, hip, and or hand OA
conditionally rec
49
duloxetine is conditionally recommended for _____,________,_________ OA
knee, hip, hand
50
what is another drug class used for OA pain that tramadol may interact with
antidepressants
51
tramadol effect on OA (select all that apply) 1. significant improvement in pain 2. significant improvement in function 3. pain improvement may not be significant 4. functional improvement may not be significant 5. increased risk of serious AEs 6. are conditionally recommended 7. are conditionally not recommended
3,4,5,6
52
what does the ACR say about opioid use in OA
conditional rec against use, but recognize that they may be used in certain circumstances
53
what are glucosamine and chondroitin
endogenous cartilage maintianing substances
54
what is the proposed MOA of glucosamine and chondroitin
stimulate production of cartilage, prevent inflammatory cartilage destruction, maintain joint fluid viscosity
55
glucosamine and chondroitin onset of pain relief
1-3wks
56
those with ___________ allergies should not use glucosamine and chondroitin
shellfish
57
what dose the ACR say about glucosamine and chondroitin use in OA
glucosamine strongly recommended against for knee, hip, and/or hand OA. chondroitin strongly recommended against for knee and/or hip OA, but conditionally recommended for hand OA
58
name the 7 NHPs used in O
SAMe avocado/ soybean unsaponifiables MSM vit D antioxidants boswellia serrata extract ginger
59
ASU effect in OA
reduce pain and NSAID use in pts with knee/ hip OA
60
vit D efficacy in OA
supplementation for 2 yrs did not reduce knee pain or cartilage volume loss in pts with symptomatic knee OA
61
boswellia serrat extract eff in OA
assoc with improvement in knee pain, flexion, and walking distance over 8 wks
62
what CS may be injected in OA
triamcinolone methylprednisone
63
how often can intraarticular CS be used in OA
3-4x/yr max (and no more freq than q3mths) Repeated inj may damage cartilage
64
when should pain relief start with IA CS for OA? when does it peak? how long does it last?
starts at 24-72hrs, peaks 7-10d, can last 4-8wks Should minimize activity and stress on joint for several days after injection
65
what is the ACR rec for intraarticualr CS
strongly recommended for knee/ hip conditionally for hand
66
which of the following is false about hyaluronic intraarticular tx 1. it assists with joint lubrication and cartilage rehydration 2. it lasts longer than CS injections 3. it has a slower onset than CS but may be more effective 4. is conditionally recommended in knee and hand OA 5. 3+4
3+4
67
what does the ACR say about hayluronic inj for OA
conditionally recommended against in knee and/or hand OA, strongly against in hip OA
68
T or F: in most pts, APAP with NSAIDs is enough for OA pain
T

443-SRH and MSK (24 decks)

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