Osteoarthritis

Question 1

What is the etiology of Osteoarthritis?

Answer 1

1. Commonly due to “Wear and Tear” from use
   *associated with age, obesity, previous trauma, or other disorders
   *have primary and secondary joints

Question 2

What does OA commonly effect?

Answer 2

Weight bearing joints
1. Hips
2. Knees
3. Ankles

Question 3

What demographic does OA affect?

Answer 3

70-80% of adults over age 50
*90% with radiographic evidence by age 40

Question 4

What is the pathphysiology of OA?

Answer 4

1. Joint cartilage breaks down
2. Joint space narrowing occurs (bones get closer together when cartilage is gone, puts more pressure on the nerves)
3. The underlying bone begins to rub
4. Osteophytes (bone spurs) are formed

Question 5

What happens in the later stages of OA?

Answer 5

The synovial membrane becomes inflamed (from the chronic arthritis)

Question 6

Is OA reversible?

Answer 6

No

Question 7

What are the primary and secondary reason of OA?

Answer 7

P: age
S: due to trauma

Question 8

What are the stages of OA?

Answer 8

1. Softening of the articular cartilage
2. Cracking, fissuring, blistering of articular cartilage
3. Thinning/wearing away of the articular cartilage
4. Areas of bone exposed

Question 9

What are some symptoms of OA?

Answer 9

1. Stiffness/gelling (gone within 15 mins)
2. Pain (esp with motion, esp if weight bearing)
   *will be relieved by rest
3. Deformity
4. Decreased motion (osteocytes may cause a mechanical block)
5. Crepitus (cracking, crunchy feeling)

Question 10

During the PE of a patient with OA what might you find?

Answer 10

1. Palpable osteophytes
2. ROM decreased
3. Muscle strength decreased
4. Knees (vagus MC bow legged knees far apart, valgus knees together, flexion contracture)
5. Altered gait
6. Crepitus
7. No systemic manifestations

Question 11

Completing a radiograph of a patient with OA what might you find?

Answer 11

1. Joint space narrowing
2. Periarticular osteophytes
3. Bony sclerosis
4. Subchondral bone cysts

*Labs have no evidence of inflammation

Question 12

What is important about radiographs for a patient suspected with OA?

Answer 12

Always get a weight bearing film

Question 13

What will the synovial fluid look like when a patient has OA?

Answer 13

1. Colorless or yellow
2. Transparent to newsprint
3. Viscous (will decrease over time)
4. Synovial fluid non-inflammatory <2000 WBC/mm
5. No crystals

Question 14

What would be an abnormal finding that is NOT consistent with OA?

Answer 14

1. RBC high
2. WBC high
3. Gram stain positive
4. Cloudy and less viscous
5. Crystals present (gout or pseudogout)

Question 15

What medication can be useful for OA?

Answer 15

1. Tylenol (do not exceed 4,00mg daily)
2. NSAIDs (more effective for increasing severity
3. Intraarticular cortisone injections (up to 4 years)