Osteoarthritis

Question 1

What is the WHO definition of OA?

Answer 1

A long term chronic disease characterized by the destruction of cartilage in joints which results in bones rubbing together creating stiffness, pain and impaired movement

Question 2

What is chondral cartilage?

Answer 2

Cartilage which lies on the surface of the bones to allow low friction movements

Question 3

OA is a degenerative disease of what cartilage?

Answer 3

Chondral Cartilage

Question 4

When does inflammation occur in OA relative to RA?

Answer 4

Inflammation occurs late in the onset of disease compared to RA

Question 5

What are the main inflammatory cytokines involved in OA?

Answer 5

TNF-alpha and IL-1Beta

Question 6

What are two examples of proteinases?

Answer 6

Matrix Metalloproteins and aggrecanases

Question 7

What is the effect of inflammatory cytokines like TNF on the articular cartilage membrane?

Answer 7

TNF increases the synthesis of proteinases and other catabolic factors which degrade the articular cartilage membrane

Question 8

What factors can lead to endogenous predisposition OA?

Answer 8

Age, gender, genetics and high BMI

Question 9

What external factors can increase the risk of OA?

Answer 9

Trauma and overload

Question 10

How do subchondral cysts form?

Answer 10

When inflammatory cells eat away at bone

Question 11

How does loss of joint space lead to sclerosis?

Answer 11

When osteoblasts try and make more bone to compensate for the loss of bone and it thickens

Question 12

Which type of cartilage is broken down by Matrix Metallo Proteinases?

Answer 12

Hyaline articular cartilage

Question 13

What causing the caving in of the bones?

Answer 13

When the lateral sides of the knee cartilage has been degraded

Question 14

Describe the cycle which is involved in the development of OA?

Answer 14

Joint pain -> Lead to limited mobility -> Lack of physical activity -> Leads to obesity -> Increased pressure on joints

Question 15

What are the main locations where OA can be found?

Answer 15

Knee, Hip, Spine, Fingers

Question 16

What affect does having a family history of Osteoarthritis have on the age on onset of OA?

Answer 16

it causes a left shift in the curve - onset is earlier

Question 17

How does the pain of OA change throughout the day?

Answer 17

gets worse throughout the day

Question 18

How long does morning stifness/pain last with OA?

Answer 18

Minimal - less than 20 minutes

Question 19

Compare the timing of pain between OA and RA?

Answer 19

OA gets worse throughout the day and RA is worse in the morning and gets better throughout the day

Question 20

What is crepitus?

Answer 20

When you get crunching of your bones as they are rough surface on rough surface

Question 21

What happens to a patients range of motion when they suffer from OA?

Answer 21

Range of motion is limited

Question 22

What are the four stages of assessment for OA?

Answer 22

Look
Feel
Move
Special Tests

Question 23

What is the bone deformity commonly seen in OA patients when standing?

Answer 23

Valgus deformity - this is where the lateral sides of the articular cartilage are further degraded than the medial resulting in the inwards collapse of the legs

Question 24

What is the bulge test for knee effusion?

Answer 24

The dimple of fluid will disappear when it gets pushed away and bulge again when the fingers are moved

Question 25

What is the name given to fluid swellings in the knee joints?

Answer 25

Fluid effusion

Question 26

What are the two things that should be felt for during an OA assessment?

Answer 26

Knee effusion and warmth which would indicate inflammation

Question 27

What is a lab tests which can be done to test for OA?

Answer 27

Check for cartilage degradation products in the serum and joint fluid

Question 28

What are four radiological changes seems with OA?

Answer 28

LOSS Loss of joint space Osteophytes sclerosis subchondral cysts

Question 29

What are injections which can be given to manage OA?

Answer 29

Steroid, lubrication gel, platelet rich plasma, hyaluronic acid

Question 30

What are some conservative OA management strategies?

Answer 30

Weight loss, analgesics, physiotherapy, walking aids, avoiding exacerbating activity

Question 31

What operative procedure is done if OA is found in the knee?

Answer 31

Knee replacement

Question 32

What operative procedure is done if OA is found in the wrist?

Answer 32

Denervate wrist

Question 33

What are some signs and symptoms which patients might present with if they have OA?

Answer 33

Swollen joint, ballotable effusion, warmer indicating inflammation, limited range of motion

Question 34

What are the seven elements of the flow chart which outlines the progression of injury to OA?

Answer 34

Injury -> meniscal tear -> surgery / removal -> increased pressure in the knee -> articular cartilage wear -> loss of joint space -> OA

Question 35

Which nodes are found at the DIP joints?

Answer 35

Heberdens nodes

Question 36

Which nodes are found at the Proximal Interphalangeal Joints?

Answer 36

Bouchards

Question 37

Between DIP and PIP joints, which are more likely to be found in OA?

Answer 37

DIP