Osteoarthritis

Question 1

What is osteo-arthritis?

Answer 1

The gradual abrasion of articular cartilage layer

Question 2

Osteoarthritis symptoms

Answer 2

Pain
Inflammation
Joint stiffness & deformity
Crepitus
Bony spurs
Loss of cartilage

Question 3

Most common sites of OA

Answer 3

1. Knee
2. Hip

Question 4

Ages affected from OA

Answer 4

> 30 = increased prevalence iwth age

Question 5

Why are women more heavily affected by OA?

Answer 5

Hormone changes (< estrogen after menopause).

Question 6

Relationship between OA and osteoporosis?

Answer 6

Inverse relationship (typically you either have OA or osteoporosis not both)

Question 7

How is OA genetically caused?

Answer 7

Vitamin D receptor gene (causes it not to be absorbed properly resulting in OA)

Question 8

What age group is most at risk of OA

Answer 8

70-79

Question 9

Prevalence of knee arthritis

Answer 9

Women = 1100/100,000
Men = 800/100,000

Question 10

Prevalence of hip arthritis

Answer 10

Women = 600/100,000
Men = 400/100,000

Question 11

Prevalence of hand arthritis

Answer 11

Women = 550/100,000
Men = 300/100,000

Question 12

Typical osteoarthritis arthritis

Answer 12

Cartilage erosion

Exposed bone (accelerates degradation)

Movement is painful/ROM decreased due to meniscus and cartilage degradation (these structures are meant to be protective cushioning)

Bone spurs - heightened osteoblast activity = new bone laid down (further limits ROM/causes pain)

Question 13

Role of X-ray in OA

Answer 13

Determines extent of damage

Can identify presence of bony spurs, lesions and subchondral sclerosis (thickening of bone)

Question 14

Role of MRI in OA

Answer 14

Higher level of detail

T2 mapping (colour scale) can estimate the amount of cartilage collagen

Sodium imaging (heat scale) can estimate cartilage glycosaminoglycan content

Question 15

What is rheumatoid arthritis

Answer 15

Synovial disease characterised by joint inflammation and destruction

Affects the joint capsule.

Question 16

Rheumatoid arthritis symptoms

Answer 16

Joint deformity
Stiffness
Swelling
Pain

Question 17

What type of disease is rheumatoid arthritis

Answer 17

Autoimmune disease - joint tissue perceived as foreign

Question 18

What happens to the broken down tissue in rheumatoid arthritis

Answer 18

It is replaced with non-functional scar tissue

Question 19

Causes of rheumatoid arthritis

Answer 19

Hereditary and overactive

Question 20

How does the inflammation affect the jont?

Answer 20

Inflammation of the synovial capsule leads to destruction of the joint (causes pain, discomfort, inability to function under high intensity)

Question 21

What site of arthritis causes the greatest amount of pain & what site affects quality of life the most?

Answer 21

Knee = Highest level of pain
Hand = Greatest effect on QOL

Question 22

OA medication

Answer 22

Pain relief
Anti-inflammatories
Corticosteroids
Hyaluronic acid

Question 23

How long should you exercise per week to reduce symptoms of OA?

Answer 23

75 minutes

Question 24

What vitamins are important for OA?

Answer 24

Vitamin C (anti-oxidant)

Vitamin D - bone resilience building capability helps with swelling/joint pain

Question 25

What is the focus of exercise in OA?

Answer 25

Reducing body mass (less load on joint) Aerobic capacity

Question 26

Treatments for OA

Answer 26

Cartilage replacement therapy: synthetic hydrogels painted directly onto damaged cartilage Joint replacement (last resort). Now lasts between 25-30 years.

Question 27

RA medication

Answer 27

DMARD - disease modifying non-steroidal anti inflammatory drug eg ibuprofen (anti-rheumatic drug) Celebrex Immunomodulators Glucocorticoids Rose hip berries

Question 28

RA surgical options

Answer 28

Synovectomy - synovial fluid removed from joint capsule Joint replacement surgery

Question 29

What supplements can be taken for arthritis

Answer 29

Glucosamine and chondroitin Can assist in the integrity of glycosaminoglycans which assist in cartilage formation Meta-analysis reported no significant effect of chondroitin on pain in OA patients

Question 30

Physical assessments for arthritis

Answer 30

X-ray/MRI Blood tests CV assessment (treadmill, etc) HR, ECG, RPE, dyspnea monitored

Question 31

What is the rheumatoid factor in a blood test?

Answer 31

Low hematocrit or c-reactive protein

Question 32

What 3 factors contribute to symptoms of OA

Answer 32

Deconditioned muscle Inadequate motion Periarticular stiffness

Question 33

Osteoarthritis and rheumatoid cardiovascular guidelines

Answer 33

Initially: 3/week, 40-50% MHR, 20 mins Progress to: 5/week, 80-85% MHR, 60 mins

Question 34

Osteoarthritis and rheumatoid strength guidelines

Answer 34

2-3/week, high rep range, compound, max vol effort

Question 35

Osteoarthritis and rheumatoid flexibility guidelines

Answer 35

4-5/week, no pain, 15-30s stretch, all major muscle groups x 2-4