Osteoarthritis Flashcards by Michael MacDiarmada

Q

How does osteoarthritis occur?

A

when abnormal loads are placed on a normal joint or when normal loads are placed on an abnormal joint

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

How is OA characterised?

A

Pain Limited ROM plus or minus deformity of the joint

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

OA of the facet joint of the spine is called what???

A

Spondylosis

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What is OA associated with?

A

Increased BMI and aging

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What percentage of the population over 55 years have OA?

A

44-70%

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What percentage of the population over 75 years of age have OA?

A

85%

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What joints of the hand most commonly are associated with OA?

A

DIPJ and CMC

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Name a biochemical change in OA?

A

articular cartilage

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Name a biochemical change in OA?

A

Loss of proteoglycan relative to collagen

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Name a biochemical change in OA?

A

Decrease in water content and permeability

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Name a biochemical change in OA?

A

reduction in collagen tensile stiffness and strength

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Name a biochemical change in OA?

A

Proteolytic enzymes- matrix mer
mettalloproteases (MMPs)

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Name a biochemical change in OA?

A

Pro-inflammatory cytokines; TNF, IL 1b

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Pathology of OA

A

Failed attempt at repair

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Pathological changes in OA

A

Joint Space Narrowing

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Pathological changes in OA

A

bony sclerosis

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Pathological changes in OA

A

excessive shear at the joint space

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Pathological changes in OA

A

osteoblast activity as attempt to redistribute load

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Pathological changes in OA

A

osteophyte formation

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

How many stages of degeneration are there in knee OA?

A

IV

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Stage IV Knee OA

A

joint-space greatly reduced 60% cartilage lost - large osteophytes

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What are modifiable risk factors in OA?

A

Obesity (knee/hip)

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What are modifiable risk factors in OA?

A

Occupation / heavy work

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What are modifiable risk factors in OA?

A

Excess physical activity

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

What are unmodifiable risk factors in OA?

Age

What are unmodifiable risk factors in OA?

Genetics 40%-80%

What are unmodifiable risk factors in OA?

Local bony changes Pincer/cam/hip dysplasia

What are unmodifiable risk factors in OA?

Previous joint trauma

What are unmodifiable risk factors in OA?

ACL injury

What are unmodifiable risk factors in OA?

intra-articular fracture

What are unmodifiable risk factors in OA?

female gender

Which is an example of Primary OA?

Idiopathic (spontaneous onset)

Which is an example of Primary OA?

Small joints, hand, hip & knee

Which is an example of Primary OA?

May affect >1 joint

Which is an example of Primary OA?

Genetics

Which is an example of Secondary OA?

Specific to one joint

Which is an example of Secondary OA?

Post-inflammatory arthritis e.g. RA

Which is an example of Secondary OA?

Post-traumatic (e.g. tibial plateau fracture)

Which is an example of Secondary OA?

Post-traumatic OA e.g. post ACL repair

Clinical Dx of OA

joint pain

Clinical Dx of OA

stiffness <30mins am or prolonged rest

Clinical Dx of OA

+/- crepitus on movement

Clinical Dx of OA

bony enlargement

Clinical Dx of OA

little to no swelling

Is radiological Dx necessary for OA?

Clinical Dx can be made without x-ray imaging

What are radiological symptoms of OA?

joint space narrowing

What are radiological symptoms of OA?

+/- Osteophyte formation

What are radiological symptoms of OA?

+/- Bony sclerosis

Name a differential diagnosis to OA of the hip

Hip labral tear

Name a differential diagnosis to OA of the hip

FAIS - CAM / PINCER deformity

Name a differential diagnosis to OA of the Knee

degenerative meniscal injury

Pain referral differential diagnosis?

Knee pain referred from the hip

Pain referral differential diagnosis?

Hip pain referred from the spine

What are the most common joints of the hand in OA?

CMC, PIP, DIP

Having at least on co-morbidity is significantly associated with worse, or greater deterioration of symptoms of pain and physical function. True or False?

True

Is OA related pain mechanical or inflammatory in nature?

mechanical

Name OA pain symptoms

Activity related pain, worse at end of day after rest

How are symptoms of OA related pain eased?

Movement

What are symptoms of pain as OA disease progresses?

Night pain and resting pain

Dose cartilage cause OA pain?

No - it is anerual

Causes of OA related pain

peri-articular-capsule/ligaments

Causes of OA related pain

Periosteal

Causes of OA related pain

muscular

Causes of OA related pain

compensatory movement e.g. LBP

Causes of OA related pain

low grade inflammation

Stiffness is. a symptom of OA, how does this differentiate from RA stiffness?

The duration of stiffness

What can indicate OA joint in a physical examination?

Hard end feel

What can indicate OA joint in a physical examination?

Loss of PROM

Is stiffness objective or subjective?

Either

Name subjective features of OA

Psychological health

Name subjective features of OA

Fatigue, second to joint stiffness limited ROM & pain

Symptoms of a physical examination of an OA joint can present as...

heat

Symptoms of a physical examination of an OA joint can present as...

Erythema

Symptoms of a physical examination of an OA joint can present as...

Tenderness

Symptoms of a physical examination of an OA joint can present as...

Effusion

Symptoms of a physical examination of an OA joint can present as...

Discomfort

Symptoms of a physical examination of an OA joint can present as...

Pain

How can you tell if there is a loss of ROM in OA joints

compare right to left

Examination findings found?

Pain inhibition

Examination findings found?

disuse atrophy

Examination findings found?

Reduced function related to specific body region

Examination findings included

knee valgus/varus

Examination findings included

hand heberden's (DIP) & Bouchard's nodes (PIP)

Examination findings in more advanced OA included

Foot-Hallux Valgus

Joint instability examination findings in more advanced OA included

Ligament laxity, compounded by muscle weakness

Pharmacological management of knee OA with comorbidities

Topical NSAIDS - Feldene & Voltorol

Name an oral NSAIDS for OA

difene, aulin, mobic

What are the side effects of difene, aulin and mobic?

GI & CVS side-effects (may need proton pump inhibitor

What are side effects of intra-articular steroid injections for knee OA?

Recurrent cortisone injections can decrease cartilage volume.

What DMOADS are not recommended for OA?

Chondroitin sulphate & Glucosamine

does Paracetamol have a benefit in OA?

No

Are opioids recommended for OA pain relief?

No

What surgical options are available for OA hip and knee?

THR / TKR / Osteotomy

Name an outcome measure used by physiotherapists in OA patients?

WOMAC

Name an outcome measure used by physiotherapists in OA patients?

KOOS

Name an outcome measure used by physiotherapists in OA patients?

HOOS

Name an outcome measure used by physiotherapists in OA patients?

AUSCAN

Name the molecular composition of bone

30% Organic, 70% Mineral (inorganic)

What inorganic minerals make up the 70% of inorganic composition of bone?

Calcium, Phosphate, Magnesium, Sodium & 5% water.

What are the 2 classification types of bone?

Cortical Bone & Trabecular bone

What does cortical bone consist of?

Dense calcified tissue, providing structure and protection.

What dose Trabecular Bone consist of?

horizontal and vertical interconnecting plates permit marrow, blood vessels and connective tissue to be in contact with the endosteum