Osteoarthritis

Question 1

How does osteoarthritis distribute throughout the body?

Answer 1

1. Hands (Basilar CMC is common)
2. Spine
3. Hips
4. Knees
5. 1st MTP

Question 2

IS OA mono,oligo, or polyarticular?

Answer 2

Can be all of them!

Question 3

What are the clinical characteristics of someone with OA?

Answer 3

1. Age > 50
2. Morning stiffness < 30 min
3. Crepitus
4. No inflammation
5. Bony enlargement

Question 4

What lab findings would you see in OA?

Answer 4

ESR not elevated (<40)
RF titer low
Noninflammatory synovial fluid

Question 5

What are the radiographic findings of someone with OA?

Answer 5

1. osteophytes
2. joint space narrowing
3. Subchondral cysts/sclerosis
4. malalignment

Question 6

What are causes of secondary OA?

Answer 6

1. Inflammatory dz (RA)
2. Trauma
3. Hemachromatosis

Question 7

What are osteophytes?

Answer 7

Areas of bone hypertrophy with absent cartilage

Question 8

What are the histological changes you would see in OA?

Answer 8

Hypercellularity of cartilage
Loss of acid mucopolysaccharide (red areas)
Eventual clefts show up in the cartilage

Question 9

What are the physical changes in the cartilage seen in OA?

Answer 9

1. Higher water content of cartilage=soggy
2. Cartilage is more pliable
3. Osteophytes
4. cartilage loss
5. narrowing of joint spaces

Question 10

Describe the pathophysiology of OA

Answer 10

Proliferation of adult chondrocytes

• > Matrix degradation and downregulating of cartilage repair
• > BMP, TGF beta released into the joint space

Question 11

What are the differences in distribution of OA vs RA? And timing of onset?

Answer 11

OA: SLOW insidious onset of a FEW joints. Can commonly present first in the knees/hips
RA: subacute or acute onset of many joints almost always the hands first

Question 12

OA of the DIP joint is called?

Answer 12

Heberdon’s

Question 13

OA of the PIP joint is called?

Answer 13

Bouchard’s

Question 14

Which part of the knee is more commonly affected in OA?

Answer 14

Medial knee is more commonly affected. Results in bow-legs

Question 15

What are the risk factors for OA?

Answer 15

1. increasing age
2. gender
3. obesity
4. joint injury
5. previous deformity
6. ligamentous laxity
7. Post menopause
8. Injuries (fractures, meniscal injuries, repetitive use (tennis elbow)

Question 16

Does running result in increased risk of RA?

Answer 16

Moderate running=NO

Question 17

Is there a genetic risk to OA

Answer 17

YES. But unlike RA, there is not single gene that can account for OA

Question 18

What is at the top of your differential if a young person has osteoarthritis of the MCP?

Answer 18

Hemochromatosis

Question 19

Is there a correlation btw the clinical findings and morbidity of OA?

Answer 19

NO. Can have little pain but lots of changes in the joints or vice versa

Question 20

What are the medications that can alter the progression of OA?

Answer 20

None! Meds can only alleviate the pain. (NSAID, tylenol, cortisone injections, etc) However, exercise and weight loss can alter the progression of OA

Question 21

What are the only effective treatments for RA?

Answer 21

1. weight loss
2. exercise
3. joint replacement