Osteoarthritis Flashcards
(29 cards)
Osteoarthritis - gen info
most common arthropathy - involves cartilage
non-inflammatory
path and findings the same regardless of jt involved
OA - multifactoral etiology
progressive deterioration and loss of articular cartilage
-> loss of normal jt structure and function
Primary - aging (60)/ genetic (nodal OA)
Secondary - disorders that damage joint surfaces
trauma
2 principle mechanisms of OA
damage to normal articular cartilage by physical forces
chondrocytes react - degradative enzymes,
inadequate repair response
fundamental defective cartilage fails under normal jt loading - Type II collagen gene defect (Ochronosis)
Describe Type II collage gene defect
ochronotic cartilage - pigmented and defective
OA - pathologic characteristics
altered chondrocyte fxn loss of cartilage subchondral bone thickening- sclerosis remodeling of bone - marginal spurs(osteophytes) cystic changes insubchondral bone mild reactive synovitis
OA risk factors - systemic
age, obesity, genetics, gender(M>W), menopause?
OA risk factors - local
muscle strength, joint proprioception, repetitive use, configuration of joint(extra pressure in areas), trauma
OA common presentations
C-spine, L spine, 1st CMC, PIP, DIP!!!, Hip, Knee, 1st MTP
osteoarthritis - locations
hands - nodal
heberdens nodes - dip
bouchards nodes - pip
1st CMC jt - base of thumb
Knees - most common location med/lat/pat-fem
Hips
spine
feet 1st MTP
OA symptoms
insidious onset joint pain w/ movement limitation of motion/ decreased fxn minimal stiffness after rest referred pain no acute flares not systemic
Why OA painful - no nerves in cartilage
synovitis jt capsul/ligament stretching periosteal irritation from osteophytes trabecular microfractures muscle spasm intraosseous hypertension
OA physical exam
bony changes in jt shape crepitus malalignment/instability limited ROM Jt line tenderness cool effusions - no inflammaiton no pannus/tcells spasm or atrophy of adjacent muscles
OA x ray findings
cartilage loss/ joint space narrowing
subchondral sclerosis
osteophytes at jt margins
subchondral cysts
Types of OA
generalized nodal spondylosis erosive inflammatory - rare from overuse diffuse idiopathic skeletal hyperostosis (DISH chondromalacia patellae - young girls
findings with inflammatory osteoarthritis
fuzzy cartialge on arthoscopy
inflamed heberdens nodes
findings with erosive OA
big cysts/holes
spondylolysis - wearing through pars interarticularis at L5/S1
spondylolystheisis - spondylolis with translation
what is a syndesmophyte
body growth inside of cartilage- often intervertebral joints
what is spondylitis
inflammation of vertebrae (ankylosing spondylitis)
What causes DISH?
compulsive osteoblasts
entheses are the point of origin
non inflammatory
DISH symptoms
up flowing osteophytes
in c-spine - causes dysphagia
Right sided candle wax ossification (opp in situs inversus)
Environmental factors of DISH
fluoride
synthetic retinoids
obesity
IGF-1
best place to look for DISH
thoracic spine
flowing anterior osteophytes on the anterior of the thoracic vertebrae
downward pointing spurs in C-spine
calcification of the post long ligament
upward pointing lumbar osteophytes
ligamentous calcification at the entheses (whiskering)
foot and ankle entheses calcification
Chondromalacia of the patella
young girls with wide Q angle
patella tracks incorrectly
shredded cartilage on scope
goals of management of OA
no cure pain control improve function enhance health related quality of life avoid rx-related side effects pharmacologic treatment
