Osteoarthritis Dx and Tx

Question 1

Can pts with osteoarthritis present with mono-, oligo-, or polyarthritis?

Answer 1

• YES

Question 2

What are the symptoms of osteoarthritis?

Answer 2

• PAIN= localized to characteristic joints.
• STIFFNESS= generally less than 15 mins duration.
• onset gradual and additive
• acute and intermittent flares

Question 3

Does pain from osteoarthritis become more aggravated or improve with activity?

Answer 3

• aggravated

* contrast to ankylosing spondylitis, which improves with activity.

Question 4

Will 80% of pts over age 55 show x-ray evidence of osteoarthritis?

Answer 4

• YES

* more women than men

Question 5

What are the risk factors for OA?

Answer 5

• age
• obesity
• trauma
• occupational hx
• genetic factors

Question 6

In contrast to RA, what type of disease is osteoarthritis?

Answer 6

• disease of CARTILAGE, where increased water content leads to softening, fissuring, and microfractures, resulting in sclerosis and bone cysts.

Question 7

What is the hallmark of osteoarthritis (OA)?

Answer 7

• EBURNATION and new bone formation

Question 8

Is osteoarthritis a non-inflammatory disease?

Answer 8

• YES, but we will see microscopic inflammation.

Question 9

What are the types of idiopathic (primary) OA?

Answer 9

• localized

- generalized (Kellgren-Moore).

Question 10

What will you classically see in the DIPs of pts with OA?

Answer 10

• Heberden’s nodes

Question 11

What will you classically see in the PIPs of pts with OA?

Answer 11

• Bouchard’s nodes

Question 12

What is secondary OA?

Answer 12

• brought on by trauma, prior bone disorder (aseptic necrosis, infection, RA), neuropathic disorder (Charcot’s), metabolic disorder (alkaptonuria, wilson’s, hemochromatosis), or congenital disorder.

Question 13

What medication can lead to avascular necrosis (usually of the femoral head)?

Answer 13

• corticosteroids

Question 14

What age does OA usually occur?

Answer 14

• over 40

Question 15

What is the joint distribution of OA?

Answer 15

• DIP, PIP, first CMC, knee, hip, first MTP, spine

Question 16

What joints are usually SPARED in OA?

Answer 16

• MCPs
• wrists
• shoulders
• elbows
• ankles

Question 17

Does pain get better or worse as the day goes on in OA?

Answer 17

• worse

Question 18

What labs will you see with OA?

Answer 18

• cbc= normal
• esr= normal
• RA= negative
• normal chemistries
• group I synovial fluid

Question 19

Will you see symmetric or asymmetric joint space narrowing in OA?

Answer 19

• asymmetric

Question 20

What x-ray findings will you see in OA?

Answer 20

• asymmetric joint space narrowing
• bony sclerosis (eburnation)
• osteophyte formation
• bone cysts
• subluxation and ankylosis (late)

Question 21

Will you see erosions in OA?

Answer 21

NO

Question 22

What should be on your DDx for OA?

Answer 22

• RA
• other DIP diseases (psoriatic, reiter’s)
• CPPD
• aseptic necrosis, PVS, infections

Question 23

How do we manage OA?

Answer 23

• patient education and reassurance
• physical and occupational therapy
• medications
• supportive services

Question 24

What pharmacologic therapies do we use for OA?

Answer 24

• acetaminophen
• NSAIDs
• opioid analgesics

Question 25

What injections can you use for OA?

Answer 25

- steroid | - hyaluronic acid (lubricating solution).