Osteoarthritis (OA)

Question 1

Joints that are commonly affected by OA (6)

Answer 1

Cervical spine
Lumbosacral spine
Hip
Knee
Hand
First metatarsal phalangeal joint  (big toe)

Question 2

Spared joints of OA

Answer 2

wrist,
elbow
ankle

Question 3

Risk Factors of OA (6)

Answer 3

Aging

Obesity

History of participation in
team sports

History of trauma or overuse of a joint

Heavy occupational work

Misalignment of the pelvis, hip, knee, ankle, or foot can contribute to the development of osteoarthritic changes.

Question 4

Etiology of OA

Answer 4

Stresses applied to joints (weight bearing)

Degeneration of cartilage

• Excessive loading of healthy joint
• Normal loading of previously injured joint

Chronic disease

Question 5

What is 8 steps in the patho of OA

Answer 5

Excess pressure on a joint gradually wears away the cartilage surface and the subchondral bone is exposed developing cysts.

Cysts move through the cartilage and destroy along the way

Chondrocytes synthesize a fluid called proteoglycans in an effort to repair the cartilage. This excess fluid causes swelling of the joint.

Localized inflammation (cytokines & mediators)  degradation of cartilage.

Osteoblasts are activated →leading to bony spurs → synovial fluid thickening

Proteoglycans and cartilage degeneration can occur for years.

As OA progresses the level of proteoglycans decreases.

Loss of cartilage  narrowing of the joint space.

Question 6

What are osteophytes

Answer 6

small bony projections that develop along the rim of bone adjacent to cartilage loss.

Question 7

What is an important hallmark of OA

Answer 7

Osteophytes

Question 8

What are the symptoms of OA (7)

Answer 8

Deep, aching joint pain, occurring especially after exercise or weight-bearing; relieved with rest.

Joint pain during cold weather

Stiffness when arising in the morning

Crepitus of the joint during motion

Joint swelling

Altered gait

Limited range of motion

Question 9

What are some physical examination findings of OA

Answer 9

Joint deformity

Joint tenderness

Decreased range of motion

Fingers are often involved in OA:

Swellings at the distal interphalangeal joint (DIP), called Herbeden’s nodes, and

Proximal interphalangeal joint (PIP), called Bouchard’s nodes.

Question 10

3 Treatment Goals of OA

Answer 10

manage pain

Maintain mobility

Minimize disability

Question 11

What is the focus of management of OA

Answer 11

pain and reduce swelling

Question 12

OA treatment of mild-moderate pain (3)

Answer 12

Acetaminophen (Tylenol)

Topical capsaicin

NSAIDS (OTC)

Question 13

OA treatment of moderate to severe pain (5)

Answer 13

NSAIDS (Rx strength)

NSAIDS + Colchicine

Tylenol + Tramadol

Opioids

Steroid injections

Question 14

How do NSAIDs work

Answer 14

reducing the production of prostaglandins (prostaglandins are what promotes inflammation, pain and fever)

Question 15

Caution about NSAIDs

Answer 15

Use the lowest effective dose possible

May effect kidney function

Risk for GI bleed
Risk increases drastically with aging
Contraindicated with peptic ulcer disease
Use caution if previous history of GI bleed or current anticoagulant therapy

Question 16

4 Pharm treaments of OA

Answer 16

Use of medications: NSAIDs; inhibit formation of prostaglandins

Intra-articular injection of glucocorticoids

Dietary supplements such as chondroitin sulfate and glucosamine may help

Artificial joint fluid containing hyaluronic acid, such as Synvisc

Question 17

2 Dietary Supplements in OA

Answer 17

Glucosamine Sulfate

Naturally occurring compound in body
Also a supplement
Maintains cartilage health
Decreasing amounts with age

Chondroitin Sulfate

Naturally occurring chemical in cartilage
Also a supplement
Might slow cartilage breakdown

Question 18

Degenerative Disc Disease (DDD) is common cause of what and where does it most often occur

Answer 18

pain
motor weakness
neuropathy

Most often occurs in lumbar or cervical spine

Question 19

What happens with age in degenerative discs

Answer 19

With age, intervertebral discs dehydrate and vertebral bone become compressed -> impinge on the entering and exiting nerves.

Dysfunction of motor and sensory spinal nerves impedes movement and sensation in the extremities.

May see weakness and paresthesia’s

Question 20

Signs and symptoms in the LUMBAR of DDD

Answer 20

Pain in the lower back that radiates down the back of the leg (also called “sciatica”)

Pain in the buttocks or thighs

Pain that worsens when sitting, bending, lifting, or twisting

Pain that is minimized when walking, changing positions, or lying down

Numbness, tingling, or weakness in the legs

Foot drop

Question 21

Signs and symptoms in the CERVIAL of DDD

Answer 21

Chronic neck pain that can radiate to the shoulders and down the arms

Numbness or tingling in the arm or hand

Weakness of the arm or hand