Rheum/osteo arthritis Flashcards

Question

Characteristics of Synovial Joints

Answer 1

**Articular cartilage** Made of hyaline Covers the ends of bones Provides shock absorption, stability, and lubrication **Synovial membrane** Loose, vascularized connective tissue **Secretes synovial fluid** into the joint cavity for lubrication **Joint/articular capsule** A fibrous connective tissue that surrounds the bony ends forming the joint

Answer 2

Irreversible, progressive multifactorial disease affecting the entire joint **Most common form of arthritis** (> 70% of all cases of arthritis) Traditionally known as “wear and tear arthritis” Incidence: Affects ~41 million people in the United States (www.arthritis.org) Prevalence increases with age 80–90% of individuals < 65 years have radiographic osteoarthritis (OA) Symptoms are generally not noticed until after the age of 50

Answer 3

Primary Osteoarthritis Idiopathic form Secondary Osteoarthritis Caused by another disease or condition **Obesity** Repeated trauma or surgery to the joint Infection Congenital abnormalities (scoliosis) **Metabolic disorders:** Gout Hemochromatosis- MCPs Bone disorders: Paget’s disease

Answer 4

**Age - ↑ with age Obesity** Sex: Women > Men Physical activity and repetitive use Joint injury Muscle weakness or dysfunction Genetics and family history

Answer 5

Hands **PIP and DIP joints CMC joint** Feet **1st MTP joint** Shoulder Hips…younger age! Knees Spine Neck Low back

Answer 6

**Degradation of the articular cartilage** and **remodeling of bone** due to an active response of **chondrocytes** in the cartilage and the **inflammatory cells** in the surrounding tissues Release of degradative enzymes from **chondrocytes causes breakdown of collagen and proteoglycans**→ destruction of the articular cartilage Exposure of underlying subchondral bone → **sclerosis** and reactive **remodeling changes** (**formation of osteocytes and subchondral bone cysts**) Progressive **loss of joint space** over time

Answer 7

Gradual onset of achy pain **Asymmetric** More severe with: Activity and Weight bearing Relieved with rest Later in the disease: Pain is more constant Affects sleep and level of activity **Radicular pain** results from: (pain that shoots down) Spondylolisthesis Nerve impingement ## Footnote Spondylolisthesis: displacement of a vertebra forward in relation to the vertebra below

Answer 8

Most noticeable upon awakening or after being inactive Duration **< 30 minutes** Improves with movement **Swelling of the joint** **Limited range of motion** (ROM) Sensation of **joint instability, locking, buckling Crepitus**- Crackling, crunching, grinding or grating noise

Answer 9

Joint line tenderness Limited range of motion (ROM) Crepitus with passive ROM Evidence of osteophytes **DIP joints: Heberden’s nodes PIP joints: Bouchard’s nodes First CMC joint: thumb squaring** Knee varus or valgus deformities

Answer 10

Clinical diagnosis that is confirmed with imaging Radiography Classic findings: Joint space narrowing (asymmetric) Subchondral sclerosis Osteophytes Subchondral cysts (late) Findings do not correlate well with symptoms No specific blood test for the diagnosis of osteoarthritis

Answer 11

1 - Joint space narrowing 2 - Osteophytes 3 - Joint destruction 4 - Involvement of the carpometacarpal (CMC) joint which is very common

Answer 12

Used to exclude other causes of arthritis Everything should be normal Arthrocentesis with synovial fluid analysis Non-inflammatory with a **WBC count < 2,000 cells/μL** Crystal analysis to rule out gout and pseudogout Laboratory testing Negative rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) Normal erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) Negative antinuclear antibody (ANA)

Answer 13

Goals of management include alleviating pain and minimizing the loss of physical function General conservative measures Lifestyle modifications: Minimize weight bearing activities Good posture Sleeping on a firm mattress Wearing supportive shoes **Weight loss** **Physical therapy** to increase: Strength Flexibility Range of motion Endurance Assistive devices: Cane, brace, splints, and taping Hot and cold therapy

Answer 14

Acetaminophen (Tylenol) Oral and topical nonsteroidal anti-inflammatory drugs (NSAIDs) Muscle relaxants Cyclobenzaprine, methocarbamol Relieve pain from strained muscles Use with caution in elderly patients Duloxetine (Cymbalta) – second-line agent Can be used in patients with contraindications to NSAIDs Alternative for those who do not respond to first-line therapies Corticosteroids Should not be used chronically Can be used orally or as an intra-articular injection Hyaluronic acid Intra-articular injection Supplements Glucosamine & chondroitin Evidence is limited Opioids – BE CAREFUL! Can be considered for short-term use For patients who fail or are not candidates for other treatments Consider referral to a chronic pain management clinic ## Footnote Tramadol (Ultram) is the only opioid medication listed as a medication option through the Arthritis Foundation

Answer 15

Reserved for patients with advanced disease who have failed other treatments Total joint arthroplasty (replacement) is the most common procedure

Rheum/osteo arthritis Flashcards

(42 cards)