Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Block 2 - MSK > WEEK 5 - MINI LECTURES - OSTEOARTHRITIS > Flashcards

WEEK 5 - MINI LECTURES - OSTEOARTHRITIS Flashcards

(60 cards)

Start Studying
1
Q

What is OA

A
  • progressive disease
  • failed repair of joing damage that has been triggered by abnormal intra-articular stress
  • synovial inflammation in OA may be secondary to breakdown of cartilage and bone
  • all tissues of joint are involved
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

OA disease vs OA illness

A
  • disease: radiographic OA: 30% of adult population

- Illness: pain: 10% of adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Criteria for hand diagnosis of OA

A
  • hand pain, aching, stiffness

3 or more of

  • hard tissue enlargement of 2 or more of 10 selected joints
  • hard tissue enlargement of 2 or more DIP joint
  • fewer than 3 swollen MCP joint
  • deformity of at least 1/10 joints
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

ACR criteria for diagnosis of knee OA: clinical and laboratory

A
  • knee pain plus at least 5 of the following
    1) >50 yo
    2) stiffness for less than 30 min
    3) crepitus
    4) bony tenderness
    5) bony elargement
    6) no palpable warmth
    7) ESR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

ACR criteria for diagnosis of knee OA: clinical and radiographic

A

Knee pain + 1+ of the following:

  • age 50+
  • stiffness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

ACR criteria for the diagnosis of knee OA: Clinical

A
  • knee pain + at least 3 of the following
    1) age 50+
    2) stiffness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Criteria for hip OA diagnosis

A
  • hip pain + 2+ of these features

1) ESR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Knee joint

A
  • largest, most complex joint in the body
  • synovial, modified hinge joint
  • articular surfaces: patellar surface of femur to patella, and femoral condyles to tibial plateau
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

KNEE JOINT collateral ligaments

A
  • fibular collateral ligament: round, cord like, separate from capsule, limits adduction
  • Tibial collateral ligament: broad and flat, blends with joint capsule, attaches to medial meniscus and limits movement, limits abduction movement, more commonly damaged
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Knee joint also stabilised by

A
  • biceps femoris and ITT on lateral side

- sartorius, gracillis, semitendenosis, semimembranosus on medial side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Knee joint menisci

A
  • fibrocarilage
  • lateral meniscus more mobile
  • medial mniscus more commonly injured
  • thicker laterally
  • outer part more supplied
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Knee joint - synovial joint

A
  • synovial joint caviry is the largest in the body -> communicates with suprapatellar bursae
  • cruciate ligaments are outside the synovial joint cavity
  • Bursae: 11 in knee joint: reduce friction between adjacent structures
  • bursae in the anterior of the knee may become inflammed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Ligaments of the hip joint

A
  • 3 major stabilising ligaments: iliofemoral, pubofemoral, ischiofemoral
  • are thickenings of capsule
  • taut on extension -> more stable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Synovial joints: normal morphology and function

A
  • different tissues functioning together to enable movement, provide frictionless bearing and transmit load
  • have proprioceptive function
  • are able to adapt to different physiological requirements/loads
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Bone morphology and function

A
  • continuum from diaphysis to metaphysis to subchondral plate
  • absorb and translate load
  • rapidly adaptable - remodelling
  • really about load bearing capacity
  • 1st affected in OA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Cartilage normal morphology and function

A
  • calcified and non calcified
  • different morphology, biochemistry, metabolism and function deep to superficial and topographially
  • compression resistant, frictionless
  • surface: parallelly oriented
  • deeper: more vertically oriented
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Joint capsule, synoviu, synovial fluid: morphology and function

A
  • filtration barrier: protein, cells: reduce cell influx
  • immune privileged
  • lubrication
  • nutrition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Meniscus: morphology and function

A
  • load translation, lubrication, proprioception
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Ligaments and capsule: morphology and function

A
  • ligaments (and capsule)
  • constrain and regulate range of motion
  • proprioception
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

OA - a disease of the joint organ - BONE

A
  • increased bone formation: subchondral thickening, osteophytes, enthesophyte
  • lower bone mineral density, increased turnover
  • increased vascularity
  • BML - necrosis, microfractute
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

OA - a disease of the joint organ - CARTILAGE

A
  • loss of aggrecan early on (reversible)
  • Collagen breakdown in late stages (irreparable)
  • cartilage loss is an autplytic process: the cells taht lay down cartilage also produce proteins that break it down (ADAMTS)
  • hypertrophic differentiation and apoptosis
  • recapitulates grown plate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

OA: a disease of the joint organ: JOINT CAPSULE, MENISCUS, LIGAMENT

A
  • capsule fibrosis, loss of SF HA and lubricin
  • inflammation - innate and adaptive
  • altered biochemistry , loss of biomechanics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

OA is NOT just a wear and tear - its an active disease

A
  • respond to external signals
  • drive the pathology and pain pathwyas
  • interactions between structures
  • extrinc factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Study if you target one system

A
  • different OA models compared in same GM strain
  • 70% had same outcome
  • 30% have a different outcome
  • molecular pathophysiology differs with OA phenotype
  • makes it difficult to find a treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
4 general pathways of OA
- cartilage matrix degradation - chondrocyte hypertrophic differentiation and apoptosis - inflammation/synovitis - bone turnover
26
Pain sensitive structures in the normal knee
- joint capsule - ligaments - outer third of meniscus, especially near capsule - periosteal and subchondral bone - synovium - soft tissues including fat around and deep to patellar tendon (LAST 3 MOST IMPORTANT)
27
Other reasons for pain
- pain behavior, distress, disability - SES - psychosocial comorbidity - altered cortical processing, spinal cord gating, PNS...
28
Prevalence of kneee pain and OA in persons age 55+
- 25% of adults above 55 have had more than 4 weeks of knee pain, half of them had radiographic evidence of OA
29
Characteristic symptoms of OA
- pain is mechanical in nature - occurs with activity and is relieved with rest - insiduous onset of pain - morning stiffness absent or lasts
30
Other symptoms of OA
- limited function or disability - joint swelling - feeling of giving way - reduced ROM
31
Physical examination of OA
- tenderness over joint line - crepitus - bony enlargement - reduced ROM - joint swelling/deformity - instability/laxity of joint
32
Other types of arthritis that may involve hip, knee or hand
- RA - Psoriatic arthritis - otehr seronegative spondyloarthripathies - crystal arthropathy - sarcoidosis
33
Diseases that can predispose to OA
- metabolic diseases - endocrine diseases - hypermobility - crystal arthropathy (gout) - neuropathic joint - chondrodysplasia
34
Other common causes of hip pain
- trochaneric bursitis - iliopsoas tendonitis - referred pain from lumbosacral spine - avascular necrosis - inguinal hernia - hip fracture
35
Radiographic patterns of OA
1) patellofemoral: most common 2) medial tibiofemoral (50% cooccur with patellofemoral) 3) lateral tibiofemoral: less common
36
Other common causes of knee pain
- pes anserine bursitis - ITT friction sundrome - patella tendonitis - PFPS - prepatellar bursitis - semimembranosous bursitis
37
HEberden's and bouchard's nodes
- most commonly affected by OA - Heberden's node: distal IP of third finfer - Bouchard node: middle IP of second finger - base of thumb also prevalent: squaring deformithy
38
Other common causes of hand pain
- De Quervain's tenosynovitis - Carpal tunnel syndrome - flexor tenosynovitis - Ulnar nerve compression
39
Lab test and OA
- non contributory as OA is a non-inflammatory arthritis - aspiration if another diagnosis is feared - synovial fluid in OA should be clear and viscous with a WCC
40
Role of radiography in OA
- confirm clinical suspicion and exclude other conditions | - can see osteophyte formation, joing space narrowing, subchondral sclerosis, sunchondral cyst
41
X ray of hand and wrist principles
- bone more than soft tissue - centred on important part, close to film - joint surgace in multiple projections - often useful to include both hands to compare - need good spatial detail
42
Osteoarthritis X ray changes - general changes
- cartilage loss - non uniform joint space thinning - subchondral bone sclerosis, cyst formation, intraarticular lose bodies - reactive proliferative changes; sclerosis, osteophytes - weakening: isntabilities, malalignment, capsular tears ganglia - absence of erosive changes
43
OA specific changes on XRAY
- symmetrical - DIP 2 and 3 - IP thumb - MC thumb - deformities: heberden, bouchard
44
Geodes
- subchondral cysts | - lucent space in subchondral bone formation
45
Ganglia and mucous cysts
- common at the back of the wrist | - localised collection of joint fluid
46
OA: aims of management
- patient education about both the disease and its management - pain control - improvement of function - alteration of the disease process and its consequence: disease modification
47
Algorhythm for OA management
1) Non pharmacological management (education, exercise, weight loss, appropriate footwear) 2) physiotherapy, braces, simple analgesic 3) pharmacological management: NSAIDS, opioids 4) Surgery: osteotomy, total joint replacement
48
Concomitant morbidities
- 90% overweight/obese - 60% have hypertension - 20% have depression - 20% have diabedeteied
49
Knee osteoarthritis - prevention - progression - palliation
1) Prevention: obesity, joint injury 2) progression: reduce load, disease modification 3) palliation: analgesia, joint replacement
50
What is the most important intervention for OA
- weight loss | - those that lost 10% of their body weight improved by 50% in their symptoms
51
EWxercise
- generally ineffective at home because exercise trechnique not appropriate - exercise leads to improvement in strength, proprioception, pain and function - combination of strength training and aerobic conditioning - low impact exercises
52
ConclusionOA management
- adequate pain control still unmet need - dichotomy between guidelines and clinical practice - focus management on risk factors - reduce compressive load - recognize those at risk and encourage them to lose weight
53
OA epidemiology and prevention
1: 8 australians are affected by OA 2: 1 F:M - disease of old age, but 2/3 are still in working age
54
Risk factors for OA
- Susceptible joint: injury, alignment, limp length inequality, structural abnormality, muscle eweakness... - susceptible individual: obesity, age, gender, race, genetic predisposition, dietary
55
Surgical options for OA
- arthroscopic surgery - chondrocyte implantation - relaignment osteotomy - joint replacement
56
Arthroscopic surgery
- no direct benefit for OA -> not indicated if symptoms are mostly related to OA - possible role in significant displaced meniscus tears or early OA
57
Joint replacement
- commonly performed - mostly for old patients - for advanced OA clinically and radiologically - failure of non operative treatment - severe pain and disability
58
Total knee replcement especially for
- more than one compartment affected - fixed deformity - stiffness - all joint surfaces replaces with metal and plastic components - computer navigation - postoperatively
59
Contraindications to joint replacement
- active infection - knee: absent extensor mechanism - hip: absent abductor mechanism - medically unfit
60
Outcomes of joint replacement
- reduced pain - increase activity level - improved fitness and longevity - improved quality of life - not normal but not much improved - hips surgery slightly more successful than knees - approximately 5% revision surgery over 10 years

Block 2 - MSK (38 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions