SM_225a: Osteoarthritis Flashcards Preview

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Flashcards in SM_225a: Osteoarthritis Deck (39)
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1

Describe osteoarthritis

Osteoarthritis

  • Joint failure, pathologic change in all joint structures
  • Hyaline articular cartilage loss, initially focal
  • Thickening and sclerosis of subchondral bony plate
  • Outgrowth of osteophytes at joint margins
  • Articular capsule stretching
  • Mild synovitis
  • Weakness of muscles bridging a joint

2

Describe the general schema of factors leading to osteoarthritis

Schema of factors leading to osteoarthritis

  • Systemic factors lead to OA susceptibility
  • OA susceptibility and local factors lead to OA disease

3

Describe risk factors for incident ostheoarthritis

Risk factors for incident osteoarthritis

  • Systemic: age (all joint sites), gender (all sites), genetic factors (many sites, especially hand), excess body weight (especially knee), certain occupations, elite athletic activity
  • Local risk factors: major injury (all, even atypical sites), meniscectomy (knee), developmental abnormalities (especially hip), varus alignment (knee), meniscal tear/extrusion (knee)

4

Describe why there is an increase in osteoarthritis with age

Increase in osteoarthritis with age due to age-related decline in

  • Neuromuscular joint protective mechanisms: muscle function, proprioception, soft tissues that stabilize joint
  • Biomechanical properties of cartilage matrix
  • Joint less able to rebound from injury
  • Reduced regenerative potential of joint tissue

5

Describe excess body weight in osteoarthritis

Excess body weight

  • Increases risk of incident and progressive knee OA
  • Weight in young adulthood/middle age predicts knee OA risk later in life
  • In overweight persons, weight reduction reduces risk of incident knee OA
  • Increases risk of hip OA (less than for knee)

6

Describe occupational risk factors for OA

Occupational risk factors for OA

  • Knee: frequent knee bending + heavy lifting, mining
  • Hip: farming
  • Elbow: jackhammer operation
  • Hand: cotton mill work

7

Describe nonoccupational physical activity as a risk factor for OA

Nonoccupational physical activity as a risk factor for OA

  • Recreational - no increase in risk
  • Non-elite athletic - no increase in risk, unless injury occurs
  • Elite athletic - increase in risk

8

Describe the effects of physical activity in OA

Effects of physical activity in OA

  • Certain amount of regular loading required for cartilage and bone health
  • Under experimental conditions, cartilage fibrillation and thinning seen in immobilized limbs and excessively loaded joints

9

Describe developmental abnormalities in OA

Developmental abnormalities in OA

  • Potentially any abnormality that alters joint sirface fit will increase risk of OA
  • Especially at hip: acetabular dysplasia

10

Describe the phases of OA

Phases of OA

  1. Phase 1: edema of extracellular matrix, microcracks on cartilage surface, focal loss of chondrocytes alternating with areas of chondrocyte proliferation
  2. Phase 2: microcracks deepen, vertical clefts form in cartilage, clusters of chondrocytes appear arround these clefs and at surface
  3. Phase 3: fissures cause cartilage fragments to break off (osteocartilaginous loose bodies), subchondral bone uncovered, subchondral cysts, mild synovitis (more focal and milder than RA), subchondral bone sclerosis

11

Describe Phase 1 of OA

Phase 1 of OA

  • Edema of extracellular matrix
  • Microcracks appear on cartilage surface
  • Focal loss of chondrocytes alternating with areas of chondrocyte proliferation

12

Describe Phase 2 of OA

Phase 2 of OA

  • Microcracks deepen
  • Vertical clefts form in cartilage
  • Clusters of chondrocytes appear around these clefts and at surface

13

Describe Phase 3 of OA

Phase 3 of OA

  • Fissures cause cartilage fragments to break off: osteocartilaginous loose bodies
  • Subchondral bone uncovered
  • Subchondral cysts
  • Mild synovitis: more focal and milder than RA
  • Subchondral bone sclerosis

14

Describe the joints most commonly affected in OA

Joints most commonly affected in OA

  • Primary: hands, cervical and lumbar spine, feet, knees
  • Hips: superolateral or inferomedial narrowing 

15

Describe the sites most commonly affected by primary OA

Sites most commonly affected by primary OA

  • Hands (DIP, PIP, first CMC)
  • Cervical and lumbar spine
  • Feet (1st MTP)
  • Knees: only tibiofemoral or only patellofemoral but not both, medial or lateral tibiofemoral compartment but not both
  • Hips: superolateral or inferomedial narrowing

16

Joint involvement in OA can be _____, _____, or _____

Joint involvement in OA can be monoarticular, oligoarticular, or polyarticular

17

When hips are affected by OA, there is _____ 

When hips are affected by OA, there is superolateral or inferomedial narrowing

18

Describe the pattern of joint involvement in primary OA

Pattern of joint involvement in primary OA

  • Hand
  • Cervical and lumbar spine
  • Feet
  • Knees 
  • Hips

19

Pattern of joint involvement in generalized OA is _____ + _____

Pattern of joint involvement in generalized OA is hands + at least one large joint

20

Secondary OA involves OA in joints ____, such as ____, ____, ____, and ____

Secondary OA involves OA in joints not typically affected, such as MCP, wrist, elbow, shoulder, and ankle

21

Describe generalized OA

Generalized OA

  • Hands + at least one large joint
  • Familial predisposition
  • More common in women, onset in middle age
  • Multiple Heberden's nodes
  • Polyarticular finger interphalangeal joint OA
  • Symptoms persist for years but settle down
  • Predisposition to OA at other sites such as knee

22

Describe secondary OA

Secondary OA

  • Premature onset
  • Atypical site: MCP, wrist, elbow, shoulder, ankle

23

Describe general clinical characteristics of OA

General clinical characteristics of OA

  • Onset tends to be gradual
  • Usually only one/few joints problematic at given time
  • Evolution of symptoms and structure change slow
  • Strong age association: men 40s and older, women peri-menopause and older

24

Describe symptoms of OA

Symptoms of OA

  • Aching
  • Early OA: increases with joint use, relieved by rest
  • Advanced OA: pain at rest as well as with use, night pain, not relieved easily, sleep interference worsens pain experience
  • Pain/structure change closest relationship at hip, weakest at hand and spinal apophyseal joints
  • Morning stiffness: ≤ 30 minutes, shorter than RA
  • Stiffness after inactivity
  • Swelling: less pronounced, less persistent then RA

25

Morning stiffness duration in OA is _____ than in RA

Morning stiffness duration in OA is shorter than in RA

26

Swelling in OA is ____ persistent than in RA

Swelling in OA is less persistent than in RA

27

In OA symptoms occur at ____

In OA symptoms occur at specific sites

28

Describe symptoms occuring at specific sites in OA

Symptoms occuring at specific sites in OA

  • Knee: pain global or compartmental, pain/difficulty with stairs and sitting to standing
  • Hip: pain in groin or deep posterolateral, pain/difficulty in/out of car and with putting on shoes and socks
  • Spine: pain in region of involvement, radicular symptoms of osteophytes compressing nerve roots

29

Describe physical exam findings of OA

OA physical exam findings

  • Bony enlargement
  • Limitation of motion: limited flexion, inability to achieve full extension
  • Crepitus
  • Malalignment
  • Mild inflammation, warmth, effusion (if moderate or severe consider joint infection or crystal process)

30

______ is a warning sign and symptom of OA

Marked joint inflammation is a warning sign and symptom of OA

  • Flares of OA are common and may show mild joint inflammation
  • More marked warmth, swelling, or redness warrants urgent investigation for another cause: crystal, septic arthritis (damaged joints are predisposed), coexisting crystal and septic arthritis

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