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42 Cards in this Set
- Front
- Back
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What are the hallmarks of osteoarthritis?
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Loss of articular cartilage
Increased bone formation The end point of these processes is joint pain and dysfunction |
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Where on the bone does the dysfunction take place in osteoarthritis?
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Subchondral bone plate
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What are the cells that synthesize cartilage matrix? What else do they produce?
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Chondrocytes
Also, generate degradative enzymes |
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What are the molecular components of the the normal extracellular matrix?
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Collagen II
Hyalouronan Proteoglycans |
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What is the normal blood supply to cartilage?
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There isn't any!
It's avascular |
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What is the cause of osteoarthritis?
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Damage to the cartilage caused by biomechanical force/trauma
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What occurs to the chondrocytes in reaction to repeated damage/trauma?
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Altered phenotype
Increased production of degradative enzymes, cytokines results in more net degradation than synthesis-->altered composition |
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What is the role of inflammation in OA?
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It's usually thought that inflammation doesn't have a big role...
BUT -Some cytokines found -Synovial thickening -Response to NSAIDs |
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What are the risk factors for OA?
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AGE!!!!! (75% of persons >70)
Genetics Biomechanical factors (Scholiosis, worked in hard labor entire life) Trauma Obesity FEMALES NMJ dysfunction (can't sense trauma) Metabolic disorders |
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Where are the most common places for OA changes on Xray?
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DIP
Knee Hip More changes in women than in men |
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What are the symptoms of OA?
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Pain:
-Worse with use -Worse as day progresses -If severe enough, rest/nocturnal pain Minimal morning stiffness Stiffness after inactivity (gelling) |
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What are the signs of OA?
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Pain with movement
Bony enlargement Restricted movement Crepitation Joint instability Joint deformity |
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Where are the most common places in the body for OA?
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Cervical, lumbar spine
Upper: PIPs, DIP, base of thumb Lower: hips, knees, 1st MT/Phalangeal joint |
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What are the labs that you do for OA?
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None!
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What are the different classes of joint fluids?
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Class 1: Clear, normal
Class 2: Inflammatory Class 3: Septic/gout; pus, neutrophils Class 4: Sickle cell; hemorrhagic |
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What are the signs of OA on Xray?
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Joint space narrowign
Marginal osteophytes Subchondral cysts Bony sclerosis Malalignment |
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If there's "OA" in a joint that shouldn't have it, what should you think?
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Think about a secondary cause!!
-trauma -NMJ disease (diabetic, other neuropathies) -Metabolic disorders |
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How do you differentiate between diabetic neuropathy and calcium pyrophosphate deposition disease?
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Diabetic: lower extremity bias
CPPD: upper extremity bias |
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What parts of the body are affected by diabetic neuropathy?
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MTPs 2-5, as well as the 1st
Midfoot |
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What are the signs of diabetic neuropathy on plainfilms?
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Super destructive changes!
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What are some of the nonpharmacologic therapies for OA?
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Weight loss
Hot/cold application Joint protection: strengthen the muscles around the joint PT: splints, exercises, water therapy Orthotics!!! (correct the valgus deformity of the knees) |
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When giving meds to old people, what are some concerns that you need to have?
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GI: slowed motility, altered pH, past surgery
Increased fat: lean body weight Hepatic: decreased oxidation, liver disorders Decreased GFR Neurologic disorders--> increased cholinergic SEs |
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What are some of the medical therapies for OA?
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1. Acetaminophen
2. NSAIDs Higher/more extreme -Tramadol -Opioids -Topical agents -Central pain agents |
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What is the maximum dose of acetaminophen?
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4 g/day in healthy person; elderly, 3g/day or less
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What are some of the side effects of acetaminophen?
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Liver toxicity
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What is a special concern that you need to have when giving out acetaminophen?
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Lots of different kinds of meds have it inside of it...need to be careful about dosing/educating the patient
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What substance shouldn't you use with acetaminophen?
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Alcohol
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What are some of the toxicities associated with NSAIDs?
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GI
Renal CV |
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What is the mechanims of the NSAIDs?
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COX-2 inhibitors
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What pathways does tramadol affect?
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Opoid
Serotonin |
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What is the effect of tramadol on mucosal membranes?
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NOTHING!
It doesn't cause ulcers |
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What are some of the side effects of tramadol?
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Nausea
Vomiting Lowered seizure threshold Constipation Drowsiness Diziness |
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What are some of the topical agents used in OA?
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Capasacin
NSAIDs |
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What is the effect of using capsaicin in OA?
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Desensitizes the body there to pain by having pain fibers fire all of the time.
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What are indications for using intra-articular steroids?
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Knee pain
Gives good pain relief |
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What is a transient effect of intra-articular steroids?
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Poor glucose control for up to 10 days.
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What are the effects of injecting hyalouronate into joints? How long does it take to work?
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Symptomatic relief; improved function
Benefits don't take place until after a month of injecting Also, it requires a series of injections |
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What are some of the CAM therapies for OA?
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Ingested: ginger, willow bark, stinging nettle, MSM, fish oil
Glucosamine sulfate + chondroitin Acupuncture Tai Chi |
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What are some of the surgical interventions for OA?
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Osteotomy: resection of some of the joint to shift load to a different portion
Arthroplasty: joint eplacement Arthrodesis of 1st TMT joint |
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What is the initial treatment for OA?
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-Muscle strengthening exercies
-Weight loss -Adunctive therapies -Acetaminophen -Local heat/cold |
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What is the second-line treatment for OA?
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-NSAIDs
-Intra-articular agents -Others -Opioids -Central pain agents |
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What are the third-line treatments for OA?
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-Osteotomy
-Joint replacement |
