Osteoarthritis

Front 1

What is the most common form of arthritis?

Back 1

Osteoarthritis

Front 2

List some factors that contribute to osteoarthritis

Back 2

Older age

Female gender

Genetic predisposition

Joint misalignment

Muscle weakness

Obesity

Macrotrauma and microtrauma

Compromised joint integrity (RA, gout, etc.)

Front 3

What is the #1 joint affected by osteoarthritis?

Back 3

Knee

Front 4

After knee, which are the other most commonly affected joints in osteoarthritis?

Back 4

Hip

Hand (PIPs and DIPs, 1st MCP)

Front 5

Why is osteoarthritis painful?

Back 5

Referred pain from synovium, ligaments, joint capsule (distension due to effusion), muscle, or subchondral bone

(NOT due to articular cartilage degeneration, since it is not innervated)

Front 6

Describe the development of osteoarthritis in a joint

Back 6

Focal erosions of articular cartilage → erosion expands to include more joint surface → chondrocytes increase metabolic activity → surrounding proteoglycan matrix is depleted, making the cartilage more susceptible to further injury → activation of osteoclasts/osteoblasts below cartilage, producing a thick, stiff subchondral bony plate → new cartilage is produced at the margin of the joint → neurovascular invasion from bone causes ossification (osteophyte forms)

Front 7

What are the symptoms of osteoarthritis?

Back 7

Pain that worsens with activity

Stiffness with rest (limited to <30 minutes)

Bony enlargement on examination

Reduced range of motion

Soft tissue or joint swelling (but considerably less than seen in inflammatory diseases)

Front 8

What are Heberden's nodes?

Back 8

Bony swellings that develop in the DIP joints of the hands

Front 9

What are Bouchard's nodes?

Back 9

Bony swellings that develop in the PIP joints of the hands

Front 10

List the clinical manifestations of knee osteoarthritis

Back 10

Pain with walking, transferring, or stair climbing

Crepitus with knee movement

Front 11

List the clinical manifestations of hand osteoarthritis

Back 11

Pain in the first MCP joint

Reduced grip strength

Nodal changes in the hand (DIP, PIP)

Front 12

List the clinical manifestations of hip osteoarthritis

Back 12

Groin pain with walking, bending, or stair climbing

Limited and painful internal rotation

Front 13

List the clinical manifestations of spine osteoarthritis

Back 13

Face joint arthritis

Radiculopathies (nerve impinged by osteophyte)

Front 14

What are the classical signs of osteoarthritis on a radiograph?

Back 14

Loss of joint space (e.g., medial knee progressing to lateral/patellofemoral compartments)

Osteophytes

Sclerosis (thickening of bone adjacent to articular cartilage)

Subchondral bone cysts (focal spherical lucency adjacent to articular cartilage)

Front 15

How is osteoarthritis treated?

Back 15

Reverse mechanical strain

Pharmacotherapy

Surgery

Front 16

List some strategies for reversing the mechanical strain in a joint with osteoarthritis

Back 16

Avoid activities which overload the joint

Improve the strength of the muscles that bridge the joint (low impact exercises, like water aerobics)

Redistribute the load on the joint (weight loss, splinting, canes, crutches, walkers, orthotics)

Front 17

What drugs are used in the management of osteoarthritis?

Back 17

Topical therapies (capsaicin, NSAID gels)

Oral therapies (acetaminophen, NSAIDs)

Intra-articular injections (glucocorticoids)

Front 18

What surgeries are performed to treat osteoarthritis?

Back 18

Arthroscopic interventions (joint irrigation +/- arthroscopic debridement - select patients only - not effective)

Osteotomy (knee - proximal wedge removal from tibia to correct varus deformities)

Partial joint arthroplasty (knee - unicondylar) or total joint arthroplasty (knee or hip)

Front 19

List some causes of secondary osteoarthritis

Back 19

Joint trauma (fracture, sports injury, septic arthritis, inflammatory arthropathies)

Calcium pyrophosphate deposition disease (CPPD, pseudogout)

Childhood conditions (slipped capital femoral epiphysis, Legg-Calve-Perthes disease, congenital hip dysplasia, limb length discrepancy)

Front 20

What are some clues to secondary osteoarthritis?

Back 20

Atypical age of onset (<50)

Atypical appearance (unilateral or asymmetric, erosive changes, narrowing w/o sclerosis or osteophytes, subchondral cysts w/o sclerosis or narrowing)

Atypical joint involvement (shoulder, elbow, wrist, MCPs, ankle, tarsals, etc.)