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27 Cards in this Set
- Front
- Back
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Osteoarthritis (OA):
Definition? Different terms used to refer to OA? Primary: arises from? Secondary: what diseases can be associated with OA? |
Definition
Progressive deterioration and loss of articular cartilage, leading to loss of normal joint structure and function Terms used interchangeably - Osteoarthritis (OA) - Degenerative Joint Disease (DJD) - Osteoarthrosis Primary: arising from unknown or hereditary causes Secondary to: other rheumatic diseases, trauma, neurologic disorder, metabolic disease, structural abnormality of the joint |
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Functions of Articular Cartilage? (2)
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1. Smooth gliding
2. Load support |
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COLLAGEN
Type? articular cartilage Function? Binds? |
1. Type II in articular cartilage
2. Produce tensile strength 3. Binds proteoglycan |
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PROTEOGLYCAN
1. Proteoglycan = ________ + _______ 2. Hydrophilic/Hydrophobic? 3. Function? |
1. Proteoglycan = glucosaminoglycan + link protein
2. Strongly hydrophilic 3. Produce resistance to compression |
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Biochemical Changes in Osteoarthritic Cartilage
Water? Collagen? Proteoglycan? |
Water: content decreased
Collagen: early - synthesis increased; fibers abnormal late - synthesis and content decreased Proteoglycan: early - synthesis increased; subunits smaller and aggregation diminished late - synthesis and content decreased |
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Articular Cartilage of the Hip: Normal vs. OA
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LISTEN TO SLIDE AND GET MAIN POINT AGAIN (slide 9)
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Pathogenesis of Osteoarthritis
Physical Stress --> _______ --> ______ --> _______ --> loss of tensile strength, load support --> _______ --> _______ --> Physical Stress |
Physical Stress -->Chondrocyte Injury --> Release of degradative enzymes --> Altered matrix structure --> loss of tensile strength, load support --> microfracture of subchondral bone --> Loss of compressibility --> Physical Stress
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Epidemiology of OA: Incidence of Symptomatic Disease
Where is OA highest in females? In males? |
Female Knee
Male Knee |
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Risk Factors for OA
Systemic Factors? Local Factors? |
Systemic Factors:
- age - obesity - genetics - gender - menopause Local Features: - Trauma - Muscle Strength - Joint Proprioception - Repetiive Use - Configuration of joint |
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Obesity as a Risk Factor for OA: Twin Study
Main result? |
Twins with OA had higher mean weight
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Body Weight and OA in Women
Obesity associated with OA of ______, ______, more than ______? Every 5 unit increment of BMI at baseline _______ Odds Ratio for knee OA by _____? For every 10 pounds lost from baseline visit, Odds Ratio for knee OA fell by _____? |
Obesity associated with OA of knee, CMC more than hip
Every 5 unit increment of BMI at baseline raised OR for knee OA 1.8 For every 10 pounds lost from baseline visit, OR for knee OA fell 40% |
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Quadriceps Strength and OA of the Knee
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REVIEW VIDEO FOR MAIN POINT (slide 22)
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OA: Symptoms
Joint pain when? Others? |
Joint pain on use or motion
Loss of motion/function Minimal (< 15 minutes) stiffness after resting Systemic symptoms (fatigue, fever or generalized weakness) are rare Acute variation in disease severity (“flare”) suggests another diagnosis |
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OA: Physical Examination
Bony enlargement? Joint tenderness? Range of Motion? Alignment? Atrophy? Effusions? |
Bony enlargement of the joint
Minimal joint tenderness Limited range of motion Crepitus Malalignment/instability Atrophy of muscle adjacent to involved joint Effusions can occur |
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OA: Distribution of Involved Joints
Common? Uncommon? |
Common:
- Cervical Spine - Lumbar Spine - First CMC, PIP, DIP - Hip - Knee - First MTP Uncommon: - Shoulder - Thoracic Spine - Elbow - Wrist - Ankle - Subtalar |
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OA: Laboratory Findings
Hematocrit? Erythrocyte Sedimentation Rate? ANA, rheumatoid factor - ? Synovial fluid? |
Hematocrit - normal
Erythrocyte sedimentaion rate (ESR) - normal for age ANA, rheumatoid factor - negative Synovial fluid - Class 1 (noninflammatory) - 50 - 200 wbc/mm - Normal viscosity, protein |
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American College of Rheumatology Guidelines for the Management of OA
Start with? 2nd? 3rd? 4th? |
1. Nonpharmacological modalities -->
2. Acetaminophen (up to 1 g QID) 3. If inappropriate --> alternative analgesic --> ibuprofen or non acetylated salicylates, or COX2 inhibitors, 4. if still inadequate, full dose NSAIDs, with misoprostol or Proton pump inhibitor or COX2 inhibitor |
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OA: Nonpharmacologic Management
Name 5 PAWF: |
Education - for patient and family
Weight loss Physical and occupational therapy Aerobic conditioning exercise Footwear and walking aids |
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Physical Therapy in the Management of Arthritis
Indications? Procedures? |
Indications
- Loss of joint motion, but preserved structure - Muscle weakness with joint instability - Severe symptoms Procedures - Muscle strengthening - Range of motion exercises - Modalities (heat, ice) - Gait training |
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Exercise in the Management of OA of the Hip and Knee: Rationale
Level of activity for OA? Inactivity may lead to? |
People with arthritis are less physically active
Physical inactivity may lead to: - Weight gain - Muscle atrophy - Loss of flexibility - Cardiovascular deconditioning - Incoordination with enhanced risk of falling - Osteoporosis - Social isolation, depression - Reduced pain threshold |
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Goals of Exercise in the Management of OA
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Reduced impairment: pain, loss of motion
Improved function: strength, gait, activities of daily living Protect arthritic joints from further damage: reduce joint stress, improve biomechanics Prevent disability and poor health due to inactivity |
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Effect of Supervised Exercise on Physical Disability Scores in Patients with Knee OA
health education vs. aerobic exercise vs. resistance exercise? |
Aerobic exercise and resistance exercise were statistically significantly more helpful in the long term than health education alone
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OA - Pharmacologic Treatment
Systemic Drug Therapy? Intra-articular therapy? Topical Therapy? |
Systemic drug therapy
- Acetaminophen - NSAIDs - Analgesics - COX-2 inhibitors Intra-articular therapy - Corticosteroid - Hyaluranon Topical therapy - Capsaicin P - Methylsalicylate |
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Acetaminophen vs. NSAIDs for OA of the Knee
Main results of comparative trials? |
High dose acetaminophen (4000 mg) vs low and high dose ibuprofen
184 patients over 4 weeks randomized, double-blind trial - No significant differences between groups Acetaminophen (2600 mg) vs naproxen (750 mg) - Randomized, double-blinded trial 2 years of treatment randomized, double-blind trial - no significant advantage for NSAID |
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Novel Therapies for Osteoarthritis
Glucosamine and chondroitin sulfate - better than placebo? Doxycycline - putative mechanism of action - Side effects? Diacerein - metabolizes to? which has what properties? - comparable symptom control to? - putative mechanism of action? |
Glucosamine and chondroitin sulfate
- widely used, OTC, unregulated - in meta-analyses, not better than placebo Doxycycline - may slow progression of cartilage loss (??) - use limited by GI side effects Diacerein - metabolizes to rhein, which has anti-inflammatory and analgesic properties - comparable symptom control to NSAIDS - may slow progression of cartilage loss |
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Orthopedic Surgery in OA
Why? When? |
Why
- Relieve pain - Improve function - Prevent progressive damage, deformity When - Failed nonspecific treatment - Major lifestyle restrictions - Motivated patient |
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Orthopedic Surgery in OA:
Procedures to Consider |
Osteotomy
Joint debridement/lavage Arthodesis (fusion) Arthroplasty: partial or total Cartilage implant |
