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31 Cards in this Set
- Front
- Back
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Symptoms of OA?
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Pain (localized, aggravated by activity)
Stiffness (with inactivity) actue intermittent flares |
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Whats OA according to American Academy of Orthopedic Surgeons?
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- Result of both mechanical and biologic events
- loss of coupling of degradation and synthesis of articular cartilage and subchondral bone |
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Whats OA according to American Academy of Orthopedic Surgeons?
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- Result of both mechanical and biologic events
- loss of coupling of degradation and synthesis of articular cartilage and subchondral bone - Might initiate by multiple factors (genetics, developmental, metabolic and traumatic - Biological and molecular changes of both cells and matrix -> softening, fibrillation, ulceration and loss of cartilage |
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Etiology of OA?
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- Multifactorial:
Joint instability Age Hormonal factors Trauma Altered biochem Inflammation Genetic |
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What are risk factors for gastropathy due to NSAIDs?
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age >60
GI ulcer or bleeding concomitant use of corticosteroids Systemic illness might have H. pylori might be due to smoking or alcohol use |
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Idiopathic OA?
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Localized
Generalized Heberden's and Bouchard's node Inflammatory erosive OA |
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Whats the role of collagen fibrils in cartilage?
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provides framework
impart tensile strength |
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Morphology of OA
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Thickened capsule
Cyst formation Sclerosis in subcondral bone Osteophyte formation Altered contour of the bone |
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Bouchard's node?
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Widening in PIP
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Prevalence of knee involvement
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knee involvement: <35 higher in men, >35 higher in women
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Characteristics of OA
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Not necessary age related
Asymmetry more related to impact loading then frictional wear |
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How is a cartilage developed?
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Chondrocytes make the fibrous elements and mucopolysaccharide (MPP) elements
Chondrocytes are ordered and nested within the cartilage and are protected in collagen type II fibers and MPP Type II collagen attracts MPP MPP is - charged --> attracts water |
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What causes the widening of DIP or PIP?
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cartilage thinning
Dorsal osteophyte |
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Whats an osteophyte?
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Increased stress on the bone --> perpendicular pressure --> bone over growth --> osteophyte
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Heberden's node?
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Widening in DIP
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What is the chondrocytes imbedded in?
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collagen type II fibers and proteoglycans (MPP)
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Whats the role of proteoglycans?
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Attract water
Impart elasticity |
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Secondary OA?
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Trauma
Metabolic Endocrine Neuropathic Chodrocalcinosis Congenital and developmental Inflammatory arthritis |
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Whats a proteoglycan aggregate?
How does it hold water in it? |
Hyluronic acid axis
individual proteoglygan units (large molecule with a protein core and side sugars side sugars have - chagers --> hold Na --> Na holds water. |
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Whats OA according to American Academy of Orthopedic Surgeons?
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- Result of both mechanical and biologic events
- loss of coupling of degradation and synthesis of articular cartilage and subchondral bone |
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Joints involved in OA
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PIP (bouchard's), DIP (heberden's), 1st MTP, hips, knees, lower neck, lower lumbar
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Whats the pathogenesis of OA?
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Stress --> chondrocyte injury --> degradative enzymes --> PG breakdown --> reduced elastic and lubricating properties --> cartilage degeneration
stress --> collagen breakdown --> unravelling of PG --> loss of PG |
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OA classification?
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primary or idiopathic
Secondary |
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Goals of treatment?
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Reduce pain
maintain mobility minimize disability |
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Diagnostic tests for OA?
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No specific tests : ESR, RF
Xrays (bony sclerosis, loss of cartilage, osteophytes) |
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Whats OA according to American Academy of Orthopedic Surgeons?
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- Result of both mechanical and biologic events
- loss of coupling of degradation and synthesis of articular cartilage and subchondral bone |
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Whats the prevalence of OA
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Age related:
usually 80% show xray evidence by 55 y/o women more affected |
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What change do you expect to see in synovial fluid viscosity in OA?
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normal viscosity because hyaluronic acid is preserved
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Medical management?
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Rest
Correction of strain factors weight reduction physical therapy (increase range of motion) Analgesic and anti-inflammatory drugs (give low doses) intra-articular corticoids surgery where indicated |
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what is Hallux Valgus?
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Deviation caused by widened transverse metatarsal arch
Big toe points out Surgery |
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Genu Varum?
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Distal part of the femur is pointed inward.
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