OA

Question 1

Strongest modifiable risk factor for OA

Answer 1

Obesity (2–3× risk)

Question 2

Other modifiable OA risks

Answer 2

Quadriceps weakness, repetitive use, metabolic syndrome, low vit K, low muscle strength

Question 3

Non‑modifiable OA risks

Answer 3

Age >50, female sex, genetics, prior injury, anatomic variants

Question 4

Pathophysiology summary

Answer 4

Cartilage degeneration > repair; ↑MMPs/ADAMTS, ↓TIMPs; subchondral osteophytes (TGF‑β, BMP‑2, IGF‑1); low‑grade inflammation

Question 5

OA inflammatory cytokines

Answer 5

IL‑1, TNF‑α

Question 6

Synovial process

Answer 6

Macrophage activation → immune exhaustion → pain

Question 7

Systemic inflammation link

Answer 7

OA pain correlates with systemic inflammation and ↑CV mortality (~3×)

Question 8

Heberden’s node inheritance

Answer 8

Autosomal dominant

Question 9

OA heritability

Answer 9

≈40–65% (twin studies)

Question 10

Clinical hallmark

Answer 10

Pain ↑ with use ↓ at rest; <30 min stiffness; gelling; crepitus; ↓ROM

Question 11

Classic radiographic features

Answer 11

Joint space narrowing, osteophytes, subchondral sclerosis, cysts

Question 12

Radiographic–symptom relation

Answer 12

Often discordant; imaging not required for diagnosis

Question 13

First‑line non‑drug management

Answer 13

Education, self‑management, weight loss, exercise

Question 14

Exercise benefit

Answer 14

Most effective non‑drug therapy; aerobic + resistance + Tai Chi

Question 15

Weight loss target

Answer 15

> 5% reduces pain ≈30%; >10% slows progression

Question 16

Supportive devices

Answer 16

Braces (knee), splints (thumb)

Question 17

Pharmacologic – Paracetamol

Answer 17

Minimal benefit; not first‑line (hepatotoxicity risk)

Question 18

Pharmacologic – NSAIDs

Answer 18

Most effective for pain; oral short‑term; topical safer for hand/knee OA

Question 19

Pharmacologic – Opioids

Answer 19

Short‑term relief only; avoid chronic use

Question 20

Pharmacologic – Duloxetine

Answer 20

For central pain/NSAID failure; 30–90 mg daily; ~30% pain reduction

Question 21

Pharmacologic – Methotrexate

Answer 21

Lancet 2023: benefit in hand OA with MRI synovitis

Question 22

Pharmacologic – Bisphosphonates

Answer 22

No clinical benefit (Risedronate, Zoledronate negative)

Question 23

Pharmacologic – Chondroitin/Glucosamine

Answer 23

Limited benefit; stop if no improvement after 6 months

Question 24

Pharmacologic – Intra‑articular steroids

Answer 24

Short‑term (<3 mo) relief; risk cartilage loss on MRI

Question 25

Pharmacologic – Viscosupplementation

Answer 25

Minimal benefit; not recommended

Question 26

Pharmacologic – Doxycycline

Answer 26

↓ joint‑space loss but not clinically useful

Question 27

Emerging therapies – NGF inhibitors

Answer 27

↓ pain but ↑ rapid OA progression + arthroplasty risk

Question 28

Emerging therapies – Cathepsin K inhibitors

Answer 28

↓ biochemical markers; no clinical effect

Question 29

Emerging therapies – Strontium ranelate

Answer 29

↓ pain + joint‑space loss; ↑ VTE risk

Question 30

Inflammatory OA flare Rx

Answer 30

Short course oral steroids; no role for colchicine/HCQ/anti‑TNF/IL‑1 blockade

Question 31

Surgical – Arthroscopy

Answer 31

No benefit vs sham

Question 32

Surgical – Joint replacement

Answer 32

TKR/THR effective for pain & function; ~50% incidence in 15 years

Question 33

Surgical – Osteotomy

Answer 33

Young malaligned OA

Question 34

Surgical – Arthrodesis

Answer 34

End‑stage hand/foot OA

Question 35

Exam clue

Answer 35

OA = pain ↑ with use + brief stiffness <30 min

Question 36

Post‑meniscectomy OA risk

Answer 36

≈50% within 20 years

Question 37

Low BMD link

Answer 37

Low BMD protects against fracture but ↑ OA risk

Question 38

Erosive OA imaging sign

Answer 38

Central erosions + gull‑wing appearance

Question 39

Inflammatory OA effective drug

Answer 39

Only short‑course steroids

Question 40

Semaglutide trial finding

Answer 40

Improved WOMAC pain scores in obese OA patients