OA

Question 1

OA

Answer 1

(DJD- Degenerative Joint Dz)

• most common joint dz
• non-infl
• lack of systemic sx’s
• pain relieved by rest/ morning joint stiffness is brief
• oligoarticular
• generalized
• aging!

Question 2

OA- bony changes

Answer 2

• crepitus
• malalignment/instability
• limited ROM
• joint line tenderness
• cool effusions
• spasm or atrophy of adj m’s

Question 3

OA- risk factors

Answer 3

• age, obesity, genetics, menopause

- m strength, proprioception, repetitive use, joint configuration, trauma

Question 4

OA- most common joints involved?

Answer 4

• cervical spine, lumbar spine
• 1st CMC, PIP, DIP
• hip, knee
• 1st MTP

Question 5

OA- radiographic findings

Answer 5

• joint space narrowing
• osteophytes and marginal lipping
• subchondral thickening
• bone cysts (from microfractures)
• joint mice

Question 6

OA- pathogenesis

Answer 6

• degeneration of articular cartilage
• chondrocytes= stress
• damage from physical forces- chondrocytes release degradative enzymes; inadequate repair response- drop out, cartilage loss, bone changes, loose bodies
• defective cartilage fails under normal joint loading (type II collagen gene defect)

Question 7

OA- subchondral bone

Answer 7

= new articular surface

• friction, bone eburnation
• sclerosis, small fracture, cyst
• altered bone contour, lipping
• osteophyte

Question 8

OA hereditary

Answer 8

• sum of mult genes- risk of OA
• heterogeneous
• hand and hip
• generalized osteoarthritis- osteophytes of DIP and PIP (Heberden’s and Bouchard’s nodes)

Question 9

OA- primary, secondary?

Answer 9

• progressive deterioration!!
• primary- aging, idiopathic, genetic (nodal OA- DIP and PIP)
• secondary- disorders that damage joint surfaces

Question 10

OA subsets

Answer 10

• generalized
• nodal
• spondylosis
• erosive
• hyperostosis
• chondromalacia patella

Question 11

Generalized OA

Answer 11

-spine, hand, +other

Question 12

Nodal OA

Answer 12

-DIP and PIP (hereditary some)

Question 13

Spondylitis OA

Answer 13

-facet joint OA, frequently + DDD (degenerative joint dz)

Question 14

Erosive OA

Answer 14

-rare, DIP more common than PIP

Question 15

Hyperostosis OA

Answer 15

DISH (Diffuse Idiopathic Skeletal Hyperostosis)

• > 50 yo, M>F
• freq asx- cervical spine= dysphagia
• osteophytosis of spine- spans > 3-4 segments
• paraspinous ligaments= calcifications/ossification- “flowing wax” appearance on ant vertebral bodies
• preservation of disc space
• some assoc w DM

Question 16

OA- management

Answer 16

• no cure
• pain control, minimize disability, improve quality of life
• surgery
• OMT, exercise, PT

Question 17

OA- pharmacologic tx

Answer 17

• acetaminophen- 1st line!
• NSAID
• capsaicin
• intraarticular glucocorticoids

Question 18

OA- if sx relief inadequate, consideR?

Answer 18

• intraarticular hyaluronic acid
• plt rich plasma
• glucosamine and chondroitin
• opioid analgesics