OA

Question 1

OA

Answer 1

• AKA Degenerative joint disease or hypertrophic arthritis
• Most common joint disease
• Affects almost 50% in those >65 y.o. and almost everyone >75 y.o. (generally from age and repetitive motion)
• Women twice as likely to develop OA, especially in knees and hands
• Characterized by pain, joint stiffness, muscle weakness

Question 2

OA General Criteria

Answer 2

• Presence of Pain
• Bony changes on exam
• Normal erythrocyte sedimentation rate
• Characteristic radiographs
• Presence of erosion and marked proliferation in proximal and distal interphalangeal joints of hands

Question 3

Hip OA Criteria

Answer 3

• Hip pain PLUS 2 of the following:
• ESR < 20
• Radiographic femoral or acetabular osteophytes
• Radiography joint space narrowing

Question 4

Knee OA Criteria

Answer 4

• Knee pain and radiographic osteophytes PLUS 1 of the following:
• Age > 50 y.o.
• Morning stiffness of 30 minutes or less
• Crepitus (creaking) on motion

Question 5

OA General Information

Answer 5

• Primarily idiopathic
• Generally asymmetrical
• Treat to relieve pain

Question 6

OA Labs

Answer 6

• ESR < 20
• RF Titer < 1:40 (negative)
• Non-inflammatory synovial fluid

Question 7

OA Pharmacological Treatment Options

Answer 7

DEPENDS ON AFFECTED SITE:
-Tylenol
-Topical NSAIDs/capsaicin
pOral NSAIDs (<75 y.o.)
-COX-2 selective inhibitor
-Tramadol
-Duloxetine
-Intraarticular CS

Question 8

ESR

Answer 8

• General marker of inflammation
• Measures how quickly RBCs settle in blood sample
• Nonspecific
• Increased fibrinogen auses RBCs to stick together and settle faster
• High ESR, more inflammation

Question 9

OA Etiology

Answer 9

• Increased body weight strongly associated with hip, knee, and hand OA
• Activities involving repetitive motion or injury increase risk

Question 10

Localized v.s. Generalized OA

Answer 10

Localized = 1-2 sites
Generalized = 3+ sites

Question 11

OA Pathophysiological Changes

Answer 11

• Initial thickening of articular cartilage as ECM is damagedand water content increases
• Proliferation of chondrocytes
• Decline in response of chondrocytes to stabilize or restore tissue, resulting in progressive cartilage loss
• Increased turnover of adjacent subchondral bone
• Release of vasoactive peptides and enzymes, causing cartilage degradation, neovascularization, ad increased leakiness of adjacent cartilage

Question 12

As cartilage is destroyed…

Answer 12

• More brittle, stiffer bone with decreased weight-bearing ability
• Development of sclerosis and microfractures
• Microfractures lead to new bone formation at the joint margins called “osteophytes”

Question 13

Joint Capsule and Synovium

Answer 13

• Inflammation from inflammatory mediators from chondrocytes

- Inflammation localized to affected joint

Question 14

OA Physical Exam - Hands

Answer 14

• Asymmetrical involvement
• Distal interphalangeal (DIP) joints - Heberden’s nodes (osteophytes)
• Proximal interphalangeal (PIP) joints - Bouchard’s nodes

Question 15

Pain of OA

Answer 15

• Activation of nociceptive nerce endings within the joint by mechanical and chemical irritants
• Distention of synovial capsule by increased joint fluid

Question 16

Pain Assessment in Dementia

Answer 16

• Facial expressions
• Vocal expressions
• Rigid, tense body posture
• Fidgeting, pacing, rocking
• Changes in eating or sleeping habits
• Increased confusion, irritability, distress, or wandering

Question 17

OA Nonpharm

Answer 17

• Rest
• Physical therapy - ROM, muscle strengthening, aerobic exercise
• Assistive devices
• Splints
• Diet-weight loss
• Thermal modalities

Question 18

Hand OA Pharm Guidelines

Answer 18

-No strong recommendations for pharm. management

Use one or more of the following:

• Topical capsaicin
• Topical NSAIDs
• Oral NSAIDs
• Tramadol

Conditionally recommend to not use:

• Intraarticular therapies
• Opioid analgesics

Persons >75 y.o. should use:
-Topical NSAIDs over oral

Question 19

Knee OA Pharm Guidelines

Answer 19

Use one of the following:

• Tylenol
• Oral NSAIDs
• Topical NSAIDs
• Tramadol
• Intraarticular CS injections

Do NOT Use

• Chondroitin sulfate
• Glucosamine
• Topical capsaicin

No recommendations regarding:

• Intraarticular hyaluronates
• Duloxetine
• Opioid analgesics

Question 20

Hip OA Pharm Guidelines

Answer 20

Use one of the following:

• Tylenol
• Oral NSAIDs
• Tramadol
• Intraarticular CS injections

Do NOT use:

• Chondoitin sulfate
• Glucosamine

No recommendation for:

• Topical NSAIDs
• Intraarticular hyaluronate injections
• Duloxetine
• Opioid analgesics