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Osteoarthritis
Rheumatology
| Question | Answer |
|---|---|
| OA prevalence: | 60-90% of >65; 1 in 5 adults; knee OA most common cause LT disability in US |
| OA pathophys | progressive loss of articular cartilage with assoc remodeling of subchondral bone |
| Generalized OA = | 3 or more joint groups |
| Joints most affected by OA | C-spine, L-spine, fingers, CMC, hips, knees, 1st MTPs |
| OA: xray findings | loss of joint space; subchondral sclerosis; osteophytes; subchondral cysts |
| OA: early chondral erosions | not visible on xray, but on arthroscopy |
| OA: dx criteria:knee | Knee pain and x-ray osteophytes; and (one): age >50 yo; a.m. stiffness (<30 min); or crepitus with motion |
| OA: other dx | Mechanical pain (deep, slow onset, local); Gel; joint-line tenderness, bony enlargemt +/- effusion; crepitus; Dec ROM; Mx atrophy (may precede sx); mild inflame; ESR <20 (M), <40 (F); non-inflam syn fluid (WBC 200-2000, <25% PMN) |
| Cartilage is nourished and maintained by: | hydrostatic transfer of joint fluid (no vascular network); need ROM with joint loading |
| OA: Genl nonpharm tx | Wt loss; pt education; joint protection; patellar taping, ergonomics, thermo, exercise |
| OA: wt loss | min 5% if BMI >25; OR for OA = 1.4 per 10 lb increased wt; 5 kg loss = 50% dec risk in 10 yrs |
| OA sx improvement w/education | 15 to 30% |
| Goals of OA tx | Decrease pain; protect jts from further injury; preserve fn |
| OA tx that are not effective | wedged insole (esp not for severe); unloader brace; some thermal (diathermy, infrared) |
| OA tx: patellar taping | for P-F compartment, for medial pull of patella only; combo w/VMO exercise |
| Useful thermal tx OA | US (only modality to increase hip temp); microwave (deeper) |
| Exercise that can worsen OA | high impact, repetitive, high loading, collision sport |
| Exercise: hips & knees | bike for hips, elliptical for knees |
| Mx decrease w/age | strength dec 15% / decade (50-70 yo); mass dec 40% by 80 yo |
| OA: if Tylenol inadequate but GI risk high: | NSAID & PPI; or COX-2; or Tramadol; or ST opioids, neuroleptic, or prednisone |
| OA: if effusion, consider: | aspiration and (steroid) injection |
| OA alt tx: | glucosamine / chondroitin (safe, won’t slow progression); doxycycline, vit C,D; acupuncture? |
| Tx: fish oil | evidence for RA (not OA) |
| OA: surg tx | wedge osteotomy okay; Arthro debridement no (except for torn meniscus); microfx (not LT cure); Carticel; OATS; joint replacement |
| Nodal OA | distal & proximal IP joints; F > M; female first-degree relatives |
| OA comorbid disorders | hemochromatosis & ochronosis; mutations in type II, IX, & X collagen genes |
| Most common cause of secondary OA is | a severe joint injury |
| Common synovial crystals in OA | calcium pyrophosphate dihydrate and apatite |
| Fibromyalgia defn | chronic pain syn of unk origin; not inflame or autoimmune; does not r/o other dz (& vice versa) |
| Fibromyalgia: genetics | pt w/ first-degree relative w/dz has 8x risk |
| Fibromyalgia: PE | no joint swelling or inflammation; dx by press 18 tender points (press until thumb nail blanches) |
| Fibromyalgia tender points: | back of head; chest (upper & lower); upper back (medial & lateral); low back; buttocks; gr trochanter ; medial knee; lateral epicondyles |
| Fibromyalgia: Labs | within normal limits |
| Fibromyalgia: Tx | multifaceted; Self-care/ pt ed (exercise, yoga, support grp); CBT; Sleep improvement |
| Fibromyalgia: Tx: antidepressants | TCA; SSRIs (fluoxetine, paroxetine); SNRIs (duloxetine / milnacipran) |
| Fibromyalgia: Tx: analgesics: | tramadol, gabapentin, pregabalin |
| Fibromyalgia: Tx: muscle relaxers: | cyclobenzaprine |
| Fibromyalgia: Tx (genl) | NSAIDS, prednisone not helpful; combination therapy best |
| OA pathophys | progressive loss of articular cartilage with assoc remodeling of subchondral bone |
| Joints most affected by OA | C-spine, L-spine, fingers, CMC, hips, knees, 1st MTPs |
| OA: dx criteria: knee | Knee pain and x-ray osteophytes; and (one): age >50 yo; a.m. stiffness (<30 min); or crepitus with motion |
| OA: if effusion, consider: | aspiration and (steroid) injection |
| Most common cause of secondary OA is | a severe joint injury |
| Fibromyalgia defn | chronic pain syn of unk origin; not inflame or autoimmune; does not r/o other dz (& vice versa) |
| Fibromyalgia: genetics | pt w/ first-degree relative w/dz has 8x risk |
| Fibromyalgia: PE | no joint swelling or inflammation; dx by press 18 tender points (press until thumb nail blanches) |
| Fibromyalgia tender points: | back of head; chest (upper & lower); upper back (medial & lateral); low back; buttocks; gr trochanter ; medial knee; lateral epicondyles |
| Fibromyalgia & SLE | 50% of patients with lupus have fibromyalgia |
| Female, fatigue, general aching, pain at neck, upper shoulders, sleeping problems, tender points | Fibromyalgia (exercise program good management) |
| Heberden nodes | OA at DIP |
| Bouchard nodules | OA at PIP |
| OA usually spares joints at: | MCP (except thumb), wrist, hip, knee, spine |
| OA s/s | >50 yo; AM stiffness <30 min; crepitus; Bony tenderness & enlargement’ No palpable warmth |
| OA vs RA | OA: worse w/motion (PM stiffness), better w/rest; hands DIP Heberdens; thumb CMC. RA: hand MCP/PIP; warm tender joint swelling; AM stiffness |
| OA tx | short acting NSAID (motrin/naproxen) x2-4 wks; inc dose prn; COX-2 in some pts; Csteroid injxn |
| Osteoporosis RF | *Advanced age; *Previous fx; Also LT glucocorticoid tx; Low body wt (< 58 kg [127 lb]); FH hip fx; smoking; Excess alcohol intake |
| Osteoporosis epi | F>M (4:1); 1.7M fx in US; 6M hip fx world; W&Asian > Hisp > AA; 4 in 10 WF will fx |
| DEXA values | T score: BMD > -1SD below YN = nml; severe osteo = BMD <-2.5 |
| best predictor of fx risk | bone density (75-85% of variance in bone strength) |
| DEXA used for: | PA spine, lateral spine, hip, forearm, total body |
| T-score: osteopenia | -1 to -2.5 SD below YN |
| Dz examples of bone loss | Osteoporosis, FAS (amenorrhea, anorexia, osteoporosis) |
| Fibromyalgia DDx | RA, SLE, hypothyroid, polymyositis (weakness, not pain), polymyalgia rheum, low PO4 |
| Fibromyalgia | F>M 20-50 yo; neg inflam sxs/labs; fatigue, HA, numbness; TCAs, Flexeril, SNRI |
| Osteoporosis = | Reduction in bone mass (Low peak mass; inc bone loss; hyperparathyroid, chronic steroids) |
| Osteoporosis: DEXA Scan: | T score of < -2.5 |
| Osteoporosis: Clinical Features: | vertebral compression fracture |
| Osteoporosis: Rx: | Oral Ca & Vit D; exercise, SMK cessation; Estrogen in postmen reduces bone reabsorption; Bisphosphonates augment bone density; Raloxifene inc bone density & dec total & LDL-C |
| Examples of bone loss | Osteoporosis, FAS (amenorrhea, anorexia, osteoporosis) |
| Dietary requirement of Ca: | 1000-1500 mg/day |
Created by:
Abarnard
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