Osteoarthritis Learning Outcomes

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Questions and Answers

What is a likely cause of multiple epiphyseal dysplasias?

  • Hormonal imbalances unrelated to estrogen
  • Overuse injuries in professional sports
  • Single gene mutations impacting cartilage matrix components (correct)
  • Environmental factors affecting joint health

Which occupation is associated with an increased risk of hip osteoarthritis (OA)?

  • Retail staff
  • Farmers (correct)
  • Accountants
  • Office workers

What factor plays a role in the increased prevalence of knee OA in South and East Asia?

  • Genetic predisposition to joint disorders
  • Low body mass index (BMI)
  • High levels of physical inactivity
  • The practice of squatting (correct)

How might cytokines from adipose tissue influence osteoarthritis risk?

<p>They potentially contribute to inflammation (C)</p> Signup and view all the answers

What effect does hormone replacement therapy (HRT) have on osteoarthritis rates in women?

<p>Reduces the rates of OA (A)</p> Signup and view all the answers

Which of the following is a characteristic change in the joints affected by osteoarthritis?

<p>Osteophyte formation at the joint margin (B)</p> Signup and view all the answers

What type of inheritance pattern is commonly associated with the risk factors for osteoarthritis?

<p>Polygenic inheritance (D)</p> Signup and view all the answers

Which of the following best describes the clinical examination findings in osteoarthritis?

<p>Limited range of motion with joint pain (A)</p> Signup and view all the answers

What is the primary aim of the biopsychosocial model in managing osteoarthritis?

<p>To integrate biological, psychological, and social factors in care (D)</p> Signup and view all the answers

Which of the following is NOT a common feature of osteoarthritis presentations?

<p>Morning stiffness lasting more than 30 minutes (C)</p> Signup and view all the answers

What is one of the main symptoms of osteoarthritis as described in the content?

<p>Intermittent pain related to movement (C)</p> Signup and view all the answers

Which statement best describes the changes in bone associated with osteoarthritis?

<p>The subchondral bone becomes sclerotic and may develop cysts. (B)</p> Signup and view all the answers

What is a consequence of fibrocartilage production at the joint margin in osteoarthritis?

<p>It causes an increase in joint surface area. (B)</p> Signup and view all the answers

Which joints are primarily affected by osteoarthritis?

<p>PIP and DIP joints of the hands (A)</p> Signup and view all the answers

How does the pain associated with osteoarthritis typically fluctuate?

<p>It is variable with periods of 'good days' and 'bad days'. (D)</p> Signup and view all the answers

Which factor is NOT considered a risk factor for osteoarthritis?

<p>Regular exercise (C)</p> Signup and view all the answers

What describes the degeneration of articular cartilage in osteoarthritis?

<p>Chondrocytes begin to divide and produce metabolically active cells. (B)</p> Signup and view all the answers

Which of the following is primarily affected as osteoarthritis progresses?

<p>Articular cartilage thickness (B)</p> Signup and view all the answers

What pathological change occurs in the cartilage during osteoarthritis?

<p>Deposition of CPP and calcium phosphate crystals (C)</p> Signup and view all the answers

Which risk factor is specifically linked to hormonal changes in osteoarthritis?

<p>Oestrogen deficiency (D)</p> Signup and view all the answers

What is a common consequence of cartilage fissuring in osteoarthritis?

<p>Localized chondrocyte death (D)</p> Signup and view all the answers

Which activity is a potential cause of repetitive loading, increasing the risk for osteoarthritis?

<p>Mining (C)</p> Signup and view all the answers

What role do osteophytes play in osteoarthritis?

<p>They indicate advanced joint degeneration. (D)</p> Signup and view all the answers

Flashcards

Osteoarthritis Definition

Osteoarthritis is the most common type of arthritis, primarily characterized by the loss of cartilage in joints, bone hardening, and abnormal growth of bone around joints.

Osteoarthritis Pathophysiology

Progressive loss of articular cartilage, subchondral bone sclerosis, osteophyte formation, and joint remodeling.

Risk Factors of Osteoarthritis

There are both genetic and environmental components related to the development of osteoarthritis. In most cases, the inheritance is polygenic

Osteoarthritis Symptoms

Can be symptomatic or asymptomatic depending on the extent of joint damage.

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Microscopic Changes in OA

Focal loss of cartilage, subchondral osteosclerosis, osteophyte formation, and joint remodeling.

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Clinical Diagnosis

A clinical diagnosis is the process of evaluating a patient's symptoms, medical history, and physical examination to arrive at a diagnosis that a physician can support from multiple sources of information.

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Differential Diagnoses for OA

Other conditions that mimic osteoarthritis symptoms, requiring appropriate differentiation.

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Disability in OA

Describes the limitations in physical function and activities of daily living.

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Biopsychosocial Model

A model that considers biological, psychological, and social factors in health and illness

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Investigation Diagnosis of OA

Using imaging, laboratory, or other tests to asses joint issues for more accurate diagnosis.

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Epiphyseal Dysplasia

A group of disorders causing abnormal bone growth at the ends of long bones.

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OA Risk and Limb Deformity

Structural abnormalities like slipped femoral epiphysis and hip dysplasia increase OA risk due to abnormal joint load distribution.

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OA and Biomechanical Factors

Certain occupations (farming, mining, athletics) and activities (squatting) increase OA risk due to repetitive stress on specific joints.

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OA and Destabilizing Injuries

Injuries like cruciate ligament rupture and meniscectomy increase the likelihood of developing OA.

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Obesity and OA

Obesity is strongly linked to hip and knee OA, likely due to both biomechanical factors and the effects of adipose tissue cytokines.

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Oestrogen and OA

Oestrogen may protect against OA; Hormone Replacement Therapy (HRT) reduces OA risk, while aromatase inhibitors increase symptoms.

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Osteoarthritis (OA) Cartilage Fibrillation

Cartilage in OA deteriorates, becoming frayed and uneven.

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OA X-ray Findings

X-rays show osteophytes (bone spurs), subchondral sclerosis (hardening), and subchondral cysts.

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OA Subchondral Bone Changes

Subchondral bone hardens (sclerosis) in OA, forming cysts.

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Osteophytes Formation

Bone spurs at joint margins from fibrocartilage production and ossification.

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OA Joint Shape Changes

Bone remodeling and cartilage loss alter joint shape to widen the joint surface.

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OA Homeostatic Mechanism

Enlargement of the joint in OA may spread the load over a greater surface, acting like a mechanism to protect it.

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OA Joint Distribution

OA commonly affects hips, knees, and hand joints (PIP/DIP).

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OA Main Symptoms

Pain and reduced joint function are the main symptoms of OA.

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OA Pain Origins

OA pain stems from subchondral bone pressure, microfractures, capsule stretch, and mild inflammation.

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OA Pain Characteristics

OA pain develops gradually over time, is intermittent, and worsens with movement and weight-bearing.

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Osteoarthritis Risk Factors

Factors increasing the chance of developing osteoarthritis, including genetics, repetitive stress like in farmers, obesity, and trauma.

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Genetic Factors (OA)

Inherited traits that can influence the development of osteoarthritis, such as skeletal disorders or polygenic inheritance.

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Repetitive Strain (OA)

Joint wear-and-tear from repeated actions over extended periods, like in miners or athletes.

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Obesity & OA

Excess body weight contributes to increased stress on weight-bearing joints, rising the risk of osteoarthritis.

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Abnormal Joint Mechanics (OA)

Issues in how a joint moves, like from injuries or abnormal bone growth, can increase OA risk.

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Cartilage Degradation (OA)

Chondrocytes, cartilage cells, divide and abnormally degrade healthy cartilage matrix (collagen II, etc).

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Chondrocyte Proliferation (OA)

Increased cell division of cartilage cells, leading to irregular cartilage structure and potentially accelerated damage.

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Matrix Degradation (OA)

Speeding up of cartilage matrix breakdown (like collagen and aggrecan), weakening and increasing damage.

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Joint Space Narrowing (OA)

Progressive reduction in the space between bones in a joint due to cartilage loss, leading to increased bone-on-bone contact.

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Crystal Deposition (OA)

Certain crystals, like those of calcium phosphate, can accumulate in the degenerating cartilage, compounding the damage.

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Study Notes

Osteoarthritis Learning Outcomes

  • Osteoarthritis is the most common form of arthritis.
  • Understand the pathophysiology of osteoarthritis.
  • Identify risk factors for osteoarthritis.
  • Describe microscopic changes in osteoarthritic joints.
  • Recognize common presentation features of osteoarthritis.
  • Describe the joint distribution of osteoarthritis.
  • Outline findings of osteoarthritis on clinical examination.
  • Define clinical diagnosis.
  • List common differential diagnoses for osteoarthritis presentations.
  • Understand terms related to disability.
  • Describe the components of a biopsychosocial model in healthcare.
  • Describe the role of investigations in diagnosing osteoarthritis.
  • Outline the principles of osteoarthritis management.
  • Describe common analgesics and their mechanism of action in osteoarthritis treatment.
  • Outline the principles of joint replacement.

Risk Factors for Osteoarthritis

  • Genetics (skeletal dysplasias, polygenic inheritance, developmental abnormalities like slipped femoral epiphysis, repetitive loading)
  • Occupation (farmers, miners, elite athletes, professions with repetitive tasks)
  • Biomechanics (injuries, squatting, meniscectomy)
  • Obesity
  • Hormonal factors (estrogen deficiency, aromatase inhibitors)

Pathological Changes in Osteoarthritis

  • Focal loss of articular cartilage
  • Subchondral sclerosis
  • Osteophyte formation at the joint margin
  • Remodeling of joint contour
  • Some cases asymptomatic

Clinical Features of Osteoarthritis

  • Characteristic distribution (hips, knees, hands, neck, lumbar spine)
  • Main symptoms: pain, functional restriction
  • Pain may be related to pressure in subchondral bone, microfractures, capsular distension, low-grade synovitis
  • Pain: insidious onset over months/years, variable nature (good days, bad days), mainly related to movement & weight-bearing, relieved by rest.
  • Mild morning stiffness (less than 15 minutes) & post-inactivity stiffness (less than 5 minutes)
  • Usually affects one or a few joints

Generalised Nodal OA

  • Characteristic lateral deviation and asymmetric facial cartilage loss are common
  • First CMC joint involvement is also common.
  • Polyarticular finger interphalangeal joint osteoarthritis (Heberden's and Bouchard's nodes)
  • Marked female preponderance
  • Peak onset in middle age, good functional outcome for hands
  • Increased risk in those with a family history of nodal OA, especially in the knee

Knee Osteoarthritis (OA)

  • OA primarily targets patello-femoral and medial tibio-femoral compartments
  • May be isolated or part of generalized nodal OA
  • Bilateral and symmetrical involvement is common
  • Trauma and meniscus injuries a significant risk factor, especially in men

Hip Osteoarthritis

  • Frequently targets superior aspect of the joint
  • Often unilateral at presentation
  • Poor prognosis compared to other types
  • More centralized cartilage loss is largely confined to women
  • Bilateral joint presentation with general nodal OA gives better prognosis

Spine Osteoarthritis

  • Cervical and lumbar spine are common targets
  • Pain in lower back, neck, shoulders, buttocks, knees and shin bones

Causes of Early Onset OA

  • Monoarticular: Previous trauma, localised instability
  • Pauciarticular/Polyarticular:

Investigations in Osteoarthritis

  • X-rays are helpful for evaluating the severity of structural change, often used when the diagnosis is uncertain, and helpful in assessing prognosis in patients with severe symptoms.
  • MRI may be useful if diagnosis is uncertain.

Treatment of Osteoarthritis

  • Patient education (lifestyle advice)
  • Weight control
  • Exercise
  • Social support
  • Analgesics (e.g., paracetamol, NSAIDs, Intra-articular glucocorticoid injections, nerve root and/or spine complications needing MRI)

Surgery in Osteoarthritis

  • Total joint replacement surgery; indicated for patients with significant symptoms and functional impairment who haven't responded to other treatments

Summary of Osteoarthritis

  • Variable presentation
  • Symptoms do not always correlate to changes in pathology
  • Diagnosis is typically based on clinical presentation, often supplemented with x-rays
  • Holistic management with education, lifestyle support and analgesia as a key aspect of treatment

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KCP Osteoarthritis Past Paper PDF

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