Osteoarthritis Overview and Epidemiology

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Questions and Answers

What percentage of patients experience pain relief and satisfactory function after total joint replacement?

100%

70%

80%

90% (correct)

Which technique involves transferring cylinders of bone and cartilage from a healthy area to an articular defect?

Autogenous Osteochondral grafting (correct)

Somatic Gene therapy

Cartilage implantation

Stem cell transplantation

What is the main purpose of Somatic Gene therapy?

To remove damaged cells

To introduce genes into cells containing defective genes (correct)

To extract undifferentiated cells

To create stem cells from adult tissues

In which joints is sugary most commonly employed for osteoarthritis?

Hip & knee Signup and view all the answers

What are the three sources of stem cells mentioned?

Adult, fetal, and embryonic Signup and view all the answers

What is one effect of patient education on osteoarthritis management?

It is about 20% as effective as NSAIDs. Signup and view all the answers

Which method of patient education is mentioned as effective?

One-to-one discussions Signup and view all the answers

How much weight loss is estimated to reduce the risk of OA by more than 50% for a woman of normal height?

5 kg Signup and view all the answers

What is a recommended instruction for joint protection?

Avoid standing in the same position for long periods. Signup and view all the answers

Which statement about the impact of substantial weight loss on OA prevention is correct?

It could prevent 33% of OA in women. Signup and view all the answers

What is the primary characteristic of localized osteoarthritis (OA)?

Involves Heberden’s nodes at DIP joints Signup and view all the answers

Which of the following is NOT a suggested practice for joint protection?

Lying or sitting long in one position Signup and view all the answers

Which of the following is considered a risk factor for primary osteoarthritis?

Age Signup and view all the answers

Which type of osteoarthritis is characterized by onset before the age of 50?

Secondary OA Signup and view all the answers

What is a key benefit of aerobic exercise programs in OA management?

They help improve overall physical function. Signup and view all the answers

In OA management, psychosocial support primarily aims to:

Enhance the emotional and mental well-being of patients. Signup and view all the answers

What condition is characterized by the accumulation of homogentisic acid in connective tissue?

Ochronosis Signup and view all the answers

How does advancing age contribute to osteoarthritis pathology?

Causes loss of glycosaminoglycan from cartilage Signup and view all the answers

Which joint-related disease can lead to the development of secondary osteoarthritis?

Rheumatoid arthritis (RA) Signup and view all the answers

What is the primary effect of mechanical factors on the development of osteoarthritis?

Accumulated micro-trauma causing changes in bone Signup and view all the answers

What is a common manifestation of osteoarthritis on articular cartilage?

Fibrillation and thinning of the surface Signup and view all the answers

What characterizes the degeneration process in osteoarthritis?

Focal degeneration of articular cartilage Signup and view all the answers

Which population is primarily affected by osteoarthritis?

Older adults, particularly those over 65 Signup and view all the answers

What is a common radiographic finding in older adults concerning osteoarthritis?

Presence of osteophytes at joint margins Signup and view all the answers

What occurs to the bone as a result of cyst formation in osteoarthritis?

Formation of weak bone due to cysts Signup and view all the answers

What component of the joint is NOT covered by the synovial membrane?

Articular cartilage Signup and view all the answers

What is the relationship between synovial fluid and osteoarthritis?

It enters the bone through cartilage breaks Signup and view all the answers

Which of the following statements about articular cartilage is true?

It lacks nerve supply Signup and view all the answers

What is the earliest documented human disease among mammalian species?

Osteoarthritis Signup and view all the answers

What is an important benefit of isometric exercises for individuals with knee and hip osteoarthritis?

Reduces pain and disability Signup and view all the answers

What type of exercise is considered ideal for individuals with osteoarthritis when performed in a warm pool?

Swimming Signup and view all the answers

Which physiotherapy measure involves the application of heat or cold for pain relief?

Cryotherapy Signup and view all the answers

How should the gradual exercise program for osteoarthritis patients be structured?

Tailored to individual needs and gradually increased Signup and view all the answers

What is the purpose of lateral or medial heel wedged insoles for patients with osteoarthritis?

To relieve weight on the knee compartments Signup and view all the answers

Which exercise has been shown in clinical studies to enhance pain, joint function, and psychological well-being in osteoarthritis patients?

Fitness walking Signup and view all the answers

What is a risk associated with vigorous prolonged weight-bearing exercises in individuals with osteoarthritis?

Worsening of articular cartilage and subchondral bone Signup and view all the answers

What type of supports may be used to provide relief from weight on the affected knee joint?

Support pillows and splinting devices Signup and view all the answers

Study Notes

Osteoarthritis

Osteoarthritis (OA) is a degenerative joint disease that primarily affects older individuals.
OA is characterized by the focal degeneration of hyaline cartilage, leading to the formation of cysts in the bone.
OA involves subchondral sclerosis at the base of cartilage lesions and osteophytes at the joint margins.
OA is not associated with any systemic illness.

Epidemiology and Burden

OA is the most prevalent form of arthritis in clinical rheumatological practice.
Radiographic evidence of OA is present in the majority of people over 65.
Approximately 11% of individuals over 65 experience symptomatic OA of the knee.
OA is significantly impactful, second only to cardiovascular disease in causing severe disability.

Classification

Primary OA:
- Occurs in individuals over 50 years of age.
- Characterized by a strong inherited pattern.
- Localized (nodal) OA:
  - Presents with Heberden's nodes at DIP joints and Bouchard's nodes at PIP joints.
- Generalized OA:
  - Involves three or more joints or joint groups.
  - Later stages include involvement of the knee, hip, and apophyseal joints of the cervical or lumbar spine.
Secondary OA:
- Premature onset OA occurring under 50 years.
- Affects any joint at any age, secondary to:
  - Local mechanical factors: trauma, menisectomy.
  - Joint diseases: rheumatoid arthritis, septic arthritis.
  - Systemic diseases: hyperparathyroidism, acromegaly, ochronosis, hemochromatosis.

Risk Factors of Primary OA

Age: Gradual loss of glycosaminoglycan from cartilage with advancing age, leaving unsupported collagen fibers.
Genetic Factor: May be present, especially in primary generalized OA.
Sex: Both sexes are affected, but generalized OA is more common in women, especially after menopause.
Mechanical Factors:
- Wear and Tear: Accumulated micro-trauma causes changes in subchondral bone, affecting the joint's ability to absorb force.

Non-Pharmacologic Management

Patient Education: Studies suggest patient education is as effective as NSAIDs and can have a synergistic effect with other treatments.
Psychosocial Support: Assists patients in managing pain and coping with the disease.
Weight Loss: Significant for reducing the risk of OA, especially in women (5 kg weight loss reduces risk by over 50%).
Aerobic Exercise Programs: Improve cardiovascular health, strengthen muscles, and increase endurance.
Physical Therapy: Incorporates exercises and modalities to improve joint range of motion, strength, and function.
Occupational Therapy: Adapts work and daily living tasks to reduce stress on affected joints.

Instructions for Joint Protection

Avoid prolonged lying or sitting in one position.
Avoid low chairs.
Limit prolonged standing or walking.
Avoid overexertion of the affected joint.
Avoid faulty posture that stresses the joint.
Avoid loading the joint when it is very painful.

Therapeutic Exercise in OA

Isometric exercises strengthen quadriceps and gluteals, reducing pain and disability.
Proprioception and standing balance improve secondary to muscle strength enhancement.
Exercise programs are individualized and gradually increased.
Vigorous prolonged weight-bearing exercise can worsen cartilage and bone.
Swimming is recommended, especially in warm water.
Simple home exercise programs are effective.

Other Physiotherapy Measures

Heat or cold packs for pain relief.
Transcutaneous electrical nerve stimulation (TENS) for pain relief.
Low-power laser therapy.

Weight-Relieving Measures & Splints

Walking Aids: Crutches, canes, walkers.
Support Pillows & Splinting: Cervical collars, knee supports, CMJ splints.
Lateral or Medial Heel Wedged Insoles: Medial wedged insoles for lateral compartment OA, lateral wedged insoles for medial compartment OA.
Shock Absorbing Insoles: Made of sponge or silicone.

Total Joint Replacement (Arthroplasty)

Most common for hip and knee OA.
May be helpful for OA involving CMC, MTP, DIP, and PIP joints.
Approximately 90% of patients achieve pain relief and satisfactory function.
Failure rates vary from 10% to 30% at 10 years.

New Techniques to Restore Articular Cartilage

Autogenous Cartilage Implantation: Grafting of chondroblasts, chondrocytes, and undifferentiated chondrocytes.
Autogenous Osteochondral Grafting: Transfer of bone-cartilage cylinders from a less weight-bearing area to the articular defect.
Somatic Gene Therapy: Introduction of normal genes to replace defective genes.
Stem Cell Transplantation: Utilizing embryonic, adult, or fetal stem cells to differentiate and replace damaged cartilage.

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Description

This quiz covers the essential aspects of osteoarthritis, including its characteristics, epidemiology, and classification. Learn how this degenerative joint disease primarily affects older individuals and the burden it places on health systems. Test your knowledge of the prevalence and types of osteoarthritis.