Osteoarthritis (Smarty PANCE)

Characterized by *asymmetric* joint stiffness, that *worsens as the day progresses*

Osteoarthritis

Osteophytes found at the *distal interphalangeal joints* in osteoarthritis

Heberden nodes (think HD TV - Haberdeen = distal)

Osteophytes found at the *proximal interphalangeal joints* in osteoarthritis.

Bouchard nodes (Think BP gas - Bouchard = proximal)

Which joints of the hands are most commonly affected by osteoarthritis?

The distal interphalangeal (DIP) joints of the fingers are most commonly affected by osteoarthritis.

Does osteoarthritis affect the metacarpophalangeal joints?

*NO!* Osteoarthritis is a joint disorder that *does not involve* the metacarpophalangeal joints

What are the bony prominences (caused by osteophytes) at the DIP joints in patients with osteoarthritis called?

Heberden nodes

What is the cause of osteoarthritis?

Mechanical wear and tear leading to articular cartilage destruction

What structure is progressively damaged and eroded over time leading to osteoarthritis?

Articular cartilage

Name the top three risk factors for osteoarthritis

Age, obesity, and joint trauma

Is osteoarthritis more common in men or women?

Women

Which is more common: osteoarthritis or rheumatoid arthritis?

Osteoarthritis is the most common type of arthritis

How does OA affect the joint spaces?

Osteoarthritis typically causes narrowed joint spaces

Name three common radiographic findings in OA

OA causes subchondral cysts, narrowing of the joint space, and joint sclerosis on radiography

Does the synovial fluid analysis in osteoarthritis reveal low or high levels of white blood cells?

Synovial fluid analysis in osteoarthritis reveals low levels of white blood cells

What are the most common symptoms and signs of osteoarthritis?

The most common symptoms and signs of osteoarthritis are:

● Joint stiffness

● Joint pain

● Joint deformity

What effect on function can osteophytes have in advanced osteoarthritis?

The osteophytes can cause a physical obstruction resulting in significantly decreased range of motion in the affected joints

Does osteoarthritis typically produce a mild or major joint effusion?

The effusions that occur with osteoarthritis are typically mild

What findings would commonly be seen on the weight-bearing X-rays of a patient with severe osteoarthritis of the knees?

● Decreased joint space between the femur and tibia (may be bone-on-bone), especially in the medial compartment

● Osteophytes or spurs at the joint margins

● Sclerosis of the bone

What is sclerosis of the bone?

An abnormal increase in density and hardening of bone

The loss of what motion is often an early sign of the development of osteoarthritis of the hip?

Internal rotation

Which of the following joints has the lowest occurrence rate of osteoarthritis (elbows, hands, hips, knees, spine)?

Elbows because they are non-weight-bearing joints and do not get as much repetitive use as the hands

What lifestyle changes can help patients with osteoarthritis decrease their symptoms and slow the progression of the condition?

The following lifestyle changes can help patients with osteoarthritis decrease their symptoms and slow the progression of the condition:

● Weight loss if the patient is overweight to decrease the stress on the joints

● Avoidance of activities that place heavy impact, torsion, or other stresses on the joints

● Gentle exercise that encourages motion of the joints (gentle yoga, water exercises, exercise bikes, etc.)

● Shock absorbing footwear or shoe inserts to minimize the stress transferred to the weight-bearing joints.

What types of medication may provide some relief for patients suffering with osteoarthritis?

The following medication may provide some relief for patients suffering with osteoarthritis:

● Acetaminophen

● Salicylates

● NSAIDs (oral and topical)

● Topical analgesic liquids, creams, balms, and patches

● Glucosamine and Chondroitin

● Intra-articular corticosteroid injections Intra-articular hyaluronan injections (for knee joints and possibly hip joints)

● Colchicine and antimalarial drugs may be useful in particularly challenging cases

What surgical treatment options exist for those with severe joint pain and dysfunction that have failed conservative management of their osteoarthritis?

The following surgical treatment options exist for those with severe joint pain and dysfunction that have failed conservative management of their osteoarthritis:

● Joint replacement surgery (arthroplasty) can provide significant pain reduction and increased function for many patients. There have been especially good outcomes for those undergoing arthroplasty of the hips, knees, and shoulders.

● Joint fusion surgery (arthrodesis) may be a good option to reduce joint pain in some patients, especially those suffering from severe ankle or wrist osteoarthritis. Joint motion will be lost.