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19 Cards in this Set
- Front
- Back
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Osteoarthritis: epidemiology
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75% of all arthritis
Huge cost on society Prevalence increasing (increasing obesity/age, decreasing exercise) |
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OA: patterns of disease
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Localized - hip, knee, hand
Generalized - 3+ joint groups Spine - low back, neck |
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OA: definition
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A progressive disease resulting from failed repair of joint damage due to stresses on the joint (NOT degenerative)
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OA: Relationship between structural changes (diseas) and symptoms (illness)
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Imperfect (unlike inflammatory arthritis)
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OA: pathogenesis patterns
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Abnormal stress with normal physiology/anatomy
Normal stress with abnormal physiology/anatomy |
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OA: structural changes
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Subchondral sclerosis and cysts
Osteophytes Joint space narrowing (assymetric) |
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OA: symptoms
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Pain, fatigue, stiffness, functional limitations
Deceased sleep, mood, QOL |
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OA: signs
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Jointline tenderness
Bony enlargement Crepitus Limited ROM (+/-) Mild inflammation (+/-) |
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OA: Risk Factors
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Old age
Women (hormones, body shape, genetics) Genetics (50% hip, hand, generalized; <50% knee) Joint load abnormality (malalignment, laxity in knee, nerve damage, joint injury, joint deformity) Neuromuscular defects (proprioception, muscle and spinal reflex system) Muscle weakness (Quads for knee OA in women) Obesity (knee OA in women; mal-alignment, overloading, cytokines) |
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OA: management goals
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Education
Control of symptoms Maintain/improve functioning Slow progression |
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OA: Pain management guidelines
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1st line: Education/self management+physical activity+wt loss+ acetaminophen, clucosamine/chondroitin
2nd line: Joint injections 3rd line: NSAIDS +/- GI protection 4th line: opioids 5th line: surgery |
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OA: non-pharmacologic management
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Self-management
OT and PT Dietitian Arthritis Society services: arthritis self-management program Exercise |
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OA: pharmacologic management
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Acetominphen: analgesic, not anti-inflammatory
Dietary supplements: chondroitin-no evidence of benefit, glucosamine sulphate-evidence inconsistant Joint injections: cortisone, hyaluronic acid NSAIDS:analgesic and anti-inflammatory, S/E, use with caution (kidney function, heart disease, history of GI bleed). Coxibs (cox-2 only) Joint replacement surgery: hip and knee Arthroscopic knee surgery: no evidence of benefit |
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Low Back Pain: spine OA vs. Degenerative Disc Disease
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Spine OA = facet joint OA
DDD = deterioration of inter-vertebral disc with hypertrophic sponylosis DDD can lead to spine OA |
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Acute regional LBP: symptoms
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LBP:
1.Low back to buttocks/hip to laterl thigh to calf/foot 2.Hip OA to groin to medial thigh to knee Relief when lying down +/- radiation, neurological symptoms |
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Acute regional LBP: red flags
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Pain worse at nigth
Systemic symptoms (wt loss, fever) Significant neurological deficits (bowel/bladder dysfunction,etc) |
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Acute regional LBP: Diagnosis
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Clinical - exclude other illnesses
Physical exam: back exam unreliable, neurologic status |
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Acute regional LBP: prognosis
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Self-limited in 80%
Recurrance common Educate to prevent |
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Acute regional LBP: management
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If no red flags - don't investigate!
Exercise Drugs: NSAIDS, opioid analgesics Surgery: if severe sciatica >6wks |
