Updated: 12/27/2021

Osteoarthritis

0%
Topic
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0
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N/A
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Questions
6
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Evidence
5
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0
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Videos / Pods
2
Topic
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  • Snapshot
    • A 60-year-old woman presents to her primary care physician with pain in her hands and knees. She reports to having this pain intermittently for at least 8 months and describes it being worse in the evening. On physical exam, there is bone deformity noted on the distal and proximal interphalangeal joints, swelling of the right knee, and tenderness upon palpation of the affected joints.
  • Introduction
    • Clinical definition
      • a degenerative disorder affecting the articular cartilage
  • Epidemiology
    • Incidence
      • most common articular disease
    • Demographics
      • more common in women and the elderly
    • Risk factors
      • modifiable
        • obesity
        • trauma
        • repetitive use (e.g., heavy labor)
      • non-modifiable
        • age
        • female gender
        • family history
  • Etiology
    • Pathogenesis
      • not completely understood but is more complex than "wear and tear" of the joint, and inflammation appears to be involved
        • chondrocytes attempt to proliferate and synthesize proteoglycans when it is injured
          • however, degradation exceeds synthesis, thus compromising the extracellular matrix
        • inflammatory processes appear to promote proteolytic articular degeneration mediated by chondrocytes
          • e.g., transforming growth factor-β (TGF-β) induces chondrocytes to secrete matrix metalloproteinase (MMPs) to degrade type II collagen
      • eventually portions of the articular cartilage and subchondral bone is sloughed off into the joint space (synovial space)
        • forming loose bodies (joint mice)
      • subchondral bone becomes exposed and rubs on the adjacent bone, resulting in
        • bone eburnation (polished ivory)
      • osteophytes (bony outgrowths) develop due to bone remodeling
        • can be appreciated in the
          • distal interphalangeal joint as Herberden nodes
          • proximal interphalangeal joint as Bouchard nodes
      • late stage osteoarthritis is characterized by loss of chondrocytes and degraded extracellular matrix
  • Biology and Anatomy
    • Articular cartilage greatly decreases friction with movement and resists tension and compressive forces
      • composed of type II collagen and proteoglycans which are synthesized and secreted by chondrocytes
        • chondrocytes maintain cartilage with its anabolic and catabolic activities
  • Presentation
    • Symptoms
      • pain
        • worsens with use and improves with rest
        • commonly involves the hands, hips, and knees
    • Physical exam
      • joint tenderness
      • decreased range of motion
      • bony swelling
        • swelling of the distal interphalangeal (Herberden nodes)
        • swelling of the proximal interphalangeal (Bouchard nodes)
  • Imaging
    • Radiography
      • indication
        • may be used to confirm the diagnosis and determine disease progression and severity
      • findings
        • joint space narrowing
        • osteophytes
        • joint mice
        • subchondral sclerosis
  • Studies
    • Labs
      • c-reative protein (CRP) and erythrocyte sedimentation rate (ESR) levels are normal
    • Diagnostic criteria
      • typically a clinical diagnosis
  • Differential
    • Rheumatoid arthritis
    • Arthralgia
    • Bursitis
    • Tendonitis
  • Treatment
    • Conservative
      • exercise and weight loss
        • indication
          • first-line in the management of osteoarthritis
    • Medical
      • topical or oral nonsteroidal antiinflammatory drugs (NSAIDs)
        • indication
          • for the symptomatic management of osteoarthritis in patients who do not adequately respond to conservative treatment
        • adverse effects
          • gastrointestinal side-effects such as ulcer formation
    • Operative
      • orthopedic surgery
        • indication
          • in patients with advanced pain who are unresponsive to conservative and pharmacologic therapy
  • Complications
    • Pain
    • Bone deformity
    • Functional impairment
  • Prognosis
    • Favorable with joint replacement
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(M2.OR.17.4754) A 69-year-old man presents to his primary care physician for pain when he walks. He states that the pain is the worst in his left great toe but is also present in his hips and knees. He says that his symptoms are worse with activity and tend to improve with rest. His symptoms have progressively worsened over the past several years. He has a past medical history of obesity, type II diabetes mellitus, smoking, and hypertension. He drinks roughly ten beers per day. His current medications include metformin, insulin, lisinopril, and hydrochlorothiazide. The patient has a recent travel history to Bangkok where he admits to having unprotected sex. On physical exam, examination of the lower extremity results in pain. There is crepitus of the patient's hip when his thigh is flexed and extended. Which of the following is the most likely diagnosis?

QID: 108991

Osteoarthritis

63%

(39/62)

Rheumatoid arthritis

0%

(0/62)

Infectious arthritis

11%

(7/62)

Gout

21%

(13/62)

Pseudogout

2%

(1/62)

M 6 C

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(M2.OR.15.4672) A 64-year-old male presents to his primary care physician with a complaint of bilateral knee pain that has been present for the past several years but has worsened recently. He reports pain with climbing stairs and with extended walks of greater than 100 yards. The pain worsens with activity throughout the day and is alleviated by periods of rest. He states that he has minimal morning stiffness, lasting approximately 5-10 minutes after waking up most days. Physical examination reveals tenderness to palpation of the bony structures on the medial aspect of the bilateral knees as well as crepitus and a decreased range of motion, limited at the extremes of flexion and extension. Both knee joints are cool to touch and exhibit bony enlargement upon palpation of the medial joint line. Which of the following studies would be indicated for further work-up of this patient's presenting condition?

QID: 107191

Complete blood count (CBC)

3%

(1/36)

Erythrocyte sedimentation rate (ESR)

8%

(3/36)

Rheumatoid factor (RF)

6%

(2/36)

MRI of the knee

14%

(5/36)

No further work-up needed

58%

(21/36)

M 6 E

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(M2.OR.14.44) A 72-year-old woman with a past medical history of diabetes and obesity presents to the clinic with joint pain. She has severe pain in both of her knees for which she has been taking ibuprofen daily. Her temperature is 98.2°F (36.8°C), blood pressure is 177/109 mmHg, pulse is 80/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam is notable for the finding in Figure A. Radiography of the knee shows the finding in Figure B. Which of the following is the most likely diagnosis?

QID: 104586
FIGURES:

Osteoarthritis

43%

(6/14)

Reactive arthritis

7%

(1/14)

Rheumatoid arthritis

21%

(3/14)

Septic arthritis

21%

(3/14)

Systemic lupus erythematosus

0%

(0/14)

M 6 E

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Evidence (5)
VIDEOS & PODCASTS (3)
EXPERT COMMENTS (4)
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