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Exam 4
Osteoarthritis
45
Veterinary Medicine
Professional
11/18/2016

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Cards

Term
What is arthritis?
Definition
-broad erm encompassing inflammatory diseases that occur within a joint
Term
What are other names for osteoarthritis?
Definition
-arthrosis, degenerative joint disease
Term
What is osteoarthritis?
Definition
-aberrant repair and eventual degradation of articualr cartilage in association with laterations in subchondral bone metabolism, periarticular osteophytosis, and variable degrees of synovial inflamamtion
Term
What is the prevelence of arthritis in dogs? In cats?
Definition
-20% of dogs
>60% of cats
Term
What is the most common cause of OA in cats?
Definition
-primary OA
Term
What are the secondary causes of OA?
Definition
-developmental disorder: hip dysplasia, elbow dysplasia, OCD
-joint instability: CCLR
-Trauma: articular fractures, joint luxation
Term
How does body weight lead to OA?
Definition
-inc stress
-adipokines affect cartilage turnowver, induces cartilage degradation
Term
How does gender affect OA?
Definition
-estrogen receptors are present within the joint: estrogen protects from inflammation
Term
Describe the pathogenesis of OA in the articualr cartilage?
Definition
-loss of compressive stiffness adn tensile strength
-dec responsiveness to mechanical stimuli
Term
Describe the pathogenesis of OA in the synovium?
Definition
-source of pro-inflammatory products and pain
Term
Describe the pathogenesis of OA in the subchondral bone?
Definition
-osteophyte formation, sclerosis
Term
What happens during Stage I of OA?
Definition
-proteolytic breakdown of cartilage matrix
Term
What happens during Stage II of OA?
Definition
-fibrillation and erosion of cartilage surface
-breakdown products released in synovial fluid
Term
What happens during Stage III of OA?
Definition
-synovial inflammaiton
-phagocytosis of breakdown products stimulates production of pro-inflammatory mediators: proteases, cytokines
Term
How does synovial inflammation cause joint pain with OA?
Definition
-effusion and microinstability
-stimulation of nociceptors
Term
How does subchondral bone issues cause joint pain with OA?
Definition
-neovascular invasion
-exposure of subchondral bone
-osteoclastic remdoeling
Term
What are the sources of joint pain in OA?
Definition
-synovial inflammation
-subchondral bone
-degenerate cartilage
-osteochondral fragments
-major joint instability
Term
What are the common sites of OA?
Definition
-hip
-elbow
-stifle
-shoulder
Term
How do we diagnose OA?
Definition
-clinical signs/PE
-rads
-MRI
-CT
-arthroscopy
-synovial fluid analysis
Term
What do we see on history that is suggestive of OA?
Definition
-slow to rise
-slow in the AM and improves iwht exercise
-lame/slow after activity
Term
What do we see on PE that is suggestive of OA?
Definition
-creptius/pain with ROM
-joint localizaiton
-severity of presentaiton
Term
Describe the efficacy of rads for diagnosing OA.
Definition
-most common modality but not sensitive in early stages but no info about soft tissue components of joint (synovium, subchondral bone, cartilage lesions)
Term
True or False: In regards to OA, rads directly correlate with the severity of clinical signs.
Definition
-FALSE, with OA rads do NOT correlate well with severity of clinical signs
Term
Describe the efficacy of MRI for diagnosing OA.
Definition
-superior quality and sensitivity than rads
-xcellent for eval of joint components: cartilage defects/thickness and non-cartilagenous structures
Term
What are the disadvantages of MRI for diagnosing OA?
Definition
-cost
-availability
-requires general anesthesia
Term
What are the advantages and disadvantages of using CT to diagnose OA?
Definition
-useful in complex joints with superimposition and more sensitive for bone
-not as sensitive for soft tissue assessment as MRI
Term
What are the advantages of using arthroscopy to diagnose OA?
Definition
-gross eval of joint
-can serve as a therapeutic option concurrently
-can directly assess cartilage damage
Term
What do we evaluate cytologi of synovial fluid to diagnose OA?
Definition
-cell types and numbers
-infectious agents
-color, urbidity, viscosity
Term
When do we perform an FNA in regards to imaging modalities to diagnose OA?
Definition
-perform AFTER rads/CT/MRI
Term
How do we manage OA?
Definition
-no curative options available
-no approved disease-modifying agents
-multifactorial disease = multifactorial treatment
Term
Descrive the multifactorial treatment of OA.
Definition
-weight control/ diet modificaiton
-activity management
-pharm supplementation
-surgical management
Term
Why do we manage weight to treat OA?
Definition
-maintain deal BCS
-reduce stress on joints
Term
How do we modify the diet to control weight to treat OA?
Definition
-low fat/weight loss diet
-smart treats
-family effort
Term
Describe how we manage activity levels with OA?
Definition
-exercise exacerbates OA pain but suggest regular, moderate (low-impact), controlled exercise
Term
What are our options for rehabilitation for OA?
Definition
-passive range of motion exercises
-water treadmill
-muscle strengthening exercises
-heat/cold therapy
-acupuncture
Term
What kind of pharma supplementation do we use to treat OA?
Definition
-analgesics
-NSAID: caution with long term use
-Tramadol, bagapentin, amantadine
-Gabapentin, amantadine
Term
What are some of the nutritional supplements given to dogs ith OA?
Definition
-Glucosamine (sugar) + chondroitin sulfate (PSGAG)
-Essential fatty acids
Term
What do Glucosamine and chondroitin sulfate supplements do for dogs with OA?
Definition
-chondrocyte stimulation
-anti-inflammatory effects
-takes 4-6w to se effect
Term
What do essential fatty acid supplements do for dogs with OA?
Definition
-fish-oil derived, not cereal
-anti-inflammatory effects
Term
What do chondroprotectives do?
Definition
-inhibit matrix metalloproteinases, prostaglandins (catabolic enzymes)
-cytokine inhibition
-inc the synthesis of hyaluronic acid, collagens, proteoglycans
Term
What does stem cell therapy do for dogs with OA?
Definition
-regenerative medicine
-adult multipotent stem cells: adipose tissue, bone marrow, umbilical cord blood
-most commonly used as intra-articular injections
-anti-inflammatory effect
-promote tissue growth/regenration
-extremely expensive
Term
What does platelet-rich plasma do for dogs with OA?
Definition
-boost the body's natural response to healing
Term
How do we surgically manage dogs with OA?
Definition
-correct the underlying condition to slow down progression of OA
Term
What types of surgical procedures are used to manage canine OA?
Definition
-Cranial cruciate ligament stabilization
-medial patellar luxation repair
-articular fracture repair
-removing fragmented medial coronoid process
-debridement of an OCD lesion
Term
What procedures do we use to surgically salvage OA?
Definition
-joint replacement: removes pain and inflammaiton
-FHO: remove joint contact
-arthrodesis: removes joint mechanics all together and fuse it at a functional angle
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