OSTEOARTHRITIS

OSTEOARTHRITIS

Q. 1

In patients with osteoarthritis of knee joint, atrophy occurs most commonly in which muscle :

 A >Qudriceps only
 B >Hamstrings only
 C >Both (a) and (b)
 D >Gastrocnemius
Q. 1

In patients with osteoarthritis of knee joint, atrophy occurs most commonly in which muscle :

 A >Qudriceps only
 B >Hamstrings only
 C >Both (a) and (b)
 D >Gastrocnemius
Ans. A

Explanation:

Quadriceps only Met Maheshwari 3/e, p 253;Apley’s 8/e, p 472]

In osteoarthritis of knee joint, the quadriceps muscle is usually wasted.


Q. 2

A sixty five year old lady presents with a long standing history of pain and swelling in her right knee. Pain is significantly interfering with her activities of daily living. Radiological evaluation shows grade III changes of osteoarthritis. Which of the following is the recommended line of management?

 A

Conservative management

 B

Arthroscopic lavage/washout

 C

Partial knee replacement

 D

Total knee replacement

Ans. D

Explanation:

This patients history strongly supports for a total knee replacement.

As she is sixty five years old and radiological reports showing evidence of grade III changes of osteoarthritis in this patient, the best recommendation would be a Total knee arthroplasty.

Patients with severe symptomatic Osteoarthritis have failed to respond to medical therapy and have progressive limitations in their daily activities should be referred for surgical options such as arthroplasty or joint reconstruction like osteotomy or arthrodesis.

Ref: Osteoarthritis: Diagnosis and medical/surgical management, by Roland W.Moskowitz, Page 402, 403.


Q. 3

Which of these muscles undergoes wasting first in osteoarthritis knee?

 A

Quadriceps only

 B

Hamstrings only

 C

Both quadriceps and Hamstrings

 D

Gastronemius

Ans. A

Explanation:

All periarticular muscles around the knee joint may undergo wasting in advanced osteorthritis knee. However muscle atrophy particularly involves the quadriceps which is the earliest muscle to undergo wasting.

Ref: Turek s Orthopaedics 2nd Edition, Page 1368.


Q. 4

A 35 year old male patient develops involvement of proximal and distal interphalangeal joints and 1st canpo-metacarpal joints with sparing of wrist and metacarophalangeal joint. The Diagnosis is:

 A

Osteoarthritis

 B

Psoriatic arthropathy

 C

Rheumatoid arthritis

 D

Pseudogout

Ans. A

Explanation:

Answer is A (Osteoarthritis)


Q. 5

A 60-year old man with diabetes mellitus presents with painless, swollen right ankle joint. Radiographs of the ankle show destroyed joint with a large number of loose bodies. The most probable diagnosis is:

 A

Charcot’s joint

 B

Clutton’s joint

 C

Osteoarthritis

 D

Rheumatoid arthritis

Ans. A

Explanation:

Ans. A

Although the destruction of the ankle joint with loose bodies and swelling may be seen in almost all the above conditions, the clue here lies in the fact that ‘joint is painless’ despite radiological evidence of extensive joint destruction. Further, the patient is a diabetic and today diabetes is the most common cause for neuropathic joint disease (Charcot’s joint)

Charcot’s Joint / Neuropathic Joint:

Neuropathic joint or Charcot’s joint is progressive destructive arthritis associated with loss of pain sensation, proprioception or both.

Joint involvement based on underlying joint disorder

Clinical Manifestations:

  • Begins in a single joint and then progresses to involve other joints
  • The involved joint becomes progressively enlarged from bony overgrowth and Synovial effusion (swelling).
  • Loose bodies may be palpated in the joint cavity.
  • Joint instability, Subluxation, crepitus occur as the disease progresses
  • The amount of pain experienced by the patient is less than would be anticipated based on the degree of joint involvement (sudden pain may be experienced from intraarticular fractures of osteophytes or condyles).

Q. 6 Joint LEAST involved in primary osteoarthritis:

March 2013 (b, h)

 A

Hip

 B

Trapezio-metacarpal

 C

Knee

 D

Coraco-clavicular

Ans. D

Explanation:

Ans. D i.e. Coracoclavicular

Osteoarthritis

  • Usually OA involves:

– Hip,

– Knee

  • Does not affect MCP joint
  • Interphalangeal joints & nodes:

–        DIP – Heberdens node;

PIP – Bouchard nodes

  • X-ray shows: Osteophyte formation, narrowing of joint space etc.

Q. 7 Most common joint involved in osteoarthritis in India:   

March 2009

 A Shoulder

 B

Hip

 C

Knee

 D

Ankle

Ans. C

Explanation:

Ans: C: Knee

The hip joint is commonly involved in a population with western living habits, while the knee joint is involved more commonly in a population with an Asian living habits i.e., the habit of squatting and sitting cross-legged.


Q. 8

Part of knee most commonly involved in osteoarthritis:                                      

March 2009

 A Medial compartment

 B

Lateral compartment

 C

Medial and lateral compartment

 D

Patellofemoral compartment

Ans. A

Explanation:

Ans. A: Medial Compartment

In the knee joint medial compartment is affected more than the lateral-leading to a varus deformity (genu varum)


Q. 9

Heberden’s nodes are found in:

 A

PIP joints in osteoarthritis

 B

DIP joints in osteoarthritis

 C

PIP joints in rheumatoid arthritis

 D

DIP joints in osteoarthritis

Ans. B

Explanation:

Ans. DIP joints in osteoarthritis

Heberden’s nodes are bony growths that develop on the finger joints, otherwise known as the interphalangeal joints. They most commonly develop on the joints nearest to the fingertips and can cause the fingers to appear crooked


Q. 10

Arthritis involving DIP, PIP, 1st carpometacarpal with sparing of MCP and wrist joints is typical of

 A

Osteoarthritis

 B

Rheumatoid arthritis

 C

Ankylosing spondylitis

 D

Psoriatic arthritis

Ans. A

Explanation:

Ans. is ‘a’ i.e., Osteoarthritis

1st Carpometacarpal joint Wrist- Osteoarthritis


Q. 11

False about osteoarthritis is ‑

 A

Involves synovial joints

 B

Progressive softening of the articular cartilage

 C

It is an inflammatory arthritis

 D

Marginal osteophytes are produced

Ans. C

Explanation:

Ans. is ‘c’ i.e., It is an inflammatory arthritis

  • Osteoarthritis (OA) is a chronic disorder of synovial joints in which there is progressive softening and disintegration of articular cartilage accompanied by new growth of cartilage and bone at the joint margins (osteophytes), cyst formation and sclerosis in the subchondral bone, mild synovitis and capsular fibrosis.
  • The term osteoarthritis is a misnomer as it is a non-inflammatory condition.

The right term is osteoarthrosis or degenerative joint disorder because it is a degenerative wear – and – tear process occuring in joints.


Q. 12 Osteoarthritis involves all except ‑

 A

Hip

 B

Knee

 C

PIP

 D

Wrist

Ans. D

Explanation:

Ans. is ‘d’ i.e., Wrist

Joints involved in OA

  • OA affects certain joints, yet spares others.
  • Commonly affected joint include Hip, knee, cervical & lumbosacral spine, and first metatarsophalangeal joint.
  • In Hands, the distal interphalangeal joints (DIP), proximal interphalangeal joints (PIP) and first carpo­metacarpal joint (base of thumb) are involved while sparing metacarpophalangeal (MCP) joints.
  • Shoulder joint may be affected but uncommonly.
  • Usually spared joints are the wrist, elbow, metacarpophlangeal and ankle.
  • This may simply reflect the fact that some joints are more prone to predisposing abnormalities than others.

Q. 13 Feature of osteoarthritis is –

 A Heberden node

 B

Increased ESR

 C

Onycholysis

 D

Z deformity

Ans. A

Explanation:

Ans. is ‘a’ i.e., Heberden node

Joint involvement in OA

  • Common joints : Knee, Hip, Spine (cervical, lumbosacral), Hand (PIP, DIP, first carpometacarpal), first tarso­metatarsal.
  • Uncommon joint : Shoulder
  • Spared : Wrist, elbow, ankle, metacarpophalangeal.
  • In osteoarthritis of hand :
  1. Distal interphalangeal joint :- Heberden’s node.
  2. Proximal interphalangeal joint :- Bouchard’s node

Q. 14 Bodies as marked by an arrow in the knee X-ray below is characteristic of ? 

 A Osteoarthritis.

 B

Rheumatoid arthritis.

 C

Ankylosing spondylitis.

 D

Psoriatic arthritis.

Ans. A

Explanation:

The bodies seen in the picture above represents loose bodies.A loose body is typically diagnosed with an x-ray. In most cases, the traumatic loose body has a bone chip with it or a big chunk of cartilage easily seen on an x-ray.

The loose bodies can vary in size from a few millimeters (such as the size of a small pill) to a few centimeters (the size of a quarter).  The fragments can lead to damage to the articular cartilage, causing osteoarthritis.


Q. 15

A 55 year old female with BMI value of 40,presents with complain of pain in right knee joint,stiffnessand reduced range of movement.The X ray of right knee joint is shown in the image(along with a X ray of normal Knee joint for comparison on left side).What would be the most probable diagnosis?

 

 A

Rheumatoid Arthritis

 B

Osteoarthritis

 C

Psoriatic Arthritis

 D

Reiter’s Disease

Ans. B

Explanation:

Ans:B.)Osteoarthritis

X ray of the knee joint shows narrowing of the joint space and subchondral sclerosis suggestive of Osteoarthritis.

Osteoarthritis

  • It can be thought of as a degenerative disorder arising from the biochemical breakdown of articular (hyaline) cartilage in the synovial joints. However, the current view holds that osteoarthritis involves not only the articular cartilage but the entire joint organ, including the subchondral bone and synovium.
  • Osteoarthritis predominantly involves the weight-bearing joints, including the knees, hips, cervical and lumbosacral spine, and feet. Other commonly affected joints include the distal interphalangeal (DIP), proximal interphalangeal (PIP), and carpometacarpal (CMC) joints.
  • Risk factors for osteoarthritis :
    • Age
    • Obesity :Obesity increases the mechanical stress in a weight-bearing joint
    • Trauma
    • Genetics (significant family history)
    • Reduced levels of sex hormones
    • Muscle weakness
    • Repetitive use (ie, jobs requiring heavy labor and bending)
    • Infection
    • Crystal deposition
    • Acromegaly
    • Previous inflammatory arthritis (eg, burnt-out rheumatoid arthritis)
    • Heritable metabolic causes (eg, alkaptonuria, hemochromatosis, Wilson disease)
    • Hemoglobinopathies (eg, sickle cell disease and thalassemia)
    • Neuropathic disorders leading to a Charcot joint (eg, syringomyelia, tabes dorsalis, and diabetes)
    • Underlying morphologic risk factors (eg, congenital hip dislocation)
    • Disorders of bone (eg, Paget disease and avascular necrosis)
    • Previous surgical procedures (eg, meniscectomy)
  • Symptoms :
    • Deep, achy joint pain exacerbated by extensive use – The disease’s primary symptom
    • Reduced range of motion and crepitus – Frequently present
    • Stiffness during rest (gelling) – May develop, with morning joint stiffness usually lasting for less than 30 minutes
  • Osteoarthritis of the hand
    • Distal interphalangeal joints are most often affected
    • Proximal interphalangeal joints and the carpometacarpal joints at the base of the thumb are also typically involved
    • Heberden nodes, which represent palpable osteophytes in the DIP joints, are more characteristic in women than in men.
  • Imaging studies
    • Plain radiography – The imaging method of choice: in the load-bearing areas, radiographs can depict joint-space loss, as well as subchondral bony sclerosis and cyst formation,osteophytes and joint deformity.
  • Arthrocentesis
    • The presence of noninflammatory joint fluid helps distinguish osteoarthritis from other causes of joint pain. Other synovial fluid findings that aid in the differentiation of osteoarthritis from other conditions are negative Gram stains and cultures, as well as the absence of crystals when fluid is viewed under a polarized microscope.

Treatment:

  • Nonpharmacologic interventions are the cornerstones of osteoarthritis therapy and include the following:
    • Application of heat and cold
    • Weight loss
    • Exercise
    • Physical therapy
    • Occupational therapy
    • Joint unloading, in certain joints (eg, knee and hip).
  • Pain reliever and Anti-inflammatory like Acetaminophan,Ibuprofen,etc.
  • Tramadol
  • Intra-articular pharmacologic therapy includes corticosteroid injection and viscosupplementation.
  • Surgical procedures for osteoarthritis include the following:
    • Arthroscopy
    • Osteotomy
    • Arthroplasty – Particularly with knee or hip osteoarthritis
    • Fusion

Q. 16 Least common site involved in osteoarthritis is

 A

Hip joint

 B

Knee joint

 C

Carpometacarpal joint of thumb

 D

Distal carpophalangeal joint

Ans. C

Explanation:

Ans. is ‘C’ 

In the hand the joints specifically involved are

  • Distal interphalangeal join& (of particular importance is the point that this joint is not involved in rheumatoid arthritis).
  • Proximal interphalangeal join&
  • First carpometacarpal jointsQ

Remember these two important features of joint involvement in osteoarthritis

  • It does not involve the metacarpophalangeal jointso
  • It does not involve the wrist joint(2. It also does not involve the carpometacarpalQ joint (except at the base of thumb).
  • Osteoarthritis involves the carpometacarpal joint at the base of thumb, infact it is the second most common area of involvement in osteoarthritis.

Other joints which are commonly involved in osteoarthritis are

  • Hips,
  • Knees,
  • Lower lumbar
  • Cervical.

Joints which are usually spared in osteoarthritis are

  • WristsQ, carpometacarpale
  • ElbowsQ
  • Shoulder joint

Q. 17 Joint not involved in osteoarthritis ‑

 A PIP

 B

PIP

 C

MCP

 D

Knee

Ans. C

Explanation:

Ans. is ‘c’ i.e., MCP

Joint involvement in OA

  • Common joints : Knee, Hip, Spine (cervical, lumbosacral), Hand (PIP, DIP, first carpometacarpal), first tarso­metatarsal.
  • Uncommon joint : Shoulder
  • Spared : Wrist, elbow, ankle, metacarpophalangeal.


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