Osteoarthritis
Rheumatology · Osteoarthritis 🎯 Practice these cards
OA is a chronic progressive multifactorial disorder of maladaptive ___ ___ ___ to joint stress, affecting ___ tissues of the joint.
Osteoarthritis is a chronic progressive multifactorial disorder of maladaptive cellular repair responses to joint stress — a whole-joint disease with cartilage and meniscal degradation, subchondral bone changes (marrow lesions, sclerosis), osteophytes, and low-grade synovitis. Not 'wear and tear.'
The most important modifiable risk factor for knee OA is ___.
Obesity is the most important modifiable risk factor for OA (especially knee): 3–6 times body weight crosses the knee in single-leg stance, weight loss >10% reduces cartilage loss and alleviates pain, and the risk relationship is linear in women.
Heberden nodes are bony enlargement of the ___ joints; Bouchard nodes are bony enlargement of the ___ joints.
Heberden nodes = bony enlargement of the DIP joints; Bouchard nodes = bony enlargement of the PIP joints. Both are hallmarks of hand OA. (Mnemonic: Heberden is Higher up the finger from the knuckle's perspective — the DIP.)
Radiographic features of OA: asymmetric joint-space narrowing, subchondral sclerosis, ___, and ___.
The four classic radiographic features of OA: asymmetric joint-space narrowing, subchondral sclerosis, osteophytes, and bone (subchondral) cysts. Findings may be absent early and correlate poorly with symptoms at any stage.
OA synovial fluid is noninflammatory, with a leukocyte count of ___/μL or less.
OA synovial fluid is clear and noninflammatory with a leukocyte count ≤2000/μL (2.0 × 10⁹/L). A count above ~1000/μL should raise suspicion for crystal arthropathy, infection, or inflammatory arthritis.
DISH shows flowing ossification of at least ___ contiguous vertebral levels, usually on the ___ side, and spares the ___ joints.
Diffuse idiopathic skeletal hyperostosis: noninflammatory flowing ossification of at least four contiguous vertebral levels (anterior longitudinal ligament/entheses), classically right-sided (the aorta shields the left), with sacroiliac joints spared — the key distinction from ankylosing spondylitis.
The ACR ___ recommends glucosamine for knee, hip, and hand OA; chondroitin is conditionally recommended only for ___ OA.
ACR/Arthritis Foundation guidelines strongly recommend AGAINST glucosamine for knee, hip, and hand OA and against chondroitin for knee/hip OA (large trials failed to beat placebo). Chondroitin is only conditionally recommended for hand OA.
Fibromyalgia criteria: WPI ≥7 plus SSS ≥___, or WPI 4–6 plus SSS ≥9, for more than ___ months; tender points are ___.
Fibromyalgia by 2010 ACR criteria (2016 revision): WPI ≥7 plus Symptom Severity Scale ≥5, OR WPI 4–6 plus SSS ≥9, with symptoms >3 months. Diagnosis is symptom-based — the tender-point examination is obsolete, and a fibromyalgia diagnosis does not exclude other illnesses.
FDA-approved fibromyalgia drugs: pregabalin, ___, and milnacipran. ___ have no evidence base; ___ are contraindicated.
Evidence-based fibromyalgia pharmacotherapy: pregabalin (FDA-approved) and gabapentin; SNRIs duloxetine and milnacipran (both FDA-approved); low-dose tricyclics (amitriptyline 10–25 mg at bedtime). NSAIDs lack efficacy; full opioids are contraindicated.
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