42 - Osteoarthritis Flashcards
Which of the following are true about osteoarthritis (OA)?
A. OA is more common before the age of 30 and is rarely associated with aging.
B. Previous joint damage or increased stress over time can increase the risk of developing OA in that joint.
C. OA symptoms often start with pain occurring only during periods of rest or night time.
D. Pain in OA is typically located along the joint line, while pain in other areas might suggest soft tissue pathology.
E. Prolonged morning stiffness is a common symptom of OA and suggests the presence of a rheumatologic disorder.
F. Mild joint swelling is typical in moderate to severe OA, but a joint that is hot and red suggests septic arthritis or another condition.
G. The knees, hips, thumbs, distal fingers, and cervical and lumbar spine are commonly affected by OA.
Correct answers: B, D, F, G
True or false: severity of OA on radiographs correlates with the clinical severity of OA.
False.
If a synovial aspirate is performed on a patient, what would be expected?
Bland aspirate.
* No bacteria
* No crystals
* Low cell count
* Normal colour
What is the primary aim of clinicians in the management of OA?
Target modifiable risk factors
What are three goals of OA management?
- Minimize pain
- Optimize function
- Beneficially modify the process of joint damage
What is the mainstay of OA treatment?
Non-pharmacologic interventions +/- medications for pain management
What are effective non-pharmacologic interventions used to manage OA?
Dr. Yusuf - how do you want to test this information? Seems redundant / self explanatory
Weight management and exercises
braces and foot orthoses for patients suitable to these interventions, education, and use of assistive devices when required.
A 63-year-old patient with knee osteoarthritis (OA) presents with worsening symptoms despite using topical NSAIDs. The patient also has OA affecting multiple joints. What is the most appropriate next step in managing this patient’s condition?
A. Initiate treatment with glucosamine and chondroitin supplements.
B. Start treatment with oral NSAIDs at the lowest effective dose.
C. Recommend intraarticular glucocorticoid injections.
D. Prescribe opioids for pain management.
E. Start treatment with duloxetine due to comorbidities and inadequate response to other interventions.
Correct answers: E.
According to the guidelines, oral NSAIDs are recommended for patients with inadequate symptom relief from topical NSAIDs, multiple joint involvement, or hip OA. Duloxetine is used for those with multiple joint OA and comorbidities or inadequate response to other treatments.
You are treating a patient with knee OA who has tried topical NSAIDs without sufficient relief. The patient has a history of gastrointestinal issues that contraindicate the use of oral NSAIDs. Which of the following treatments is MOST appropriate for this patient?
A. Start glucosamine and chondroitin supplements.
B. Initiate duloxetine therapy.
C. Recommend intraarticular glucocorticoid injections.
D. Prescribe opioids for pain relief.
E. Use topical capsaicin as the first-line treatment.
Correct answer: B
Duloxetine is a suitable option for patients with OA who have contraindications to oral NSAIDs or have not responded to other interventions.
A patient with hip OA and knee OA presents with moderate to severe pain. They have been using topical NSAIDs with minimal relief. Which treatment is LEAST likely to be effective or appropriate?
A. Initiate a low-dose oral NSAID.
B. Add topical capsaicin.
C. Consider a trial of duloxetine.
D. Use intraarticular glucocorticoid injections.
E. Prescribe opioid analgesics.
Correct answer: E
Opioids are not routinely recommended due to their limited efficacy compared to other treatments and potential side effects. Intraarticular glucocorticoid injections are not routinely used due to their short duration of effect.
A 52-year-old patient with knee osteoarthritis (OA) presents with activity-related joint pain and morning stiffness that lasts less than 30 minutes. According to the NICE guidelines, what is the most appropriate diagnostic approach?
A. Order an x-ray to assess joint damage.
B. Perform synovial fluid aspiration to rule out infection.
C. Make a clinical diagnosis of OA without further investigations.
D. Conduct a rheumatoid factor test to exclude rheumatoid arthritis.
E. Refer for an MRI to evaluate joint severity.
Correct answer: C
According to NICE guidelines, OA can be diagnosed clinically in patients over 45 with activity-related joint pain and short-duration morning stiffness, without the need for imaging or laboratory tests.
A 60-year-old patient with knee OA reports persistent pain despite using topical NSAIDs and following an exercise regimen. The patient has moderate-to-severe OA and expresses interest in exploring additional treatment options. What should be the next step in management?
A. Initiate treatment with oral glucosamine and chondroitin supplements.
B. Recommend intraarticular glucocorticoid injections.
C. Consider adding duloxetine to the treatment regimen.
D. Prescribe opioid analgesics for pain relief.
E. Increase the dose of topical NSAIDs.
Correct answer: C
For moderate-to-severe OA with persistent pain despite topical NSAIDs, duloxetine is recommended, especially if other nonpharmacologic and topical treatments have been inadequate.
A 45-year-old patient with knee OA has been following a weight management and exercise program with some improvement. The patient now experiences persistent pain that interferes with daily activities. What is the most appropriate addition to the current treatment plan?
A. Start oral NSAIDs on a scheduled basis.
B. Refer the patient for a surgical evaluation for joint replacement.
C. Add a nutritional supplement like glucosamine to the treatment regimen.
D. Continue with nonpharmacologic therapies and consider adding topical or oral analgesics if needed.
E. Recommend a high-impact exercise program to strengthen the knee.
Correct answer: D
The first-line approach for OA includes nonpharmacologic therapies and exercise. If pain persists, adding topical or oral analgesics is appropriate, while continuing with weight management and exercise.
You are managing a patient with mild knee OA who has responded well to nonpharmacologic interventions. The patient requests additional treatment options. Which of the following is the LEAST appropriate intervention for this patient?
A. Continue with topical NSAIDs.
B. Suggest topical capsaicin if the patient experiences localized pain.
C. Encourage ongoing low-impact aerobic exercises.
D. Implement a calorie-restricted diet if the patient is overweight.
E. Start oral opioids for pain management.
Correct answer: E
Oral opioids are not recommended due to their limited efficacy and potential side effects. For mild knee OA, topical NSAIDs, topical capsaicin, exercise, and weight management are preferred.
A 68-year-old patient with OA in multiple joints is being evaluated for treatment options. The patient has mild knee OA and also experiences pain in the hands. What initial treatment approach is most appropriate?
A. Initiate treatment with oral NSAIDs.
B. Start intraarticular glucocorticoid injections in the knee.
C. Begin with topical NSAIDs for the knee and consider topical treatments for hand OA.
D. Prescribe duloxetine as the primary treatment.
E. Recommend glucosamine and chondroitin supplements as a first-line therapy.
Correct answer: C
For mild OA localized to one or a few joints, including the knee and hands, topical NSAIDs are the first-line treatment. Oral NSAIDs and other treatments are considered if topical options are ineffective.
