Clinical Osteoarthritis - 23 WIP Flashcards
PATHOPHYSIOLOGY
Degenerative changes that occur in ___ and the associated ___. Characterized by increased destruction and subsequent ___ of cartilage and bone
- cartilage
- bone
- proliferation
INCIDENCE
most common joint releated disease
* 85% of patients over ___ years old
* severity increases with age
* more common in ___
- 75
- females
JOINT INVOLVEMENT
what are the common joints involved
- hips
- knees
- distal interphalangeal joint
RISK FACTORS
- increased age
- obesity
- congenital defects
- muscle weakness
- female
- repetitive stress
- major joiny trauma
- heredity
CLINICAL MANIFESTATIONS
- Joint pain
- __ stiffness
- Crepitus (___ sound)
- Inflammation
- Muscle ___
- ___ involvement
- morning
- popping
- atrophy
- asymmetric (left knee, right hip, etc)
CLINICAL MANIFESTATIONS
- No systemic symptoms
- Instability of weight bearing joints
- ___ and ___ nodes
- Herberden’s and Bouchard’s nodes
GOALS OF THERAPY
- Relief of pain and discomfort
- Maintain function of joint and strength
- try to minimize risk factors
cannot reverse damage that has already been done (no cure)
TREATMENT OF OA
non-drug therapy (focus on ___).
Psychological support
* education
* rest
Physical acitivity/exercise
* heat/ice
* physical and ___ therapy
* ___ loss
- strength
- occupational
- weight
TREATMENT OF OA
drug therapy - based on hand, knee, hip
- topical
- oral
- supplements
- injectables
topical therapy - Icy-Hot, Bengay, Salonpas
active ingredients: ___, camphor, ___ (methyl salicylate)
* counterirritant
* dose: apply ___ times per day
- methol, wintergreen
- multiple
Topical Therapy - Capsaicin Cream
- MOA: depletes substance ___
- Dose: apply sparingly to affected area ___ times daily
- wait ___ to evaluate results
- adverse effects: ___, ___, and ___
- substance P
- 2-4 times daily
- 2-4 week
- burning, stinging, and redness
Topical Therapy - Diclofenac (Voltaren) Gel 1%
- MOA: local inhibition of ___
- Dose: Applied to joint ___
- Max ___ to any one joint daily
- Not recommended in combination with ___
Adverse Effects: ___, ___, pain, and ___
- COX-2 enzymes
- QID
- 16g
- systemic NSAID
- pruritus, burning, rash
Topical Therapy - Diclofenac (Pennsaid) Topical Solution %
For ___ only
Dose:
* 40 ___ (___mg) to each knee ___
* Apply ___ drops at a time
* 2 ___ (40mg) ___
* Local reaction most common adverse effect
Acetaminophen (Tylenol™)
- MOA: inhibits synthesis of
prostaglandins
Dose: Max: 3g – 4g per day
Two – four week trial
ACETAMINOPHEN
Patients at risk for hepatotoxicity
* heavy ___ intake
* pre-existing ___ disease
* Monitor ALT/AST annually if on
routine doses
