MSK 05 Flashcards
OA?
Osteoarthritis/Osteoarthrosis
DJD?
Degenerative Joint Disease
What are the Nonpharmacological treatment options for OA?
Exercise and reduce weight loss Isometric exercise Use swimming pool etc Supportive foot ware Joint protection with knee braces. Heat Cold Massage Acupuncture
Does Acupuncture have any effects on hip OA?
No effect
What is the first choice of OA treatment?
Paracetamol 1g QID
1-3-week trial can give at first.
They are safe than other medicine.
Side effect of Paracetamol?
Rear but cases can lead to toxicity of liver.
Topical treatment option for OA?
Patient who cannot tolerate systemic agents
Patients should start with topical rather than oral
Topical NSAIDs are better tolerated than oral NSAIDs.
What if patient cannot get better by using only topical treatment?
Apply Topical with systemic agent where appropriate
Both can be applied 3-4 times daily
Maximal effect of NSAIDs start 3-4 weeks
What is Capsaicin? What is it used for?
Topical form for OA treatment. Similar like diclofenac.
Patients usually experience burning and tingling effect by using this product (because it has paper) but if they continue it will disappear after 4 weeks and will get maximum therapeutic effect.
What is the second line treatment of OA?
NSAIDs is the 2nd line treatment of OA.
Because Acetaminophen(para) is the first line and when it fails then we try with 2nd line treatment by NSAIDS.
Acetaminophen(para) is the superior in terms of safety compared with other pain relief.
What is the side effect of NSAIDs?
GI bleeding
So before starting NSAIDs we need to measure Risk factors?
Cardiovascular disease
GI ulceration or GI problem
Renal complications
If patients have no risk, then can be given NSAIDs
Like ibuprofen and use always lowest effective dose.
If someone has GI problem, then how NSAID given?
Use selective COX2 NSAIDs inhibitor like Celecoxib for protection of GI bleed.
Or Can be use Ibuprofen with PPIs for gastrointestinal protection.
What is the most common GI toxicity of NSAIDs is?
Dyspepsia (upset stomach) common so if patients experience dyspepsia more than 7 days in a month then best to discontinue Perforated GI (hole in GI) (rare) Haemorrhage (escape of blood from vessel) (rare)
However, if patient experience GI problem, then H2 antagonist or Misoprostol can be given. Or PPIs
NSAIDs toxicity for “cardiovascular and renal” patients how to deal with them?
NSAIDs can increase blood pressure with normal or high blood pressure. So, when starting NSAIDs to patients Measure blood pressure within 1 week of starting NSAIDs
For kidney injury NSAIDs should be well monitored while patient is having Diuretics, ACE inhibitors, and Angiotensin receptor blocker.
NSAIDS cause thrombosis which leads to thromboembolic stroke or myocardial infection.
What are the Opioids adverse effects?
Opioids only can give when NSAIDs fails or patient can’t take NSAIDs then Opioids can be given.
Opioids used for inflammation and pain, but they have side effects like sedation, constipation, dependence
Uses of Duloxetine for OA?
It is an antidepressant, approved for OA.
It is usually used as combination therapy with acetaminophen or NSAIDs and they are effective
But they have side effect like nausea fatigue and constipation.
Intra articular steroids for OA treatment?
Only given when acute knee pain
Taken out fluid from knee joint and then given the steroids into the joint space. It can give a good effect on pain for a wile like 4-6 weeks, but pain comes back and repeated application of steroids cause cartilage damage. And should not be inject 3-4 times each year.
Not useful for hand and hip OA. So only for knee
Hyaluronic Acid for OA treatment?
Hyaluronic acid is a linear polysaccharide.
Expensive
Efficacy and safety found conflicting result so need to more investigate.
Only given when all treatment failed.
What are the Alternative therapy for OA?
Glucosamine sulfate& hydrochloride helps to restore or reproduce cartilage and also prevent cartilage destruction by inhibiting inflammatory mediators and increase and maintain joint viscosity.
What kind of effect does Curcuma extract (turmeric extract) has against OA treatment?
Short term anti-inflammatory effect like NSAIDs.
Effective Arnica and comfrey (plant) also has effect of reduction of symptoms of OA
