MSK 05

Question 1

OA?

Answer 1

Osteoarthritis/Osteoarthrosis

Question 2

DJD?

Answer 2

Degenerative Joint Disease

Question 3

What are the Nonpharmacological treatment options for OA?

Answer 3

Exercise and reduce weight loss
Isometric exercise 
Use swimming pool etc
Supportive foot ware
Joint protection with knee braces.
Heat 
Cold
Massage
Acupuncture

Question 4

Does Acupuncture have any effects on hip OA?

Answer 4

No effect

Question 5

What is the first choice of OA treatment?

Answer 5

Paracetamol 1g QID
1-3-week trial can give at first.
They are safe than other medicine.

Question 6

Side effect of Paracetamol?

Answer 6

Rear but cases can lead to toxicity of liver.

Question 7

Topical treatment option for OA?

Answer 7

Patient who cannot tolerate systemic agents
Patients should start with topical rather than oral
Topical NSAIDs are better tolerated than oral NSAIDs.

Question 8

What if patient cannot get better by using only topical treatment?

Answer 8

Apply Topical with systemic agent where appropriate
Both can be applied 3-4 times daily
Maximal effect of NSAIDs start 3-4 weeks

Question 9

What is Capsaicin? What is it used for?

Answer 9

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.

Question 10

What is the second line treatment of OA?

Answer 10

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.

Question 11

What is the side effect of NSAIDs?

Answer 11

GI bleeding

Question 12

So before starting NSAIDs we need to measure Risk factors?

Answer 12

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.

Question 13

If someone has GI problem, then how NSAID given?

Answer 13

Use selective COX2 NSAIDs inhibitor like Celecoxib for protection of GI bleed.
Or Can be use Ibuprofen with PPIs for gastrointestinal protection.

Question 14

What is the most common GI toxicity of NSAIDs is?

Answer 14

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

Question 15

NSAIDs toxicity for “cardiovascular and renal” patients how to deal with them?

Answer 15

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.

Question 16

What are the Opioids adverse effects?

Answer 16

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

Question 17

Uses of Duloxetine for OA?

Answer 17

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.

Question 18

Intra articular steroids for OA treatment?

Answer 18

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

Question 19

Hyaluronic Acid for OA treatment?

Answer 19

Hyaluronic acid is a linear polysaccharide.
Expensive
Efficacy and safety found conflicting result so need to more investigate.
Only given when all treatment failed.

Question 20

What are the Alternative therapy for OA?

Answer 20

Glucosamine sulfate& hydrochloride helps to restore or reproduce cartilage and also prevent cartilage destruction by inhibiting inflammatory mediators and increase and maintain joint viscosity.

Question 21

What kind of effect does Curcuma extract (turmeric extract) has against OA treatment?

Answer 21

Short term anti-inflammatory effect like NSAIDs.

Effective Arnica and comfrey (plant) also has effect of reduction of symptoms of OA