OA/RA Flashcards
What are the physiological changes that cause OA?
Degenerative changes that occur in cartilage and associated bone. Characterized by destruction and subsequent proliferation of cartilage and bone.
How often does this occur?
Average age of onset?
About 85% of people over 75years get this
More common in females than males.
Where does OA occur in the body?
Mostly hips and knees but can also occur in the spine, neck and distal interphalangeal joints.
What are the classic symptoms of OA?
Assymetrical joint pain Stiffness when getting up in the morning, usually improves after about 30 minutes crepitus no systemic involvement pain on weight bearing
What are the classic symptoms of OA?
Assymetrical joint pain Stiffness when getting up in the morning, usually improves after about 30 minutes crepitus no systemic involvement pain on weight bearing muscle atrophy Herberdens and Bouchards nodes
What are the biggest differences in clinical signs between OA and RA?
RA is symmetrical pain
Pannus often present in joints
stiffness does not improve throughout the morning
What are the biggest differences in clinical signs between OA and RA?
RA is symmetrical pain
Pannus often present in joints
stiffness does not improve throughout the morning
systemic involvement including malaise, fatigue, musculoskeletal pain, diffuse swelling
What are the goals therapy when treating OA?
Relief of pain and discomfort
Maintain function and strength of joint
Prevent deformities and progressive changes
What does step 1 of OA therapy include?
Non pharmacologic therapy: wght loss, mild exercise, physical therapy, education, rest, heat/ice
Step 2 of OA therapy?
Pharmacologic: Acetominophen 500mg every 4-6 hours MAX of 3g/day. Use for 2-4 weeks.
Step 2 of OA therapy?
Pharmacologic: Acetominophen 500mg every 4-6 hours MAX of 3g/day. Use for 2-4 weeks.
Topical analgesics also fall into this category such as bengay, capsacin (Zostrix = takes 2-4wks for results)
When using Acetominophen be cautious of hepatoxicity
Diclofenac gel = Max of 16g
Pennsaid = gel with DMSO as carrier molecule causing garlic smell and taste
3 month Trial will let you know if it works or not.
Step 3 of OA therapy?
NSAID therapy: If step 2 can choose from a long list of NSAIDS depending on patients comorbidities and other factors. Whichever one you choose, use the analgesia dosing.
Step 3 of OA therapy?
NSAID therapy: If step 2 can choose from a long list of NSAIDS depending on patients comorbidities and other factors. Whichever one you choose, use the analgesia dosing
What are the major adverse effects that can occur from NSAID therapy?
GI upset o GI ulcers o bleeding o renal dysfunction o effects on BP
What patients are most at risk for adverse effects from NSAID therapy?
dose dependent o elderly o h/o GI bleed o h/o of PUD o anticoagulant therapy o antiplatelet therapy o glucocorticoids o patients with CHF, HTN, renal dysfunction, and dehydration are at increased risk of nephrotoxicity
What are the monitoring parameters for patients on NSAID therapy?
BP o symptoms of edema or weight gain o BUN/SCr o Hgb/Hct o signs of dehydration
What is an example of a COX 2 inhibitor that can be used in OA? What is the benefit of this class of medication?
Celebrex
Once daily dosing, decreased risk of GI bleeding
What are potential risks of using COX 2 inhibitors for OA?
increased risk of CV disease
o increased costs
o same impact on renal functions and INR
When are PPI’s beneficial in OA treatment?
When concerned about GI upset in NSAID therapy can add a PPI and decrease GI toxicity by 50%
When are PPI’s beneficial in OA treatment?
When concerned about GI upset in NSAID therapy can add a PPI and decrease GI toxicity by 50%
What is step 4 in therapy for OA?
PRN opioid use as needed for short term relief of break through pain.
What is the appropriate way to introduce opioids into OA therapy?
Start low and go slow. Use a long acting and slow acting together. Educate patient on adverse effects.
What are the potential adverse effects of opioid use?
Nausea, somnolence, constipation and dizziness
What opioid can be used in patients at risk for chemical dependence?
Tramadol
When are interarticular injections appropriate in OA therapy?
It is a step 4 therapy for patients that cannot tolerate the opioids and/or are not good candidates for surgery.
What are the IA injection options?
Corticosteroid Medications =
What are the IA injection options?
Corticosteroid Medications = Very painful injection, cannot be done more than every 4-6 months, relief in 7-10 days, repeated injections can cause further break down. Hyaluronate Injection (Synvisc) = Temperature increases the viscosity, injected every 3-5 wks, max benefit in 8-12 wks.
What is step 5 of OA therapy?
Joint replacement
What are the IA injection options?
Corticosteroid Medications = Very painful injection, cannot be done more than every 4-6 months, relief in 7-10 days, repeated injections can cause further break down. Hyaluronate Injection (Synvisc) = Temperature increases the viscosity, injected once a wk for 3-5 wks, max benefit in 8-12 wks.
