Osteoarthritis (1) Flashcards
Clinical OA
Joint pain/tenderness
Decreased range of motion
Weakness
Joint instability
Disability
Osteoarthritis – Prevalence
Vary depending on age, gender, ethnic group, and the specific joint involved
Increasing Age
Women
25% white 20% blacks 11% Asians
OA common risk factors
age
weight
gender
occupation/sports
joint injury/surgery
genetic predisposition
important preventable risk factor for OA
Weight
strong link to knee OA, also in Hip, hand and wrist OA
due to adverse metabolic and inflammatory effects
every five unit increase in BMI
Risk of knee OA increases 35%
Occupations
excessive mechanical stress
Sports
participation in activities such as wrestling, soccer, weight-lifting, football and hockey – typically pros
Trauma
Increases the risk of knee OA over a 10-year period
Genetic factors
30% of risk genetically determined
Heberden nodes - 10 times more prevalent in women
Chrom7Q22 locus highly significantly associated with knee OA
Articular cartilage
Smooth, white tissue
covers the ends of bones to form joints
Shock absorbency during rapid movements-load support
Pathophysiology of OA
Increase in chondrocyte activity to remove and repair the damage
Balance between breakdown and re-synthesis of cartilage is lost
Subchondral bone pathologic changes
May happen before, during or after damage to the articular cartilage
Loss of cartilage = joint space narrowing
Leads to brittle, stiffer bones with decreased weight-bearing ability
Development of sclerosis and microfractures
Diagnosis of Osteoarthritis (Hip OA)
Pain in the hip + 2 of the following:
Erythrocyte sedimentation rate <20 mm/hr
Joint space narrowing on radiography
Diagnosis of Osteoarthritis (Knee OA)
Pain in the knee + osteophytes on radiography + 1 of the following:
Morning stiffness no more than 30 minutes
OA Age
Usually occurs in older adults (≥65 years of age)
OA Gender
Age <45 years more common in men
Age >45 years more common in women
OA Symptoms
Pain - Deep, aching
Pain on motion
Stiffness in affected joints
Resolves with motion, recurs with rest (“gelling phenomenon”)
Duration <30 minutes
Often related to weather
Limited joint motion
May result in limitations of activities of daily living
Instability of weight bearing joints
OA Goals of therapy
Treatment may relieve pain or improve function but does not reverse preexisting damage to the joint
Educate the patient, family members and caregivers
Relieve pain and stiffness
Maintain or improve joint mobility
Limit functional impairment
Maintain or improve quality of life
OA Non-pharmacologic Treatment
Exercise
Weight loss
Patient Education
Exercise
Should be encouraged for all patients with OA
Day 1 post surgery exercise
decreased LOS after surgery and less pain
Hip and Knee OA first line pharm treatment
Acetaminophen (3-4g/day)
Topical NSAIDs
Intraarticular corticosteroids
tramadol
Oral NSAIDs
Hand OA first line pharm treatment
Oral NSAIDs (less than 75 yo)
Topical NSAIDs
Topical capsaicin
tramadol
Acetaminophen
First line for HIP and KNEE OA
do not exceed 3-4g
Oral NSAIDs
First-line for Hand OA/Second-line for Knee and Hip OA
Oral NSAIDs interactions
anticoagulants
lithium, oral hypoglycemics,methotrexate
ACE inhibitors, β-blockers, and loop diuretics
Aspirin’s wait 30 minutes after ASP
P450 inducers reducecelecoxiblevels
Patients receivingwarfarinand celecoxib should be followed closely
Celecoxibis a sulfonamide severe sulfa allergies
Topical diclofenac
Lower Limb: Apply 4 grams of gel to the affected area four times daily
Upper Limb: Apply 2 grams of gel to the affected area four times daily
Dose measuring cards provided by the manufacturer
As effective as oral NSAIDs
Intra-articular steroids
Alternative first-line treatment for both Knee and Hip OA when pain control with acetaminophen or NSAIDs is suboptimal
no more than once every 3 months
Tramadol
Alternative first-line treatment of Knee, Hip and Hand pain due to OA
Can be added to partially effective acetaminophen or oral NSAID therapy
Topical Capsaicin
Alternative first-line treatment for Hand OA
Duloxetine
Alternative second-line treatment of Knee OA ONLY
Avoid using with other serotonergic medications including tramadol
Glucosamine & Chondroitin
Alternative medication
Evidence for efficacy and recommendations regarding use are conflicting
Cannabidiol
No good evidence that CBD helps chronic pain
OA therapy wrap up
acetaminophen(≤4 g/day)/topical analgesics PRN
Consider oral NSAIDs
GI Risk?
Consider Celecoxib
increased risk for cardiovascular, renal events or poor pain control?
Consider tramadol, intra-articular corticosteroids or duloxetine
