Osteoarthritis

Question 1

Treatment (optimal)

Answer 1

Explanation: pt education and reassurance that arthritis is not the crippling disease

• perceived by most pts.
• Consider CBT.

Rest: during an active bout of inflammatory activity only.

Exercise: a graduated exercise program

• essential to maintain joint function.
• aim for a good balance of relative rest with sensible exercise.

Heat: heat packs, a hot water bottle, warm bath or electric blanket

• to soothe pain and stiffness.
• advise against getting too cold.

Diet: important to reduce weight to ideal level.

Physiotherapy: for specific purposes such as exercises and supervision of a hydrotherapy program.

Occupational therapy: refer for advice on aids in the home.

Question 2

Pharmacological Rx

Answer 2

Paracetamol; is the basic analgesic, avoid;

• opioids such as codeine or dextroproproxyphene
• aspirin if recent history of dyspepsia or peptic ulceration

NSAIDs and aspirin:

• the first-line drugs for more persistent pain or where there is evidence of inflammation.
• risk versus benefit equation has to be weighed
• should be used sparingly if possible
• aim for short courses of 14–20 d
• COX2 specific inhibitors should be considered
• risk of NSAID-induced ulceration and bleeding is high.

Consider duloxetine for some people when pain relief is inadequate.

Question 3

Intrarticular corticosteroids:

Answer 3

as a rule are not recommended

occasionally can be very effective for an inflammatory episode of distressing pain (e.g. a flare-up in an osteoarthritic knee).

Question 4

Referral for surgical intervention:

Answer 4

for debilitating and intractable pain or disability.

Examples include OA of ;

• hip
• knee
• shoulder
• first CMC joint of thumb
• first MTP joint