Osteoarthritis Flashcards
What is osteoarthritis?
It is a non-inflammatory abnormality due to wear/tear of the synovial joints as you grow older. Cartilage is then progressively lost.
Where does osteoarthritis usually occur?
Hands, knees, spine & hips
Which gender is more prone to osteoarthritis?
Women
Which 2 pro-inflammatory mediators can speed up the process of cartilage degradation?
TNF-a, and IL-1
What are some risk factors for osteoarthritis?
- Obesity
- Females
- Increasing age
- Inflammatory diseases
- Chronic strain - e.g. due to job
- Gout
What are the symptoms of osteoarthritis?
- Pain in joints - worse when moving
- Stiffness when sitting down
- Creaking/cracking of joints when moving
What one thing should patients with osteoarthritis avoid, to prevent osteoporosis?
They should avoid weight bearing exercise, as this can lead to osteoporosis.
What non-drug treatments are available for osteoarthritis?
- Weight reduction in obese patients
- Local heat to affected joint
- Physiotherapy
- Psychological support
- Surgery
- Non-weight bearing exercise
- TENS: nerve stimulation to distract pain receptors of the site
Why should oral NSAIDs be avoided in elderly patients?
Because they are more likely to have renal complications, which can be worsened by NSAIDs
Which class of drug should be given if a patient has a history of GI complications/ulcers?
COX-2 inhibitors, e.g. celecoxib
- This is because COX-2 is more selective & prevents GI side effects
What is the maximum safest dose of ibuprofen which can be given? Why is it this number?
Less than 1.2g
This is because anything higher than 1.2g is associated with increased risk of thrombotic events
Which NSAID has the best CV safety profile? Give the dose too
Naproxen 1g
Why are topical NSAIDs preferred for osteoarthritis?
Because it acts locally & has less side effects than oral NSAIDs
Why can’t oral & topical NSAIDs be given together?
Because side effects can increase due to the higher dose.
What is the max. dose of paracetamol which a patient with osteoarthritis can take?
Max 1g QDS
Must take regularly, not PRN to avoid future pains
What should you do if a patient <50kg is taking paracetamol for osteoarthritis?
Adjust the dose
Which opioid can be used in osteoarthritis?
Codeine (Co-codamol)
Can paracetamol + topical NSAID + codeine be given for osteoarthritis?
Yes.
What does topical capsaicin do?
It generates heat to distract you from the pain.
Why should NSAIDs not be given with antiplatelets?
Because they can increase the risk of bleeding
What risk factors should you consider before giving an oral NSAID to an osteoarthritic patient?
- Smoking
- GI problems
- > 65 years old
- CV risks
- Renal function
Why should laxatives be considered if you are giving a patient an opioid?
Because opioids can cause constipation.
Laxatives can include: lactulose, fybogel, porridge oats
What is always co-prescribed with an NSAID or COX-2 inhibitor (which are the 1st line treatments for osteoarthritis)?
Co-prescribe with a PPI.
What is the dose of diclofenac for osteoarthritis?
150mg daily
Why should alcohol be avoided when taking NSAIDs?
Because alcohol increases the risk of gastro intestinal haemorrhage with NSAIDs.
If a patient has had a previous ulcer history with no CV risk, which drug choice is their 1st option?
COX-2 inhibitor
Do you start with low-dose ibuprofen, or naproxen as treatment for osteoarthritis?
Start with low dose ibuprofen <1.2g (can also be taken with paracetamol)
The next choice would be naproxen.
Why would intra-articular corticosteroids be given in osteoarthritis?
Could produce temporary benefit especially if there is soft-tissue inflammation.
What other agents could the patient try which can aid in their osteoarthritis pain?
- Cod liver oil
- Vitamin E
- Glucosamine
Which type of acid can be injected in the joint to reduce osteoarthritic pain?
Why is this injected?
Hyaluronic acid.
This can be injected because the fluid in the knee is hyaluronic acid, so this can reduce the friction of the joints & relieve pain.
What is the max. number of corticosteroid injections a person can take per year?
4.
