Osteoarthritis Flashcards
what is osteoarthritis?
a degenerative joint disease that is painful and often disablint as a chronic disease
what joints does OA affect
any= knee, hip, neck, spine, ankle, etc
what is the primary issue causing OA
loss of articular cartilage
T or F: OA only affects the articular cartilage
F- is a disease of the entire joint, but the primary issue is loss of articular cartilage
what is the most common chronic joint disase
OA`
by 65yrs of age, 80% of the population has some _______ of OA
radiographic evidence
what are the 3 parts that are affected in OA pathology
cartilage
synovium
bone
describe what happens to the cartilage in OA
initial cartilage swelling and matrix synthesis, unbalanced cycle of articular cartilage destruction/ repair followed by gradual cartilage loss (degradation >repair)
describe what happens to the synovium in OA
synovial inflammation and cytokine release = breakdown and more inflammation, ligament stretching and further fibrotic thickening/ encapsulation
describe what happens to the bone in OA
may see endochondral bony growths- osteophytes
early periarticular bone turnover
late subchondral plate sclerosis
list 3 causes of Oa
obesity
occupation, sports, trauma
genetic factors
what is the most important preventable RF for OA
obesity
obesity is a predictor of
1. shoulder OA
2. rapidly progressing OA
3. needing a prosthetic joint replacement
4. heberden’s nodes
3
what is the relationship between quad muscles and OA
quad weakness = joint looseness and more likely to see ligament injury
usually quad would help stabilzie the joint
what are some genetic factors for OA
heberden’s nodes, bouchard’s nodes, F>M
what is primary OA? what are the types
Primary OA: more common, no identifiable cause
Types: localized, generalized, erosive
what is secondary OA?
Secondary OA: known association with underlying cause
Ex- post trauma, genetic, obesity
what is the clinical presentation of OA
Progressive development (usually over years) of pain, joint stiffness, loss of movement/ function
waht differentiates RA and OA
OA pain usually confined to affected joints (asymmetric), while RA pain is usually symmetric and multi joint
OA pain tends to worsen with
exercise, AM inactivity
OA pain tends to improve with
rest
what is the gold standard imaging for OA
x ray
what are the hallmarks of OA seen on xray
joint space narrowing + osteophyte formation (most common), subchondral cysts, boney sclerosis
what are the clinical and radiographic criteria for knee OA
Pain in knees most days AND
Osteophytes on xray AND
One of the following
>50yrs
Morning stiffness <30min
Crepitus on motion
what are the clinical criteria only for knee OA
Pain in the knee most days and at least 3 of the following
>50yrs
Morning stiffness <30min
Crepitus on motion
Bony enlargement
Bony tenderness
No palpable warmth
what are the clinical and radiographic criteria of hip OA
Pain in the hip most days + at least 2 of the following
ESR <20 mm/h
Femoral or acetabular osteophytes on xray
Joint space narrowing on xray
what is the primary nonpharm tx for OA
exercise and weight loss
list 3 nonpharm tx for OA
PT/OT
exercise
taichi
activity mod + pt education
GL:D canada
what is GLA:D canada
8 wk education nand exercise program for those with knee or hip OA: includes 2 education sessions + 12 supervised exercise sessions (2x/wk)
Assoc with improvement in pain and function, licensed through Canadian orthopedic foundation
how much weight loss is recommended for OA if pt is obese
~10%, but even 4% is disease modifying
when might surgery be used for OA? how effective is it?
for severe pain/ disability that can not be treated with meds
20-25% see no improvement in pain
name the 5 classes of oral meds for OA
acetaminophen, NSAIDs, glucosamine and chondroitin, opioid analgesics, antidepressants
topical tx for OA
topical NSAIDs, capsacin, other topical rubefacients
what are the 2 intraarticular injections for OA
corticosteroids
viscosupplementation/ hyaluronic acid
name the 3 first line options for OA
acetaminophen, NSAIDs, topical NSAIDs
how long is an adequate trial of acetaminophen
2-3wks
acetaminophen appears more effective than placebo for ______ OA pain (small improvement at _______), effect size may be small, less eff than NSAIDs
knee or hip
2 wks
acetaminophen improves function in pts with ____ or ______ OA
hip or knee
NSAIDs is associated with improvement in pain, function, and stiffness at 3mths in ________ OA
knee
what characteristics of OA do NSAIDs improve? what kind of OA?
pain, function, stiffness of knee OA
which NSAIDs are better than APAP for pain
naproxen, ibuprofen, diclo
which NSAIDs are better than APAP for function and stiffness
naproxen, ibuprofen, diclo, celecoxib
ACR 2019 recommends considering topicals ______ (before/after) PO NSAIDs
before
what are some non NSAID topicals that may help OA pain
Methyl salicylate, trolamine salicylate, capsaicin, menthol (rubefacient)
ACR 2019: ________for capsaicin in knee OA, _________for hand OA (may touch eye = irritate)
conditional rec
conditional rec against
is capsacin recommended for hand OA
conditional recommended against- may irritate eyes
duloxetine class
SNRI
duloxetine is _______ for knee, hip, and or hand OA
conditionally rec
duloxetine is conditionally recommended for _____,________,_________ OA
knee, hip, hand
what is another drug class used for OA pain that tramadol may interact with
antidepressants
tramadol effect on OA (select all that apply)
1. significant improvement in pain
2. significant improvement in function
3. pain improvement may not be significant
4. functional improvement may not be significant
5. increased risk of serious AEs
6. are conditionally recommended
7. are conditionally not recommended
3,4,5,6
what does the ACR say about opioid use in OA
conditional rec against use, but recognize that they may be used in certain circumstances
what are glucosamine and chondroitin
endogenous cartilage maintianing substances
what is the proposed MOA of glucosamine and chondroitin
stimulate production of cartilage, prevent inflammatory cartilage destruction, maintain joint fluid viscosity
glucosamine and chondroitin onset of pain relief
1-3wks
those with ___________ allergies should not use glucosamine and chondroitin
shellfish
what dose the ACR say about glucosamine and chondroitin use in OA
glucosamine strongly recommended against for knee, hip, and/or hand OA. chondroitin strongly recommended against for knee and/or hip OA, but conditionally recommended for hand OA
name the 7 NHPs used in O
SAMe
avocado/ soybean unsaponifiables
MSM
vit D
antioxidants
boswellia serrata extract
ginger
ASU effect in OA
reduce pain and NSAID use in pts with knee/ hip OA
vit D efficacy in OA
supplementation for 2 yrs did not reduce knee pain or cartilage volume loss in pts with symptomatic knee OA
boswellia serrat extract eff in OA
assoc with improvement in knee pain, flexion, and walking distance over 8 wks
what CS may be injected in OA
triamcinolone
methylprednisone
how often can intraarticular CS be used in OA
3-4x/yr max (and no more freq than q3mths)
Repeated inj may damage cartilage
when should pain relief start with IA CS for OA? when does it peak? how long does it last?
starts at 24-72hrs, peaks 7-10d, can last 4-8wks
Should minimize activity and stress on joint for several days after injection
what is the ACR rec for intraarticualr CS
strongly recommended for knee/ hip
conditionally for hand
which of the following is false about hyaluronic intraarticular tx
1. it assists with joint lubrication and cartilage rehydration
2. it lasts longer than CS injections
3. it has a slower onset than CS but may be more effective
4. is conditionally recommended in knee and hand OA
5. 3+4
3+4
what does the ACR say about hayluronic inj for OA
conditionally recommended against in knee and/or hand OA, strongly against in hip OA
T or F: in most pts, APAP with NSAIDs is enough for OA pain
T
