Osteoarthritis

Question 1

What is osteoarthritis?

Answer 1

non-inflammatory abnormality of the synovial joints characterised by cartilage loss and an accompanying bone response

occurs most commonly in the hands, knees, spine and hips

Question 2

What are the risk factors for OA?

Answer 2

obesity
female gender
increasing age
chronic strain - occupational
inflammatory disease
trauma
crystal arthropathy
metabolic disease
congenital abnormality

Question 3

What are the symptoms of OA?

Answer 3

pain which is made worse by movement and relieved by rest

stiffness occurring after sitting down and for a short period (<0.5h) on waking in the morning

patients may complain of a sensation of creaking and cracking in the joints relating to movement

Question 4

What is the non-drug treatment for OA?

Answer 4

weight reduction in obese patients
application of local heat
physiotherapy
- non-weight bearing exercise
- mobility aids
use of suitable footwear
transcutaneous electrical nerve stimulation (TENS) for pain relief
surgery - arthoplasty
topical capsaicin = counter irritant
- cause burning sensation

Question 5

What are the pharmacological treatments for OA?

Answer 5

1st line - paracetamol
- 1g QDS or 1g BD for patients weighing <50kg

2nd line - topical NSAIDs (for knee or hand OA)
- can cause contact dermatitis

3rd line - oral NSAIDs, COX-2 inhibitors or opioids
- co-prescribe PPI for NSAIDs
= lansoprazole, pantoprazole
= NSAIDs can lower renal function and cause AKI
- cannot co-prescribe oral and topical NSAIDs
- modified release preparations increase compliance and reduce morning stiffness

intra-articular corticosteroids
- max 4 times a year
in CVD
- 1g naproxen daily or 1.2g ibuprofen daily

Question 6

When should oral NSAIDs be avoided?

Answer 6

history of GI adverse effects
aged > 65 years
smoking
anti-coagulants/anti-platelets
- aspirin, rivaroxaban, clopidogrel
other GI irritants

Question 7

What should be monitored when taking treatment for OA?

Answer 7

renal function
BP
FBC
LFTs

Question 8

What occurs when alcohol and NSAIDs are used together?

Answer 8

alcohol increases the risk of GI haemorrhage (bleed)

Question 9

What are alternative forms of treatment for OA?

Answer 9

chondroprotective agents
- protect chondroitin which is a major component of cartilage

chondroitin
glucosamine
vitamin E