Osteoarthritis Flashcards
Glucosamine/Chondroitin considerations
guidelines don’t recommend, conflicting evidence, glucosamine sulfate may be superior to hydrochloride
DDI: may interfere with Warfarin and medications used to lower blood glucose
side effects: heartburn, diarrhea
First line for osteoarthritis
acetaminophen (avoid in liver impairment or >2drinks/day alcohol)
topical NSAIDs (preferred over po in elderly)
Second line for osteoarthritis
-add on NSAIDs to acetaminophen shortest duration lowest dose
-require regular use for at least 2 to 4 weeks to see any anti-inflammatory benefit
NSAID considerations
Caution in history of gastric/duodenal ulcers, renal impairment/disease, DM, anticoagulants,
uncontrolled hypertension, cardiac risk or history; May need to add PPI in certain patients if a trial of oral NSAIDs is
considered (eg elderly or those with history of gastric ulcers)
Higher CV risk with which NSAIDs
Diclofenac, celecoxib, ibuprofen
Lower CV risk with which NSAIDs
naproxen lowest risk
GI risk lower with which NSAIDs
COX2 Selective (celecoxib is the most selective, diclofenac somewhat)
Considerations when recommending OTC topicals
Topical diclofenac as effective as oral NSAIDs
Zucapsaicin approved as adjunct to NSAIDs
Capsaicin limited evidence and may cause burns
Arnica gel may be comparable but needs more studies
Methylsalicylate (RubA535) may increase INR, avoid in ASA allergy
non pharms
weight loss
exercise
physiotherapy
knee/hip replacement
duloxetine’s place in therapy for OA and its AEs
used in concomitant depression and/or neuropathic or widespread pain
AE: nausea, asthenia/weakness
avoid in pts w hx of falls/fractures
opioids place in therapy for OA
non-tramadol opioids - no long term value, use as last resort
tramadol - limited benefit, risk of dependence
oral and intraarticular corticosteroids place in therapy for OA
oral not recommended; significant side effects and development of osteoporosis
intraarticular: controversial, conflicting evidence
