Osteoarthritis Flashcards
Define: Osteoarthritis (OA)
Aka: Degenerative joint disease or degenerative arthritis. Most common joint disease, responsible for disability and loss of productivity. Caused by destabilization of the normal coupling of degradation and synthesis of articulation cartilage
What are the Risk Factors of Osteoarthritis (OA)?
Older age, obesity, activities involving prolonged and repetitive motion (occupation, sports, trauma)
What are the symptoms of osteoarthritis?
Pain localized to affected joint, joint stiffness, limited range of motion
What joints are affected by OA?
Hands, knee, hip, foot, spine, shoulder
What are the goals of therapy when treating osteoarthritis?
- Educate
- Relieve pain and stiffness
- Limit functional impairment
- Maintain or improve joint mobility
- Maintain or improve quality of life
What physical, psychological, and mind-body (non-pharmacological) are strongly recommended for OA
Physical/occupational therapy, exercise, weight loss, tai chi(balance)
What adverse gastrointestinal(GI) effects are a concern with NSAIDs?
-nausea, dyspepsia, anorexia, abdominal pain, flatulence, diarrhea
-gastric and duodenal mucosal bleeding that lead to ulcerations
-monitor complete blood count (CBC)
-risk factors: history of ulcer, high dose of NSAID therapy, concurrent use of aspirin or anticoagulants or corticosteroids
What adverse renal effects are a concern with NSAIDs?
do not use if CrCl <30 ml/min
-monitor: serum creatinine at baseline and within 3-7 days of drug initiation (then once a year)
-risk factors: age>65, disease states such as-renal failure, heart failure, cirrhosis, certain medications
What adverse cardiovascular effects are a concern with NSAIDs?
-increased risk of heart attack and stroke
-monitor: blood pressure and possibly lipids
-risk factors: pre-existing cardiovascular disease, duration of use (longer the use the higher the risk)
beware of using COX-2 selective inhibitor in patients with cardio risk factors
What general adverse effects are a concern with NSAIDs?
-GI effects such as nausea, diarrhea, abdominal pain but especially mucosal bleeding that lead to ulcerations
-renal effects since NSAIDs are metabolized by the kidney
-cardiovascular risk especially risk of heart attack and stroke
-allergic reactions
-drowsiness, dizziness, headaches, confusion
-increased bleeding risk especially with concurrent use with anticoagulants (ex. Warfarin)
use caution in pregnant women
What drug interactions are a concern with NSAIDs?
-WARFARIN since NSAIDs can displace from protein binding which reduces platelet aggregation and induce GI bleeding
-diuretics since NSAIDs reduce their effects
-antihypertensives since NSAIDs may cause sodium retention
What is the benefit of using a COX-2 selective inhibitor (Celecoxib)?
less GI toxicities, but increase risk of cardiovascular toxic effects
What type(s) of osteoarthritis are oral NSAIDs recommended for?
all types!
What type(s) of osteoarthritis are topical NSAIDs recommended for?
knee and potentially hand, but not recommended for hip due to the depth of the joint below the skin
typically considered before oral NSAIDs due to less systemic effects
Can you combine use of oral NSAIDs and topical NSAIDs?
not recommended unless benefit outweigh risk
What is the dosing of the topical NSAID diclofenac gel 1%?
maximum total body dose of 32g/day
-lower extremities= apply 4 g gel to affected area 4x/day (max 16g/joint)
-upper extremities= apply 2 g gel to affected area 4x/day (max 8g/joint)
What are the patient counseling point for diclofenac gel 1%?
-avoid wearing clothing for 10 minutes
-do not wash area for 1 hour following application
-avoid sunlight exposure
-avoid occlusive dressing /heat applications of treated area
What is the dosing of diclofenac solution 2%?
only use on knee
apply 2 pumps to each affected knee twice daily
What type(s) of osteoarthritis are intraarticular glucocorticoid injections recommended for?
knee and hip and potentially hand
What are the patient counseling points for intraarticular glucocorticoid injections?
-minimize activity/stress for several days after injection
-initial pain relief at 24-72 hours and lasts for 4-8 weeks but generally injections are limited to 3-4x/year
What is the recommended use of acetaminophen for OA?
possible relief in OA but minimal benefit seen, but better safety profile than NSAIDs
What is the dosing of acetaminophen?
325-650mg q4-6h or 1g 3-4x/day
max dose= 4g/4000mg/day
What adverse effects are a concern with acetaminophen?
hepatotoxicity, use caution in chronic alcohol users and liver disease (monitor liver function tests)
What is the recommended use of tramadol for OA?
modest benefit seen but risk of opioid like side effects so used in patients that have a contraindication to NSAIDs or no other therapy has proved effective
