osteoarthritis Flashcards by Keri Courtnage

what is the primary site of damage in osteoarthritis

articular cartilage

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most common risk factors for OA

female, age, obesity, injury to or overuse of a particular joint, family history, muscle weakness

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most preventable risk factor OA

obesity– weight loss of 5 kg decreases risk by 50%

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what occurs upon damage to cartilage

increased chondrocyte activity leading to cartilage swelling–> increased water content and cartilage thickening–> MMP secretion–> proteoglycan breakdown–> increased cartilage permeability and destruction–> bony remodeling

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typical age at presentation

> 50

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how long does morning stiffness last OA

<30 minutes

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the pain in OA is associated with ___

motion

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signs of OA

crepitus

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indicators of OA

osteophytes, bouchard nodes, heberden nodes, joint space narrowing

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what are the primary joints affected in OA

DIP, CMC

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joint characteristics in OA vs RA

OA hard and bony
RA soft and spongey

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lab findings in OA?

RF, ACPA
NORMAL ESR AND CRP

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strongly recommend in hand OA

oral NSAIDs

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conditionally recommend in hand OA

topical NSAIDs (pref over PO for those >75 yo)
intraarticular steroids
APAP
duloxetine
tramadol
chondroitin

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strongly recommend against in all OA

bisphosphonates
glucosamine
HCQ
MTX
biologics

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conditionally recommend against in all OA

non-tramadol opioids
colchicine
fish oil
vitamin D

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strongly recommend in knee OA

topical NSAIDs
oral NSAIDs
intraarticular steroids

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conditionally recommend in knee OA

topical capsaicin
APAP
duloxetine
tramadol

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strongly recommend in hip OA

oral NSAIDs
intraarticular steroids

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conditionally recommend in Hip OA

APAP
duloxetine
tramadol

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APAP mech

inhibition of central prostaglandin synthesis

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APAP dosing

325-650 mg q4-6h
or 1000 mg 3-4x/day

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APAP max

4 g daily or 2 g for alcoholic cirrhosis

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APAP warnings

liver disease

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APAP side effects

PO well tolerated, GI effects with IV

APAP counseling

always account for all APAP containing products

APAP advantages

multiple available strengths, no cardiac or renal toxicity

APAP limitations

may increase bleeding with warfarin multiple daily dosing

NSAID mech

block prostaglandin synthesis via inhibition of COX1/COX2

ibuprofen dosing

400 mg PO TID

naproxen dosing

220 mg PO BID

low vs high dose NSAIDs

low dose for pain higher doses for inflammation and swelling (gout and RA)

GI effects with long term NSAID

bleeding, ulcers, perforations

drug interactions with NSAIDs

warfarin, clopidogrel, SSRIs, ASA

ASA/NSAID together counseling

take ASA 30 minutes before NSAID

risk factors for GI injury

antiplatelets, anticoagulants, chronic steroid use, age >70

nsaid GI precautions

take w/ food or milk, use lowest effective dose for high risk: add a PPI can add H2RA but least evidence can add misoprostol but it is contraindicated in pregnancy

total body dose not to exceed for voltaren

32 g per day

voltaren dosing lower extremities

4 g QID

voltaren dosing upper extremities

2 g QID

do not use voltaren for more than __ days or on >_ body parts at the same time

21;2

voltaren adverse effects

local burning, stinging, erythema

tramadol mech

binds to mu-opioid receptor and inhibits reuptake of norepinephrine and serotonin: partial opioid agonist

tramadol dosing

initial 25 mg/d max 400 mg/d (300 elderly) renal/hepatic adjustments

tramadol adverse

sedation, constipation, lower seizure threshold

when to use tramadol

for severe pain after NSAIDs, APAP, adjunctive therapies fail

duloxetine mech

selective norepinephrine reuptake inhibitor (SNRI)

duloxetine dose

limit to 60 mg/day higher doses increase side effects

duloxetine adverse effects

nausea, headache, dizzy, sleep disturbance, sexual dysfunction, urinary retention

duloxetine drug interactions

SSRIs, NSAIDs, tramadol (CYP2D6)

capsaicin mech

derived from hot peppers; releases and ultimately depletes substance P from different nociceptive nerve fibers (pain transmission)

capsaicin adverse

stinging, itching, erythema, burning (wear gloves when applying)

glucosamine when to avoid

vegans (shark)

chondroitin when to avoid

shellfish allergy prostate and skin cancer

when to use intra-articular corticosteroids

not responding to oral meds, experiencing moderate to severe pain strong rec in hip OA conditional in hand/knee OA

if using intra-articular steroids for hip OA what is recommended

ultrasound guided administration

maximum frequency of intra-articular corticosteroids

every 3 months

onset of intra-articular corticosteroids

at least 1 week and lasts for 6

local side effects intra-articular corticosteroids

post injection pain flare, crystal synovitis, hemarthrosis, joint sepsis, articular cartilage atrophy

systemic side effects intra-articular corticosteroids

hyperglycemia, weight gain, osteoporosis, fluid retention

intra-articular hyaluronidase onset

13 weeks; lasts 6 months