Osteoarthritis Flashcards
What is the most common joint disease?
Osteoarthritis
What are risk factors for OA?
- Obesity
- Sex (female)
- Occupation
- Participation in certain sports
- History of joint injury or surgery
- Genetic predisposition
What are signs of OA?
- Mono/oligoarticular asymmetrical involvement
- Local tenderness
- Limited motion with passive/active movement
- Bone proliferation or synovitis
What are symptoms of OA?
- Pain
- Deep, aching
- Stiffness in affected joint
- Usually <30 minutes duration
- Often related to weather
- Limited joint motion
What are some distinguishing features that can help you distinguish OA as opposed to RA?
- Gradual onset >50 years
- Localized joint symptoms
- Larger, weight bearing joints
- Brief <30 minute attacks
- Pain with use
- Unilateral
- No auto-antibodies
What are the most common joint locations for OA?
Hands, knees, hips
(Can also be spine and feet)
How is OA diagnosed?
Through history, physical exam, X-ray findings, lab testing
What are goals of OA therapy?
- Distinguish between primary and secondary OA
- Clarify joints involved
- Assess response to prior therapies
What is primary OA?
Most common form with no identifiable cause
What is secondary OA?
Associated with a known cause such as inflammation, trauma, metabolic/endocrine disorders, or congenital factors
What are non-pharm options for OA?
- Exercise
- Self-management programs
- Weight loss
- Tai Chi
- Cane
- Knee braces
- CBT
- Yoga
- Thermal interventions (hot or cold)
What is the first step in OA treatment?
Patient education
What non-pharm treatments should NOT be done in OA?
- TENS (transcutaneous electrical stimulation)
- Manual therapy
- Massage therapy
- Modified shoes
- Pulsed vibration therapy
What is the first line treatment for ANY OA location?
Oral NSAIDs (lowest possible dose and duration)
What are second and third line treatments for OA?
- Topical NSAIDs
- Intra-articular steroids
What drug interaction should you avoid with NSAIDs?
ACEi/ARB/Loop diuretic
What kind of NSAID is better for patients at higher risk of GI problems?
COX-2 selective (-coxib)
What kind of OA is topical NSAIDs most used in (location)?
Knee OA
What are counseling tips for topical NSAIDs
- Wash hands afterwards (unless applying to hands)
- Avoid contact with open wounds
- Avoid touching eyes, nose, mouth after using
- Less ADEs than oral
What types of OA is IA steroids strongly recommended?
Knee and hip
How long does it take for IA steroids to kick in and how long should they last?
2-3 days to work and last 4-8 weeks
Should be given no more than every 3 months (risk of systemic side effects)
What are relative contraindications for IA steroids?
- Active superficial infections
- Suspected joint infection
- Unstable coagulopathy
- Uncontrolled diabetes
- Broken skin at the injection site
What are benefits of acetaminophen?
Less GI and CV effects than NSAIDs
When can tramadol be used?
- Failed treatment with APAP or topical NSAIDs
- Contraindications to oral NSAIDs
- Unable to receive IA steroids
- Add-on to APAP and/or oral NSAIDs
What is the only centrally acting agent for chronic pain that is approved for OA?
Duloxetine
What is recommended against in hand OA but supported in knee OA?
Topical capsaicin
What is recommended against in knee/hip OA but supported in hand OA?
Chondroitin
What pharmacologic treatments are recommended against in OA?
- Bisphosphonates
- IA hyaluronic acid injections
- Non-tramadol opioids
- Colchicine
- Fish oil
- Vitamin D
- Glucosamine (can be in combo with chondroitin)
- Hydroxychloroquine
- Methotrexate
- TNF inhibitors
- IL-1 antagonists
