Osteoarthritis

Question 1

Where does OA primarily affect?

Answer 1

hands, knees, hips, spine

Question 2

Who is more likely to get OA?

Answer 2

50-60 years, obese, joint trauma, genetics

Question 3

What is the most common form of arthritis?

Answer 3

OA

Question 4

How does OA happen?

Answer 4

malfunction of chondrocyte= loss of water and glycans and bones grow

Question 5

What do chondrocytes do?

Answer 5

break down cartilage

Question 6

When is pain worse for OA?

Answer 6

later in day with activity

Question 7

What are the stages of OA?

Answer 7

Stage 1- sharp pain with activity
Stage 2- pain constant and stiffness
Stage 3 -constant dull pain, chronic stiff

Question 8

What % have OA at 70?

Answer 8

50%

Question 9

What causes primary OA?

Answer 9

no idea

Question 10

What causes secondary OA?

Answer 10

acromegaly-larger bones
hemachromatosis- Iron overload

Question 11

What is diagnosis of OA?

Answer 11

usage pain, >45 more in evening pain

Question 12

What tests can we do to confirm OA?

Answer 12

X-ray, ESR, CRP, RF

Question 13

What are the 4 pillars of treatment of OA?

Answer 13

education
rehab
medications
referral

Question 14

Stages of progression of OA?

Answer 14

Articular cartilage change
bone remodel
synovial inflammation
soft tissue inflammation

Question 15

What are good lifestyle changes for OA?

Answer 15

weight control, exercise,

Question 16

At what point is it too much exercise?

Answer 16

pain in joint >2 hours

Question 17

What rehab techniques for OA?

Answer 17

tai chi for knee and hip
yoga-knee
CBT
acupuncture
canes, footwear

Question 18

What is the most effective intervention for OA?

Answer 18

non pharm

Question 19

Is acetaminophen good for OA? What is dose?

Answer 19

NOT good
1 g QID for 2-3 weeks

Question 20

What deformities can happen in OA?

Answer 20

Bouchard nodes

Question 21

Which OA is more in women?

Answer 21

knees and hands

Question 22

What are our topical NSAIDs?

Answer 22

diclofenac/ketoprofen BID for weeks

Question 23

When will I see benefit of diclofenac topical treatment?

Answer 23

hours and full effect in a week

Question 24

What is another topical product that may be of use?

Answer 24

capsaicin- depletes substance p
A535- counter irritant- AVOID in ASA allergies

Question 25

What OA is capsaicin for?

Answer 25

knee

Question 26

What are steps of drug therapy?

Answer 26

topical NSAID
Oral NSAID
IA CS
Acet
Tramadol
Dulox
capsaicin

Question 27

When should opioids be added?

Answer 27

LAST LINE

Question 28

MOA of tramadol and dosing?

Answer 28

acts on mu, serotinin and Nor E
dosing=1-2 tabs q4-6 prn

Question 29

Which OA does duloxetine have indication for? What is dosing?

Answer 29

knee
offlabel for hip
dosing=30 mg OD x 1-2 weeks get to 60 mg OD

Question 30

S/e of duloxetine?

Answer 30

gi bleed, depression, fracture
serotonin syndrom
sex dysfunction

Question 31

Who cant get duloxetine?

Answer 31

narrow glaucoma
ESRD hepatic impair, seizure

Question 32

What is the efficacy of injectable steroids?

Answer 32

short term relief ONLY, lasts for 4-8 weeks

Question 33

S/e of injectable steroids?

Answer 33

too jacked- haha jk
accelerate cartialge degrade

Question 34

What are the injectable joint fluid replacement?

Answer 34

hyaluronic acid

Question 35

How does hyaluronic acid work? Is it good? Dosing?

Answer 35

like synovial fluid
efficacy is uncertain
inject once weekly for 2-4 weeks

Question 36

Explain role of glucosamine?

Answer 36

precursor to proteoglycan, not recommended
500 mg TID for 3 months

Question 37

Which form of glucosamine may be better?

Answer 37

sulfat salt

Question 38

Is chondroitin worth it? What is dose?

Answer 38

VERY uncertain
1200mg/day

Question 39

What surgeries are an option for OA?

Answer 39

osteotomy-remove bony tissue
debridement
joint replacement

Question 40

Which form of OA does capsaicin not work for?

Answer 40

hand

Question 41

What form of OA does topical not work well for?

Answer 41

hip