Osteoarthritis

Question 1

Peak onset age of OA?

Answer 1

50-60yrs

Question 2

Primary OA?

Answer 2

No identifiable factor

Question 3

Secondary OA?

Answer 3

other metabolic factors identified

Question 4

Pathogenesis of OA?

Answer 4

imbalance between cartilage maintenance and destruction;
- malfunction of chondrocytes
- results in loss of proteoglycans and water
- formation of osteophytes
Inflammatory cytokines play a role

Question 5

Modifiable risks of OA?

Answer 5

Obesity
Joint Trauma

Question 6

Non-modifiable risks of OA?

Answer 6

age
genetics
sex
joint misalignment/deformity

Question 7

Stage of progression of OA?

Answer 7

aricular cartilage changes
bone remodeling
synovial inflammation
soft tissue inflammation

Question 8

Onset of OA?

Answer 8

gradual;
intial absence of inflammation or joint swelling
pain and stiffness w/ activity
no systemic sx

Question 9

Pain stages of OA?

Answer 9

Stage 1: predicatable sharp pain brought on by activity
Stage 2: pain becomes more constant, epsidoes of stiffness
Stage 3: constant dull/aching pain, chronic stiffness, episodes of intense exhausting pain

Question 10

When does pain tend to be worse in OA?

Answer 10

late afternoon/ early evening (as day goes on)

Question 11

Common joints affected by OA?

Answer 11

distal interphalangeal,
proximal itnerphalangeal,
joints of thumb,
cervical and lumbar spine
hip
knee
metotarsophalangeal joint

Question 12

Whereis the heberden;s nodes deformity located?

Answer 12

Distal interphalangeal

Question 13

Where is Bouchard’s node deformity located?

Answer 13

Proximal interphalangeal

Question 14

What tests used to daignose OA?

Answer 14

Persistent usage-related pain
> 45
little early morning stiffness, more in evening

Question 15

WHen is additional testing done for OA daignosis?

Answer 15

younger
atypical sx
wt loss

Question 16

3 components of diagnosis?

Answer 16

history
physical exam
imaging;
- X-ray may be helpful but does not necessarily correlate to pain

Question 17

Treatment goals?

Answer 17

focus specific lifestyle changes
reduce pain
maitain or improve joint motility
limit functional disability
improve spef-management

Question 18

4 pillars of treatment for OA?

Answer 18

pt education
rehabilitation
medications
referals (surgical/non-surgical)

Question 19

What is the initial drug of choice for OA?

Answer 19

acetaminophen

Question 20

Dosing for acet / timeframe?

Answer 20

1g QID
used max dose 2-3 weeks to judge efficacy then use lowest effective dose thereafter

Question 21

DI of acetaminophen?

Answer 21

Warfarin
Alcohol use
Isoniazid

Question 22

Topical NSAIDs used?

Answer 22

Diclofenac
Ketoprofen

Question 23

Benefits of topical NSAIDs?

Answer 23

saftey issues and DI unlikely
application directly to site
can be used BID-QID

Question 24

Capsaicin MOA?

Answer 24

deplete substance P and down regulate nociceptive fibers

Question 25

How must capsaicin be used?

Answer 25

consistently for 2-4 weeks to see benefit, needs to deplete substance P

Question 26

Methyl salicylate good?

Answer 26

not much evidence to support use avoid in ASA allergic pts potential Warfarin interaction

Question 27

Oral NSAIDs better or worse than Acet?

Answer 27

More effective but, risk of GI/ CV/ renal toxicity

Question 28

When is oral NSAID preffered over topical NSAID?

Answer 28

if topical NSAID failed, multiple joints affected, hip and spine OA

Question 29

Oral NSAIDs?

Answer 29

Dico Naproxen Ibu Indomethacin Ketoprofen Meloxicam Celecoxib

Question 30

Monitoring for long-term oral NSAID therapy?

Answer 30

BP Electrolytes Renal function CBC INR in pts w/ anticoagulants

Question 31

Opioid place in therapy of OA?

Answer 31

last line

Question 32

WHen is duloxetine used in OA?

Answer 32

second-line agent; especially used if neuropathic pain present, OA of knee

Question 33

Duloxetine AE's?

Answer 33

headache dry mouth constipation sedation fatigue dizziness sweating appetite lose High doses: BP and HR increase

Question 34

CI of duloxetine?

Answer 34

narrow angle glaucoma ESRD Hepatic impairment Seizure history

Question 35

Injectable CS's?

Answer 35

Triamcinolone Methylprednisolone hydrocortisone dexamethasone

Question 36

MOA of injectable CS's?

Answer 36

interrupt inflammatory cascade at several levels

Question 37

When are injectable CS's considered?

Answer 37

in hip, knee, shoulder OA

Question 38

Efficacy of Injectable CS's?

Answer 38

short term relief, no long term benefit

Question 39

How long do injectable CS's last?

Answer 39

4-8 weeks

Question 40

How many injections per joint per year?

Answer 40

3-4

Question 41

Hyaluronic acid MOA?

Answer 41

component of synovial fluid

Question 42

Use of hyaluronic acid?

Answer 42

Knee OA

Question 43

Downside of hyaluronic acid?

Answer 43

$$$ uncertain benefit

Question 44

Hyaluronic acid dosing?

Answer 44

IA injection once weekly for 2-4 weeks, can repeate every 6 months

Question 45

AE's of Hyaluronic acid?

Answer 45

arthalgia injection site pain/reaction post injection flare

Question 46

How long dose glucosamine need to be used to see benefit?

Answer 46

atleast 3 months

Question 47

Dosing of glucosamine?

Answer 47

500mg TID or 1500mg OD

Question 48

Chrondroitin dosing?

Answer 48

1200mg/d