Osteoarthritis Flashcards
What is Osteoarthritis? Fancy Definiton
Joint destruction and repair
What is the pea age of onset?
50-60 years
What is the MOA of OA?
Not completely understood, primary is no identififiable factors, secondary is other metbaolic factors identified
What is a factor of OA?
Joint trauma, where biochemical and mechanical changes lead to loss of funciton and changes in cartilage, join capsule, subtracheal bone.
What is the pathogenesis of OA?
Imabalnce between cartilage maintenance and destruction
What is hemachromatosis?
Iron overload
What is acromegaly
When Pituitary gland produces too much growth hormone
What results in the imbalance between cartilage maintenance and destruction?
Malfunction of chondrocyte, end results is loss of prestoglycans and water, formation of osteophytes.
What is the main type of cells of cartilage?
Chondrocyte, formed from chondrobalsts
What is the issue of chondrocytes
They have a hard time to migrate in areas of trauma. Hence, new matrix formation is slow and we see poor cartilage maintenance and destruciton
What are the modifiable risk factors of OA?
Obesity, joint trauma
What are the non-modifiable risk factors of OA?
Age, genetics, Sex, Join misalighnment/deformity
What are the main clinical features of OA?
What are the stages of progression?
Articular cartilage changes
Bone remodeling
Synovial inflammation
Soft tissue inflammation
What are the stages of OA?
S1: Predictable, sharp pain brought on by activity
S2: Pain beocmes more constant; episodes of stiffness
S3: Constant dull aching pain; chronic stiffness episodes of intense exhausting pain
What are the joints commonly affected by OA?
DIstal interphalangeal, Proximal interphalangeal, jounts of thymbs
Cervical and lumbar spine
Hip, knee, metotarsophalangeal joint
What are the deformities that may arise from OA?
Heberden’s nodes at (DIP/hands)
Bouchard’s nodes (PIP)
Which sex is Heberden’s nodes most likely to develop
Women (About 10X)
What is the diagnostic criteria for OA?
Generally
Persistant useage-related pain, age >45 years, little early morning stiffness more evening stiffness
which categories of individuals should we test more for OA?
Young people
Atypical signs or symptoms
Weight loss
What are some diagnosis tools we use for OA?
Hx
Physical
Imaging (X-ray)
Lab tests)
What can X-ray imaging be helpful for?
Helpful for diagnostic clarification or monitoring
X-ray does not necessarily correlate with painb
What lab tests would be performed?
Lab tests are used to rule out other conditions
RA, ESR, CRP
What is the focus of OA treatment?
Lifestyle changes to help
What are the goals of OA treatment?
Reduce pain
maintain or improve joint mobility
Limit functional disability
Improve self-management
What are the 4 pillars in OA treatment?
Patient education
Rehab
Medications
Referrals (Surgical/Non-surgical)
For patient education what is important for OA treatment?
Emphasize importance of weight control, psychological support, expectations of treatment
For rehabilitation what is important to emphasize?
Exercise
PT
Relaxation, Mind/Body
Other (Acupuncture, Thermal interventions)
Environmental changes/aids
What should we remember with resepect to treatment medications?
Conservative and individualized
Begin with monotherapy prn and add/substitute medications as needed
What are the dosage forms of medications?
Po, topical, Intraarticular
What is an important thing with the care of OA?
Non-pharmacological therapy is just as important as pharmacological
What are our drug treatment options
Is acetaminophen safe?
Guidelines do not strongly recommend anymore just because they show negligible, non-clinically sig effect on pain
What is an appropriate trial of acetaminophen?
1g QID as an appropriate trial in 2-3 weeks.
What is the safety about acetaminophen?
Does not cause liver disease at normal doses
Risk of patients consuming from multiple sources
Lowered doses prudent for patients with liver disease, malnutrition, low body weight, advanced age, especially with chronic dosing
What are the DI of acetaminophen
Warfarin (At higher doses)
Alcohol use
isoniazid
What are the topical NSAIDs?
Diclo and various
Ketoprofen
What is the MOA of topical NSAIDs
Thought to inhibit Cox-2near the site of action
What is the usage of topical NSAIDs?
Knee, Hand, Foot OA
Where should it be applied?
Knee, Hand, Foot OA
What are the other topicals we should know>
Capsaicin
Methyl saliculates
What is the MOA of capsaicin
Deplete substance P and down regulates nociceptive fibers
What is the MOA of methyl salicylates/
Acts as a topical counter irritant
What is the indication of Capsaicin?
Knee OA only, It will sting
How long does Capsaicin take to work?
2-4 weeks, must be consistent
What is the MOA of Oral NSAIDS?
Bind to Xoc and prevent the production of prostaglandins
What are the risks associated with Oral NSAIDs
RIsk of GI, CV, renal toxicity
What are the concerns of NSAIDs?
CV, GI, Renal, DI
Review the next table
What are the AE of oral NSAIDs?
What are some examples of oral NSAIDs?
When would we introduce opioids for chronic pain?
Take some time to review the next slide
What should be monitored while on long term therapy of NSAIDs?
Blood pressure
Electrolytes
Renal function
CBC (Bleeding risk overtime)
INR
What is the MOA of tramadol>
Centrally acting analgesic that bunds to mu opioid receptors, also inhibits reuptake of serotonin and norepinephrine
What is the concerns with tramadol usage?
What would be the dosage of tramadol?
What is the mOA of Duloxetine?
What is the indication of duloxetine?
What is the general dosing of duloxetine?
What is the general onset of duloxetine:
What is the adverse effects of duloxetine?
what are the warnings of duloxetine?
What are the CI of duloxetine?
What is the drug interactions of duloxetine?
What is the MOA of injectable CS?
Interrupt inflammatory cascade at several levels
What is the usage of Injectable corticosteroids/
What is the efficacy of injectable CS?
What ist he onset of duration of ICS?
What are the AE of ICS
What are the warnings of ICS?
What is Hyaluronic acid MOA?
What is the use of hyaluronic acid
What is the onset and duration of hyaluronic acid?
What are the AE of hyaluronic acid?
What is the precursor of proteoglycan?
Glucosamine
What is the concerns of glucosamine?
How long does glucosamine take to work?
3 months generally at 500mg TiD or 1500mg OD
Which of the glucosamine salt has better evidence?
Sulfate salt
What is chondroitin?
What are the pharmacological recommendations of treatment order?
Who are some of the other individuals we may work with for OA management?
Dietician
PT/OT
Physician
Rheumatologist or internal medicine specialist.
What are the surgery interventions we may have:
Osteotomy
Debridement
Joint Replacement.
What is an osteotomy?
removal of bony tissue, to reduce pain and increase function
What is debridement?
Orthoscopic surgery
what is arthroplasty.
Joint replacementid
