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255C > Osteoarthritis > Flashcards

Osteoarthritis Flashcards

1
Q

Definition of OA

A

chronic, progressive disorder characterized by the loss of articular cartilage in primarily hands, knees, hips and spin

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2
Q

Peak age onset of OA

A

50-60 years

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3
Q

What is the MOA of OA

A

not understood
but joint trauma is a factor

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4
Q

List the stages of progression of OA

A

articular cartilage changes
bone remodeling
synovial inflammation
soft tissue inflammation

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5
Q

Risk factors that are modifiable for OA

A

obesity
joint trauma

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6
Q

Risk factors non modifiable for OA

A

age
genetics
sex
joint misalignment /deformity

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7
Q

List some major clinical features of OA (difference between RA and OA)

A

initial absence of inflammation or joint swelling
mono-articular at first
pain and stiffness with activity
no systemic symptoms

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8
Q

Other general clinical features of OA

A

gradual onset
crepitus
tenderness
limited range of motion
bony swelling
joint deformity
instability

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9
Q

List and describe the stages of pain for OA

A

stage 1 - predictable, sharp pain brought on by activity
stage 2 - pain becomes more constant; episodes of stiffness
stage 3 - constant dull/aching pain; chronic stiffness; episodes of intense exhausting pain

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10
Q

Which joints are most commonly affected in OA?

A

Distal interphalangeal (DIP), proximal interphalangeal (PIP), joints of thumb
Cervical and lumbar spine
Hip, knee, metotarsophalangeal joint

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11
Q

Describe the general diagnostic criteria

A

persistent usage related pain
age>45 years
little early morning stiffness; more evening stiffness

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12
Q

Goals for OA

A

reduce pain
maintain or improve joint mobility
limit functional disability
improve self-management

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13
Q

List the 4 pillars of tx of OA

A

patient education
rehabilitation
medications
referral (surgical/non surgical)

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14
Q

What is the important part of patient education of lifestyle changes for OA?

A

emphasize importance of weight control

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15
Q

List some of the aspects of rehabilitation for OA

A

exercise
physiotherapy
relaxation, mind/body
other - acupuncture?
environmental changes/aids

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16
Q

(T/F)
Non pharm interventions remain the most effective interventions for OA

A

True - often underutilized interventions for OA

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17
Q

List some non surgical referrals for OA

A

dietician
physiotherapy or OT
physician - pain medication
Rheum or Internal Medicine Specialist

18
Q

Types of Surgery to help with OA

A

Osteotomy (removal of bony tissue)

Debridement (orthoscopic surgery)

Joint Replacement (arthroplasty)

19
Q

List some of the medication that can be used for OA

A

Acetaminophen
Topical NSAIDs
Other topical (capsaicin, a535)
Oral NSAIDs
Opioids (traditional and tramadol)
Duloxetine
Injectable joint replacement fluid
Injectable glucocorticoids

20
Q

When should capsaicin in OA

A

knee
Against in hand

20
Q

When should Topical NSAIDs in OA

A

hand, knee

20
Q

When should oral NSAIDs in OA

A

hand, knee, hips

20
Q

When should acetaminophen in OA

A

hand, knee, hip

20
Q

When should duloxetine in OA

A

hand, knee, hip

20
Q

When should tramadol in OA

A

hands, knee, hip

20
Q

When should hyaluronic acid in OA

A

against in hands, knee, hip

20
Q

When should traditional opioids in OA

A

against in all hands, knee, hip

21
Q

When should IA corticosteroids in OA

A

hands, knee, hips

21
Q

When should glucosamine in OA

A

against in hand, knee, hip

22
Q

When should chondroitin in OA

A

Undecided for hands

against - knee and hips

23
Q

What is the limit per year on injectable corticosteroids and why?

A

The cartilage degradation – why it is limited to 3-4 injections in one joint per year

24
Q

How long does injectable corticosteroids typically last?

A

4-8 weeks but some get longer

25
Q

What is hyalyronic acid?

A

injectable joint fluid replacement

26
Q

Dosing for OA for duloxetine

A

30mg OD x 1-2 wks, increase up to 60mg od (max 120mg od)

26
Q

Adverse effects for hyaluronic acid

A

arthralgia, injection site pain/reaction, post inj flare

27
Q

Common dose for glucosamine

A

500 mg tid or 1500 mg Once daily
need to use for 3 months before results

28
Q

Concerns about glucosamine

A

good safety profile
??incre INR, bleeding risk
do not have a great studies

29
Q

What to know about chondroitin

A

less data than glucosamine
dose - 1200mg/d
concerns - good safety profile, ?incr INR, bleeding risk

30
Q

Dose for tramadol

A

1-2 tabs q4-6h prn (max 8 tablets per day)

31
Q

When is traditional opioids used in OA?

A

only for select patients / last time therapy

32
Q

List some key takeaways for OA

A

Don’ forget about non-therapeutic measures (eg. Benefits of exercise, weight loss)

OA favours a “go slow” approach

Ensure adequate trial of an option before modifying

Generally add-on therapy rather than replacement

Acetaminophen – not as effective as previously thought

For NSAIDs, utilize low doses as much as possible

Topicals are an important option

Strong opioids are usually inappropriate

Consider each patient. Think of comorbidities, risks, benefits and preferences

255C (8 decks)

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