Osteoarthritis Flashcards
Definition of OA
chronic, progressive disorder characterized by the loss of articular cartilage in primarily hands, knees, hips and spin
Peak age onset of OA
50-60 years
What is the MOA of OA
not understood
but joint trauma is a factor
List the stages of progression of OA
articular cartilage changes
bone remodeling
synovial inflammation
soft tissue inflammation
Risk factors that are modifiable for OA
obesity
joint trauma
Risk factors non modifiable for OA
age
genetics
sex
joint misalignment /deformity
List some major clinical features of OA (difference between RA and OA)
initial absence of inflammation or joint swelling
mono-articular at first
pain and stiffness with activity
no systemic symptoms
Other general clinical features of OA
gradual onset
crepitus
tenderness
limited range of motion
bony swelling
joint deformity
instability
List and describe the stages of pain for OA
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
Which joints are most commonly affected in OA?
Distal interphalangeal (DIP), proximal interphalangeal (PIP), joints of thumb
Cervical and lumbar spine
Hip, knee, metotarsophalangeal joint
Describe the general diagnostic criteria
persistent usage related pain
age>45 years
little early morning stiffness; more evening stiffness
Goals for OA
reduce pain
maintain or improve joint mobility
limit functional disability
improve self-management
List the 4 pillars of tx of OA
patient education
rehabilitation
medications
referral (surgical/non surgical)
What is the important part of patient education of lifestyle changes for OA?
emphasize importance of weight control
List some of the aspects of rehabilitation for OA
exercise
physiotherapy
relaxation, mind/body
other - acupuncture?
environmental changes/aids
(T/F)
Non pharm interventions remain the most effective interventions for OA
True - often underutilized interventions for OA
List some non surgical referrals for OA
dietician
physiotherapy or OT
physician - pain medication
Rheum or Internal Medicine Specialist
Types of Surgery to help with OA
Osteotomy (removal of bony tissue)
Debridement (orthoscopic surgery)
Joint Replacement (arthroplasty)
List some of the medication that can be used for OA
Acetaminophen
Topical NSAIDs
Other topical (capsaicin, a535)
Oral NSAIDs
Opioids (traditional and tramadol)
Duloxetine
Injectable joint replacement fluid
Injectable glucocorticoids
When should capsaicin in OA
knee
Against in hand
When should Topical NSAIDs in OA
hand, knee
When should oral NSAIDs in OA
hand, knee, hips
When should acetaminophen in OA
hand, knee, hip
When should duloxetine in OA
hand, knee, hip
When should tramadol in OA
hands, knee, hip
When should hyaluronic acid in OA
against in hands, knee, hip
When should traditional opioids in OA
against in all hands, knee, hip
When should IA corticosteroids in OA
hands, knee, hips
When should glucosamine in OA
against in hand, knee, hip
When should chondroitin in OA
Undecided for hands
against - knee and hips
What is the limit per year on injectable corticosteroids and why?
The cartilage degradation – why it is limited to 3-4 injections in one joint per year
How long does injectable corticosteroids typically last?
4-8 weeks but some get longer
What is hyalyronic acid?
injectable joint fluid replacement
Dosing for OA for duloxetine
30mg OD x 1-2 wks, increase up to 60mg od (max 120mg od)
Adverse effects for hyaluronic acid
arthralgia, injection site pain/reaction, post inj flare
Common dose for glucosamine
500 mg tid or 1500 mg Once daily
need to use for 3 months before results
Concerns about glucosamine
good safety profile
??incre INR, bleeding risk
do not have a great studies
What to know about chondroitin
less data than glucosamine
dose - 1200mg/d
concerns - good safety profile, ?incr INR, bleeding risk
Dose for tramadol
1-2 tabs q4-6h prn (max 8 tablets per day)
When is traditional opioids used in OA?
only for select patients / last time therapy
List some key takeaways for OA
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
