Osteoarthritis

Question 1

What do chondrocytes produce

Answer 1

proteoglycans and collagen

Question 2

Proteoglycans

Answer 2

provides resiliency, form aggregates w/ hyaluronic acid

Question 3

Collagen fiber function

Answer 3

provides strength and anchor the cartilage to the bone surface

Question 4

Chondrocyte function

Answer 4

to maintain the integrity of the matrix in healthy cartilage

Question 5

Osteoarthritis most commonly affects

Answer 5

DIP, hips, knees

Question 6

Osteoarthritis risk factors

Answer 6

age, congenital/ anatomical defects, female, major joint trauma, obesity, muscle weakness, repetitive stress, genetics

Question 7

Osteoarthritis presentation

Answer 7

joint pain, worse w/ activity, pain at rest, morning joint stiffness, crepitus, inflammation, asymmetric involvement, muscle atrophy, falls

Question 8

Heberden’s nodes

Answer 8

bony spurs on distal joints in finger

Question 9

Brouchard’s nodes

Answer 9

bony spurs cover cartilage on knuckles

Question 10

Osteoarthritis non pharm treatment

Answer 10

education, rest, exercise, PT/OT, wt loss, heat, ice

Question 11

Step 1 treatment

Answer 11

APAP, use regularly, monitor LFTs, or capsaicin cream, glucosamine/chondroitin, other OTC

Question 12

Step 2 treatment

Answer 12

NSAIDs, should use lower recommended dose, best results with regular dose, caution in gi bleeds, ulcers, antiacoagulants, glucocorticoids, CHF, renal, HTN

Question 13

If there is a concern for a GI bleed

Answer 13

consider Celecoxib, NSAID +GI prophylaxis

Question 14

NSAIDs with lower/ higher risk of bleeds

Answer 14

ibuprofen, diclofenac, nabumetone, higher piroxicam, ketorolac

Question 15

If concerned for CV complications use

Answer 15

naproxen

Question 16

NSAIDs monitor for

Answer 16

renal dysfunction, bleeding

Question 17

Step 3 treatment

Answer 17

Hyaluronate injections, intra-articular steroid injections, opioid analgesics/tramadol

Question 18

Hyaluronate injections

Answer 18

replaces fluids, weekly injections x3-5 weeks, lasts 8-12 weeks, $$$

Question 19

Intra-articular steroid injections

Answer 19

Methylprednisolone (Depo medrol), injected 3-4 months or longer, risk of infection (fungal), more frequent

Question 20

Opioid analgesic/tramadol

Answer 20

added for persistent breakthrough pain, used at bedtime to help sleep, monitor for sedation, constipation, resp depression, watch APAP

Question 21

Step 4 treatment

Answer 21

Joint replacement therapy, consider for severe pain at rest, newer products/ joints last longer, timing is important