OSTEOARTHRITIS

Question 1

OSTEOARTHRITIS INFO

Answer 1

at least 1/10 older adults fufer from symptomatic asteoarthritis

• is the most prevealent chronic joint disease
• involves degeneration of cartilage in joints, which can result in PAIN + DISABILITY
• knees, hips, and hands are the most affected sites

Question 2

OSTEOARTHRITIS MANAGEMENT

Answer 2

• patients hsould receive a COMBO of
  1) NONPHARMACOLOGIC tx
  2) PAHRMACOLOGIC tx
• several pahrm therapies are useful for treating the pain associated with osteoarthritis
• none of them prevnents progression of the disease
• the choice of medication depends upon the
  1) SEVERITY of disease, and the
  2) presence/absence of LOCAL INFLAMMATORY CHANGES

Question 3

DRUGS FOR OSTEOARTHRITIS

Answer 3

1. ACETAMINOPHEN
2. NSAIDS
3. DULOXETINE
4. TRAMADOL
5. OPIOIDS
6. CAPSAICIN
7. INTRAARTICULAR CORTICOIDS

Question 4

ACETAMINOPHEN

Answer 4

ACETAMINOPHEN = TYLENOL

• is generally the FIRST LINE tx for the MILD-MODERATE OA pain WITHOUT signs/symptoms of inflammation
• has no clinically significant anti-inflammatory activity and is less effective than full doses of NSAIDS (but has fewer side effects)

Question 5

NSAIDS

Answer 5

• used
  1) if clinical response to acetaminophen is not satisfactory,
  2) clinical presentation of OA is INFLAMMATORY
• nsaids can be used IN ADDITION to or in place of acetaminophen

Question 6

DICLOFENAC

Answer 6

NSAID

DICLOFENAC –> DI CLO(F)TH –> cloth –> helped to rub in the TOPICAL GEL used for sympatic OA

• is available as a TOPICAL GEL or solution for LOCAL TREATMENT of OA
• topical preps are useful in
  1) patients with SYMPTOMATIC DISEASE limited to a few sites or in
  2) patients at increased risk for Adverse Effects with systemic NSAIDS

Question 7

DULOXETINE

Answer 7

DULOX = DELUXE –> selective Serotonin + NE REUPTAKE INHIB –> DELUXE fancy drug that helps mask chronic MSK PAIN

• selective serotonin and NE reuptake INHIBITOR
• is approved for tx of CHRONIC MSK PAIN

Question 8

TRAMADOL

Answer 8

TRAM-A-DOL –> if a tram hit a doll, it would be moderate to moderatley severe OA

-approved for tx of MODERATE-MODERATELY SEVERE CHRONIC PAIN in adults

Question 9

OPIOIDS

Which ones used? When?

Answer 9

• LAST RESORT for tx of INTRACTABLE OA PAIN
• agents used inlcude HYDROCODONE, MORPHINE, OXYCODONE

Question 10

CAPSAICIN

Answer 10

GOES ON OUR kneeCAP

topical application reduces OA pain in some patients

• it can cause severe skin burns and nerve damage at the site of application
• the dried residue can cause COUGHING, SNEEZING, EYE IRRITATION

Question 11

INTRAARTICULAR CORTICOSTEROIDS

-which two are used?

Answer 11

BETA-TRI ONE

–> it’s a BETA test so might as well TRI it in ONE knee

-in patients with persistent symptoms, in one or a few affected joints, intraarticular glucocorticoid injections can be used

BETAMETHASONE + TRIAMCINOLONE are the glucocorticoids commonly used