Osteoarthritis

Question 1

Risk factors for OA

Answer 1

• Age
• Gender - female 2-3X
• Obesity
• Occupation
• Sports: increase

Question 2

Common symptoms of OA

Answer 2

• Pain
• Stiffness (morning stiffness is COMMON, usually resolve within 30 minutes)
• Swelling (effusion)
• Crepitus (cracking)
• Osteophytes (outgrowths/bone spurs)

Question 3

Dx of OA

Answer 3

Clinical sx + Xray + (lab)

Question 4

Hand joints involved

Answer 4

DIP joints (think use) and MCP joints common

Question 5

With hip involvement, may need to rule out other caues, Lab?

Answer 5

• ESR, RF
• Synovial fluid
• Imaging

Question 6

Dx of OA of hands

Answer 6

Hand pain + at least 3 of the following 4 features:

• Hard tissue enlargement of > 2 of 10 selected joints. [The 10 selected joints are the 2nd and 3rd DIP joints, the 2nd and 3rd PIP joints, and the first carpometacarpal (CMC) of both hands]
• Hard enlargement of > 2 DIP joints
• 1 of the 10 selected joints

Question 7

Treatment goal of OA

Answer 7

• control pain and swelling
• minimize disability
• improve the quality of life
• educate the patient about their role in disease management

Question 8

1st line Rx

Answer 8

• Analgesics, such as acetaminophen (APAP), prn basis
• NSAIDs, which are also analgesic (first po and then topical NSAID or capsaicin)
• Intraarticular glucocorticoids

Question 9

Safety concern of APAP (acetaminophen/Tylenol)

Answer 9

• Hepatoxicity
• dosing less than 2 g/day
• inc risk of GI cxn, even greater with NSAIDs