Osteoarthritis

Question 1

What is the normal joint and role of cartilage?

Answer 1

Cartilage - firm rubbery material covering end of bone.

Composed of 75-80% water, chrondrocytes, collagens, proteoglycans

Question 2

Describe the process of osteoarthritis.

Answer 2

1. water content increases in cartilage leading to softening
2. loss of proteoglycans
3. increase levels of protease enzymes
4. Destruction of cartilage, structural changes of bone

Question 3

How long does joint stiffness last for in OA?

Answer 3

20-30 minutes in the morning

Question 4

What are some clinical presentations?

Answer 4

Crepitus, bony enlargements DIP,PIP joints,

Question 5

What are the risk factors for OA?

Answer 5

obesity, repetitive stress to joint, trauma to joint, age, family history

Question 6

What joints are affected by OA?

Answer 6

Knee, hip, DIP, PIP, CMC, cerival/lumbar spine, MTP of toe

Question 7

What are the radiographic findings with OA?

Answer 7

Early OA - no change
Moderate - joint space narrowing, osteophytes
Late - osteophytes, bone erosion, remodeling

Question 8

What is the difference between PT and OT.

Answer 8

PT - instructs on muscle strengthening exercise

OT- joint protection, energy conservation, ADLs, assistive devices

Question 9

Which drug is preferred for mild-moderate pain and why?

Answer 9

Acetaminophen (Tylenol)

Safety profile, cost

Question 10

What is the dosing for acetaminophen? What are the precautions?

Answer 10

325-650mg po q 4-6h max 4g/day

Liver disease, warfarin

Question 11

What is the dosing for Motrin?

Answer 11

Ibuprofen 400mg tid-800mg qid Max 3,200mg

Question 12

What is the dosing for Aleve?

Answer 12

Naproxen 250-500mg bid Max 1500mg/day

Question 13

What is the dosing for Voltaren?

Answer 13

Diclofenax 50mg 2-3x/day max 200mg/day

Question 14

What is the dosing for Relafen?

Answer 14

Nabumetone 500-1000mg 1-2x/day

Question 15

What is the dosing for Mobic?

Answer 15

Meloxicam 7.5-12mg daily

Question 16

What is the dosing for Celebrex?

Answer 16

Celecoxib 100mg bid or 200mg daily

Question 17

What is the dosing for ASA?

Answer 17

325-650mg q 4-6h max 3,600mg/day

Question 18

What drugs can offer GI protection?

Answer 18

Misprostol or PPI

Question 19

What are the risk factors for GI events?

Answer 19

> 65, comorbid, glucocorticoids, PUD, anticoagulants

Question 20

Inhibition of COX-1 increases the risk of?

Answer 20

GI ulcer, bleeding, renal

Question 21

When is the COX-2 enzyme active?

Answer 21

Only during stress or injury. Produces PG mediates pain, inflammation, fever, renal function.

Question 22

What are the strategies to prevent GI bleeds?

Answer 22

Take with food, use Celecoxib, monitor CBC yearly, PPI, misoprostol, topical Nsaid

Question 23

What is the mechanism of action of Capsaicin?

Answer 23

inhibits release of substance P in the peripheral nerves.

Question 24

How long does it take for benefit of Capsaicin?

Answer 24

2-4 weeks for max benefit

Question 25

How is voltaren gel applied? Who is it useful for?

Answer 25

diclofenac applied 4x/daily
2g upper, 4g lower. max 32g/day
Useful for elderly patients

Question 26

What drugs must be administered in the physician’s office?

Answer 26

Intra-articular injections

Question 27

What are glucocorticoids used in intra-articular injections, dosing, use?

Answer 27

Knee OA
methylprednisolone, triamcinolone
3/4 injections per year

Question 28

What dose endogenous hyaluronate do?

Answer 28

Provide lubrication and shock absorbency in the joint. Anti-inflammatory.

Question 29

What is the dosing for Ultram?

Answer 29

Tramadol 50-100mg q 4-6hrs. Max 400mg

Question 30

What drug can lower the seizure threshold?

Answer 30

Tramadol (Ultram)

Question 31

Glucosamine sulfate tends to help what kind of OA, ADR?

Answer 31

Knee OA

may increase INR