Osteoarthritis Flashcards
What is the normal joint and role of cartilage?
Cartilage - firm rubbery material covering end of bone.
Composed of 75-80% water, chrondrocytes, collagens, proteoglycans
Describe the process of osteoarthritis.
- water content increases in cartilage leading to softening
- loss of proteoglycans
- increase levels of protease enzymes
- Destruction of cartilage, structural changes of bone
How long does joint stiffness last for in OA?
20-30 minutes in the morning
What are some clinical presentations?
Crepitus, bony enlargements DIP,PIP joints,
What are the risk factors for OA?
obesity, repetitive stress to joint, trauma to joint, age, family history
What joints are affected by OA?
Knee, hip, DIP, PIP, CMC, cerival/lumbar spine, MTP of toe
What are the radiographic findings with OA?
Early OA - no change
Moderate - joint space narrowing, osteophytes
Late - osteophytes, bone erosion, remodeling
What is the difference between PT and OT.
PT - instructs on muscle strengthening exercise
OT- joint protection, energy conservation, ADLs, assistive devices
Which drug is preferred for mild-moderate pain and why?
Acetaminophen (Tylenol)
Safety profile, cost
What is the dosing for acetaminophen? What are the precautions?
325-650mg po q 4-6h max 4g/day
Liver disease, warfarin
What is the dosing for Motrin?
Ibuprofen 400mg tid-800mg qid Max 3,200mg
What is the dosing for Aleve?
Naproxen 250-500mg bid Max 1500mg/day
What is the dosing for Voltaren?
Diclofenax 50mg 2-3x/day max 200mg/day
What is the dosing for Relafen?
Nabumetone 500-1000mg 1-2x/day
What is the dosing for Mobic?
Meloxicam 7.5-12mg daily
What is the dosing for Celebrex?
Celecoxib 100mg bid or 200mg daily
What is the dosing for ASA?
325-650mg q 4-6h max 3,600mg/day
What drugs can offer GI protection?
Misprostol or PPI
What are the risk factors for GI events?
> 65, comorbid, glucocorticoids, PUD, anticoagulants
Inhibition of COX-1 increases the risk of?
GI ulcer, bleeding, renal
When is the COX-2 enzyme active?
Only during stress or injury. Produces PG mediates pain, inflammation, fever, renal function.
What are the strategies to prevent GI bleeds?
Take with food, use Celecoxib, monitor CBC yearly, PPI, misoprostol, topical Nsaid
What is the mechanism of action of Capsaicin?
inhibits release of substance P in the peripheral nerves.
How long does it take for benefit of Capsaicin?
2-4 weeks for max benefit
How is voltaren gel applied? Who is it useful for?
diclofenac applied 4x/daily
2g upper, 4g lower. max 32g/day
Useful for elderly patients
What drugs must be administered in the physician’s office?
Intra-articular injections
What are glucocorticoids used in intra-articular injections, dosing, use?
Knee OA
methylprednisolone, triamcinolone
3/4 injections per year
What dose endogenous hyaluronate do?
Provide lubrication and shock absorbency in the joint. Anti-inflammatory.
What is the dosing for Ultram?
Tramadol 50-100mg q 4-6hrs. Max 400mg
What drug can lower the seizure threshold?
Tramadol (Ultram)
Glucosamine sulfate tends to help what kind of OA, ADR?
Knee OA
may increase INR
