Osteoarthritis

Question 1

Men tend to have OA in the ____. Women tend to have OA in the _____.

Answer 1

Men: hips. Women: proximal and distal interphalangeal joints

Question 2

What are Bouchards Nodes, Herberdens Nodes

Answer 2

Bouchards: bone spur in PIP
Herberdens: bone spur in DIP

Question 3

Localized OA involves ____ sites.

Answer 3

1 or 2

Question 4

Generalized OA involves ____ sites.

Answer 4

3 or more

Question 5

What is Primary OA?

Answer 5

Results from normal aging changes, erosive.

Question 6

What is Secondary OA?

Answer 6

Results from traumatic injury or inherited conditions. RA, chronic gouty arthritis, infectious arthritis. Hemochromatosis, Wilsons disease, Pagets disease. DM, obesity, hormone abnormailities. Steroid overuse, bone dysplasia. Basically anything not associated withnormal agin changes.

Question 7

Define OA

Answer 7

Slow, progressive disorder affecting primarily weight bearing joints. Progressive deterioration and loss of articular cartilage, with formation of new bone.

Question 8

OA Rx therapy, first line

Answer 8

Tylenol325-650mg q4hr or 1000mg q6hr, max 4g daily. Must renal/heaptic adjust. Max for ETOH use is 2g/day. Inhibits COX. 4-6 weeks trial is sufficient.

Question 9

OA Rx therapy, second line

Answer 9

NSAIDs. Inhibits COX1, COX2.

Question 10

COX 1 is located where?

Answer 10

GI tract, kidneys. Produces thromboxane

Question 11

Patho of OA:

Answer 11

Normal cartilage is supported by subchondral bone. Deterioration of cartilage diffuses stress to the bone, bone responds by remodling. This new bone is thicker and if remodling occurs at joint- a bone spur can form. Decreased cartilage + decreased synovial fluid production.

Question 12

Dx of OA

Answer 12

sinovial fluid is of higher viscosity. Pt SS, crepidus, deformity of joints

Question 13

OA Rx therapy, first line

Answer 13

Tylenol 325-650mg q4hr or 1000mg q6hr, max 4g daily. Must renal/heaptic adjust. Max for ETOH use is 2g/day. Inhibits COX. 4-6 weeks trial is sufficient.
dose of 1300mg > d chronic use can increase INR if pt on Warfarin

Question 14

OA Rx therapy, second line

Answer 14

NSAIDs. Inhibits COX1, COX2.
NSAIDs require 5 half lives to be therapeutic, 5 half lives to be fully excreted. Longer half life needs longer periods to be therapeutic

Question 15

Aspirin

Answer 15

325-650mg q4-6hr, Max dose 3600mg/day. Monitor seum for >3g/day.

Question 16

Salsalate

Answer 16

500-1000mg bid-tid, max 3000mg/day

Question 17

Etodolac

Answer 17

200-400mg bid-tid IR or 400-1200mg daily. Max 1200mg

Question 18

Dicolfenac PO

Answer 18

50mg bid-tid, 75mg bid or 100-200mg daily, XR

Max dose 150mg

Question 19

Indomethacin

Answer 19

25-50mg tid, 75 mg once - bid, max 200mg day

Question 20

Nabumentone

Answer 20

500-1000mg daily, bid. Max dose 2000mg

Question 21

Ibuprofen

Answer 21

400-800mg tid-qid, Max 3200mg/day

Question 22

Naproxen

Answer 22

Controlled release: 250-500mg BID or 750-1000mg/d Max 1650mg

Naproxen Sodium 275-500mg BID max 1650mg/d

Question 23

Meloxicam

Answer 23

705-15mg daily Max 15mg

Question 24

Prioxicam

Answer 24

20mg PO daily

Question 25

Ketoprofen

Answer 25

25-75mg tid-qid, 100-200mg XR day

Question 26

Tramadol

Answer 26

Low potential for abuse compared to opioids. Risk of seizure is dose dependent and increased with antidepressant use- seratonin syndrome. Avoid with MAOIs
50-100mg q4-6hr, max 400mg. Elderly dosing is max 300mg
ER- 100-300mg daily
GFR <30- 50-100mg q12h, max dose 200mg

Question 27

Tapentadol (nucynta, nucynta er)

Answer 27

agonist for mu receptor, no effect on inflammation.
IR 50-100mg q4-6 hr max 600mg
ER 50-250 PO bid

Question 28

Glucosamine and Condroitin

Answer 28

Glucosamine is thought to be a chondroprotective, stimulating cartilage matrix.
Chondroitin is thought to inhibit degradative enzymes
Caution with shellfish allergies AND DIABETICS- MAY ELEVATE BG levels
Glucosamine 500mg tid or 1500mg daily
Chondroitin 400-800mg tid with glucosamine

Question 29

Hyaluronan

Answer 29

weekly injections for 3-5 weeks, provides longer pain relief compared to steroids

Question 30

Corticosteroids

Answer 30

Works with inflammatory component or knee effusion involving 1-2 joints. Should not be injected more than 3-5 times a year. Works quicker than HA

Question 31

Capsacian Topical

Answer 31

apply every 6-8h, max effect seen after 2-4 weeks of consistent use.

Question 32

Diclofenac gel

Answer 32

Only 6-10 percent of gel and 2-3 percent of lotion is absorbed.

Question 33

OA- caution with elderly

Answer 33

choose nsaid with a shorter half life

caution with GI risk and COX1, need to have a gastric protective as well.

Question 34

OA and pregnancy

Answer 34

caution with NSAID- increased risk of bleeding. Ibuprofen and Naproxen Cat B in 1-2 trimester
All NSAIDs are contraindicated in 3rd trimester

Question 35

Varus vs. Valgus

Answer 35

Varus: bow legged
Valgus: knock kneed

Question 36

Radiologic findings of OA

Answer 36

narrow joint spaces, bone spurs

Question 37

OA in cervical spine

Answer 37

can radiate to traps, cervical area, nerve involvement

Question 38

OA in lumbar

Answer 38

produces symptoms of neurogenic claudication

Question 39

OA in hip

Answer 39

gate disturbances

Question 40

NSAIDS with GI issues should also be given

Answer 40

PPI or misoprostol

Question 41

NSAIDS plus ACEi can cause

Answer 41

decreased renal function

Question 42

ibuprofen and ASA

Answer 42

ibuprofen is to be taken 8hr before or 30min-2hr after ASA for ASA to be cardio effective