Osteoarthritis and Gout (DONE) Flashcards
Osteoarthritis overview
Predominantly non-inflammatory Cartilage loss from synovial joints Joints affected: neck, lower back, hips, base of thumb, ends of fingers, knees, base of big toe Less likely to be symmetrical More common in women than men In > 65 years, affects 12% of population
Aetiology
Age: late 40s onwards Gender: more common in women Obesity Previous joint injury or disease Genetic factors
Symptoms
Pain- worse when moving joint or at end of day
Stiffness- joints may feel stiff after rest
Grating or grinding sensation as you move
Swelling- cause by osteophytes or synovial thickening and extra fluid
Muscles may look thin or wasted
Not being able to use your joint normally- may not move as freely or as far as normal
Clinical presentation
Wear and tear on the cartilage of your joints
Cartilage breakdown causing bones to rub together resulting in damage and pain
Pain worsened by movement, eased by rest
Joint deformities
Anxiety and depression
Management
Analgesics Topical or oral NSAIDs Local corticosteroid injections Physiotherapy Surgery Weight loss if obese
Bio-mechanical
Losing weight reduces stress on joints
Physiotherapy: preserve joint function, protect from further damage, identify damaging activities, regain muscle strength around weakened joints, advise exercise, recommend mobility aids
Surgery
May be recommended if your pain is very severe or you have mobility problems
Many thousands of hip and knee replacements are performed each year for osteoarthritis, and other joint replacements are becoming increasingly common
Surgery can be very good for easing pain when other treatments haven’t given enough relief
Drug therapy
Paracetamol regularly
NSAIDs: additional treatment (not first line), start with ibuprofen, monitor for side effects, possible place for topical therapy
Topical capsaicin- adjunct
Cortiocsteroid injection: decrease pain and inflammation of flare up
Role of pharmacist
Counselling- dosage regimen, side effects, warnings Monitoring for side effects Weight loss advice Compliance aids and living aids Advice to health care professionals
Gout overview
Type of inflammatory arthritis Causes sever pain and damage to joints 2.5% of adults in the UK Worldwide prevalence rising More common in men More common with increasing age
Aetiology
High levels of blood which allows urate crystals to from
2/3 of the urate in our bodies comes from the breakdown of purines which are naturally present in the cells of our bodies
1/3 comes from the breakdown of purines in some foods and drinks
Risk factors
Reduced excretion of uric acid by kidneys accounts for most cases
Overproduction of uric acid is the cause of gout in <10% of patients
Drugs that raise uric acid levels
Genetic predisposition
Obesity
Hypertension
Joints affected by gout
Base of big toe Knees Hands Elbows Wrists Causes intense pain in joint, also becomes red, hot and shiny
Diagnosis of gout
Blood test can measure the amount of urate in blood
X-rays of joints will reveal joint damage if you have long standing and poorly controlled gout
Synovial fluid examinations involve taking fluid samples from a joint through a needle and examining them under a microscope for urate crystals
Gout treatment
Acute: ice, rest affected joint, NSAIDs for 7-14 days for pain relief, colchicine and steroids
Ongoing treatment to reduce urate: lifestyle modifications, allopurinol, febuxostat
Colchicine
Thought to reduce inflammatory response to urate crystals
Start as soon as possible after symptoms (slower onset than NSAID)
Side effects: ab cramps, diarrhoea, vomiting, does not affect serum urate levels
Corticosteroids for gout
Use when NSAIDs or colchicine contraindicated
Oral, IM or intra-arcticular
Intra-articular effective in acute gout
Lifestyle modifications for gout
Lose weight if overweight
Restrict purine rich foods e.g. seafood, game, yeast extract, red meat
Dairy products and cherries lower uric acid
Restrict alcohol- avoid beer, stout, port
Stop diuretic if to treat hypertension
Allopurinol
Starting dose 100mg OD, increased in 100mg increments every 2-3 weeks
Reduce dose in renal impairment
Side effects- include skin rashes
Initiation may trigger acute attck
Colchicine 0.5mg BD co-prescribed for up to 6 months after initiation
Febuxostat
Recommended if intolerant of allopurinol or contraindicated
More selective xanthine oxidase inhibitor
80mg OD starting dose
Faster onset than allopurinol
Check uric acid levels after 2 weeks and titrate dose
Other drug options for gout
Uricosuric drugs- increase the excretion of uric acid
Biologics- may have role for severe refractory tophaceous gout
