Osteoarthritis Management Flashcards
What three treatments are recommended in the primary care of Osteoarthritis?
Analgesics
Weight Loss
Exercise restriction
How do force plates/ pressure mats help us assess Osteoarthritic pain?
allows objective measurement of limb use
What are the advantages and disadvantages to using Client Reported Outcome Measures (CROMS)?
Validated questionnaire that allows scoring of subjective assessments and helps identify other measures such as quality of life and motility of the dog
X- Bias is still possible [‘caregiver effect’
Why does weight loss improve osteoarthritic signs? (2)
lessens mechanical load and reduces adipogenic inflammation (fat deposition drives adipogenic mediators)
For what duration should we administer NSAIDs in the management of osteoarthritis?
Single short dose has analgesic benefit
3 weeks duration has anti inflammatory benefit
then after 4-6 weeks treatment allow wind down period (taper dose)
NSAID side effect are rare but what can increase the risk of them? (3)
Excessive dosing
Combination NSAIDs or use with a steroid
Pre existing disease
Apart from Prostaglandin antagonistic NSAIDs, what other medications can we use for Osteoarthritis management? (4)
Corticosteroids
Galliprant (EP4 receptor antagonist)
Anti-NGF mAbs
Amantadine (NMDA antagonist)
When and why is Galliprant indicated over normal NSAIDs?
If patient can’t tolerate NSAIDs e.g. Galliprant means less nausea/ vomiting
It inhibits inflammation without impacting PG2 functions
Give an example of a renally safe NSAID.
[trick question]- there is none that is completely safe when the kidney is stressed
What are Anti-NGF mAbs and how do they work?
Monthly injection of anti-NGF antibody
Osteoarthritic inflammation is high in nerve growth factor which has roles in pain signalling- this drug binds to NGF to reduce pain signalling
Give the name of the Anti-NGF mAbs drug licensed in dogs and cats?
Dogs- Bedinvetmab (Librela)
Cat- Frunevetman (Solensia)
How does Amantadine work and when is it contraindicated?
NMDA antagonist like ketamine that reduces central sensitization to provide analgesia
Contraindicated in patients with renal problems- excreted via the kidneys
Why do omega 3 fatty acid supplements work in Osteoarthritis cases?
increase anti inflammatory cytokines
What 3 surgical salvage procedures are available in the management of Osteoarthritis?
Arthroplasties- joint replacement
Arthrodesis- fusion of a joint
Amputation
How does Intra articular botox to treat Osteoarthritic pain work?
Intra articular injection of botulinum toxin inhibits the pain pathway neurotransmitter release
Tramadol is a weak opioid receptor agonist that blocks the descending pain pathway- how effective is this in OA management?
Not very- ineffective as the sole therapy but can be combined with other NSAIDs
Gabapentin MAY work in OA management- what should we consider when using this? (3)
Shouldn’t be used as the sole therapy- not effective enough
Requires several weeks to have any effect
To stop we must taper the dose over several weeks or we risk seizures occuring
Can we use Paracetamol to manage OA pain?
In dogs- yes but only licensed for 5 days and NEVER with an NSAID
In cats- NEVER!!!!
When is paracetamol indicated for OA management?
If patient has GI issues- otherwise NSAIDs much more preferable
Which stem cells are licensed for the treatment of canine OA?
equine umbilical cord stem cells (Xeno stem cell therapy)
How does platelet rich plasma treat OA?
Contains alpha granules such as TGFb, VEGF etc. that promotes angiogenesis, immunomodulation and chondrogenesis
What is the CAM home checklist?
canine arthritis management questionnaire- contains questions/ modification ideas for owners in their home such as stairs, food bowl height, non slip mats
Summarise the four stages/ process of OA management in canine patients?
- weight loss & exercise management
- inflammation control with NSAIDs then piprants > biologics > steroids
- wind down stage with gabapentin or amantadine
- salvage procedures (surgery)
How do we maintain pain perception consistency in our patients with OA?
Use a form to make it more systemic- average weekly score and 6 monthly review
How can we quantitively measure OA progression in a physical exam?
Goniometry- measuring the joint ranges in each joint plane
