Pharm Tx of OA

Question 1

Where are

1. Heberden’s nodes
2. Bouchard’s nodes

Answer 1

1. DIPs

2. PIPs

Question 2

Lifestyle modifications for OA

Answer 2

Exercise
Self efficacy and self management programs
Weight loss
Tai chi
Assistive devices (ex: cane)

Question 3

2 strongly recommended pharm interventions for OA

Answer 3

Oral NSAIDs

Topical NSAIDs

Question 4

4 conditionally recommended pharm interventions for OA

Answer 4

Acetaminophen (low evidence)
Tramadol
Duloxetine
Steroid injections

Question 5

What is the difference between COX1 and 2 pathways?

Answer 5

COX1: GI cytoprotection, PLT activity (constitutive)
COX2: inflammation, pain, fever (induced by inflammatory stimuli)

Question 6

Risks of traditional NSAIDs

Answer 6

GI ulcerations
GI bleeds
Perforation

Question 7

Celexicob

Answer 7

COX2 selective so good for the GI tract

Risks to BP control, kidneys, CV

Question 8

Duloxetine

Answer 8

SNRI anti depressant used for pain
Moderate evidence in OA knee
Conditional recommendation

Question 9

Cortisone injections

Answer 9

Helps pain control and function in short term only
Can repeat at 3-6 months
Some inhibition of MMPs by cortisone (not not that many)
Potential risk of cartilage damage

Question 10

Viscosupplementation

Answer 10

Hyaluronic acid preparations
Mimic normal lubricant of joint
Some positive studies
Chondroprotectice and inhibits IL-1 and metalloproteases
Evidence low