Rheum- OA

Question 1

Is primary (idiopathic) OA or secondary OA more common?

Answer 1

Primary (idiopathic) OA

Question 2

What are the 4 possible causes of Secondary OA?

Answer 2

• Rheumatoid or another inflammatory arthritis
• Trauma
• Metabolic or endocrine disorders
• Congenital factors

Question 3

S/s of what?

• Joint pain/tenderness
• Decreased ROM
• Weakness
• Joint instability
• Disability

Answer 3

Osteoarthritis

Question 4

What is the name of the 2 classic physical exam findings of OA?

Answer 4

Heberden’s nodes (distal joint)

Bouchard’s nodes (proximal joint)

Question 5

What is the primary objective of medication therapy for OA?

Answer 5

pain relief

Question 6

Pain from OA may result from distention of the synovial capsule caused by what 4 things?

Answer 6

• increased joint fluid
• microfracture
• periosteal irritation
• damage to ligaments, synovium, or the meniscus

Question 7

What are the 3 non-pharmacologic options for OA?

Answer 7

Exercise

Weight loss

Education

Question 8

What med is used initially for pain relief in knee and hip OA?

Answer 8

Acetaminophen

Question 9

Other than Acetaminophen, what other 4 simple analgesics can be used in OA?

Answer 9

Tramadol

Duloxitene

NSAIDs

Narcotics (in selected cases)

Question 10

Tx of OA:

Why is immobilization bad for joint health?

Answer 10

Movement allows nutrients to flow into the cartilage whereas immobilization reduces nutrient supply

Question 11

Pharmacologic tx of OA:

Nonselective NSAIDs for patients at low risk for GI complications; Otherwise, consider addition of what 4 meds?

Answer 11

• misoprostol
• proton pump inhibitor
• H2 antagonist
• COX-2-specific NSAID (coxib)

Question 12

Which two intra-articular injections are alternative first line tx for both knee and hip in OA?

Answer 12

Corticosteroid injections

Hyaluronic acid injections

Question 13

What 2 meds do you give if Acetaminophen fails?

Answer 13

Topical or oral NSAIDs (topical over knee, hands)

Topical Capsaicin

Question 14

OA treatment:

If Acetominophen fails, What medication is recommended for patients older than 75 to decrease the risks of systemic toxicity?

Answer 14

Ketoprofen

Question 15

What 2 meds should you give patients w/ OA if Acetaminophen, topical NSAIDs, Topical Capsaicin and Ketoprofen all fail?

Answer 15

Oral NSAIDs or Celecoxib (COX-2 inhibitor)

(only after careful risk assessment)

Question 16

Duloxetine is primarily effective as ____ therapy for OA

Answer 16

add-on

Question 17

Although Acetaminophen may be modestly less effective than NSAIDs in the tx of OA, a trial is favored in all patients without underlying _____ disease in the tx of knee and hip OA

Answer 17

Without underlying hepatic disease

Question 18

T/F: No NSAID has proven superior to another

Answer 18

True

Question 19

NSAIDs pose a higher risk for what 3 adverse events in comparison to Acetaminophen

Answer 19

GI, Renal, and Cardiovascular events

Question 20

OA tx:

Which 2 meds significantly reduce the occurance of GI adverse events in those taking NSAIDs

Answer 20

PPIs and misoprostol

Question 21

Treatment of OA:

What is the NSAID of choice in patients with high cardiovascular risk?

Answer 21

Naproxen

(non-selective NSAID)

Question 22

Which 2 toxicities are reported for all NSAIDs?

Answer 22

Nephrotoxicity

Hepatotoxicity

Question 23

What are the top 3 ADEs of NSAIDs and how do you monitor?

Answer 23

1. Ulcers or bleeding- monitor w/ CBC
2. liver failure (rare)- monitor w/ hepatic transaminase levels
3. Renal insufficiency, renal failure, hyperkalemia - monitor w/ SrCr

Question 24

When are NSAIDs contraindicated?

Answer 24

renal impairment

Question 25

What are 3 ways you can reduce risk of GI toxicity associated w/ NSAIDs?

Answer 25

1. Use the Nonacetylated salicylates (Choline salicylate and trisalicylate?)
2. COX-2 Selective inhibitors
3. Add Misoprostol or PPI

Question 26

RA is MC in which 2 regions?

Answer 26

Feet and hands

Question 27

OA is MC in what 4 regions?

Answer 27

• neck
• low back
• hips
• knees