Saad - Osteoarthritis Part 1 Flashcards by amanda kastel

true or false

osteoarthritis is the least common form of arthritis

FALSE - most common

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osteoarthritis increases with ___

is the incidence higher in women or men

age
higher in women

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the incidence rates of symptomatic hand, hip and knee OA increase rapidly around _______ years of age and level off after age ______

50, 70

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true or false

OA is a costly condition for the US

true - because of replacements mainly

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true or false

increasing age is a non modifiable risk factor for OA

true

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true or false

genetic mutations are a modifiable risk factor in OA

false

non modifiable

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true or false

being female is a nonmodifiable risk factor for OA

true

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true or false

excess body weight is a modifiable risk factor for OA

true

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is repetitive joint use considered a modifiable OA risk factor

yes

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___ tear is a risk factor for OA

meniscus

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joint _____ is a risk factor for OA

morphology

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leg length inequality is a risk factor for OA
how can this be controlled?

by using orthotics

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name the 3 joints most affected by OA

knees
hips
distal interphalangeal joints

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the diagnosis of OA is made through what 4 things?

history
physical exam
radiographic findings
lab tessting

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what is crepitus

cracking sound when the joint is moved

sign of OA

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how is stiffness a sign of OA

lasting less than 30 mins in the morning, or after a long period of not moving

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true or false

swelling is not a sign of OA

false - it is

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true or false

bony hypertrophy is a sign of OA

true

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state if bilateral or unilateral is more common for the following joints:

knee
hip
hand

knee - bilateral more common
hip - unilateral more common
hand - usually more severe in dominant hand

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in a person with OA, what might the XRAY findings show?

decreased joint space
loss of cartilage
bony spur formation

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what is ESR

erythrocyte sedimentation rate

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is ESR normal or elevated in OA patients?

NORMAL

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just by looking at a patient’s hand, how can you determine if they have OA and why

nodes form around the joints
because of the loss of space between the joints

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what are heberden’s and bouchard’s nodes

heberdens node – most distal joint node on finger

bouchards node - joint node proximal to the heberden node

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what are osteophytes

bone spurs that form in OA patients

what is osteosclerosis

abnormal hardening of bone - present in hip OA patients

explain how the etiology of OA used to be viewed vs the modern approach to etiology

previously - joint disease with articular cartilage loss -- less emphasis on repair process now - disease is due to FAILED CARTILAGE REPAIR -- why is it not repairing itself?

how sets out the osteoarthritis treatment guidelines in America

the American College of Rheumatology (ACR)

when was the most recent OA american college of rheumatology guideline published

2019/2020

according to ACR, what are the goals of treating OA

to relieve pain and inflammation and improve function of the joint, as well as quality of life and independence of the patient (Ultimate goal)

true or false the ACR put out nonpharmacologic interventions for treating OA

true

how is weight loss considered at non pharmacologic intervention for treating OA

because you're putting less strain on the joint

how is exercise a nonpharmacologic treatment for OA

because youre keeping the strength in muscles/bones/joints

can a cane help in OA patients?

yes, it's a non pharm intervention you're putting less pressure on the joint

thermal interventions are a nonpharm treatment for OA if the area is inflamed and swollen would it be best to use hot or cold compress

cold

name 3 categories of pharmacologic management of OA, published by ACR

drugs surgery new modaliteis

how can surgery be a pharmcologic measure in OA patients

by either cleaning out the joint or replacing it

name 2 new modalities used in OA patients

stem cell therapy platelet rich plasma stimulate joint to repair itself

what drug is strongly recommended for all 3: hand, knee, hip

oral NSAIDS

for which is topical NSAIDS STRONGLY recommended: hand, hip, knee? justify

knee hand - not convenient to have gel on your hand hip - it's a deep joint. the gel will probably not get to the site or action - no recommendation

for which is(are) IA glucorticoid injections strongly recommended? hand/hip/knee

hip and knee

is acetaminophen strongly recommended for all (hand/hip/knee) OA?

NO conditionally Oral NSAIDS are all strongly recommended

what category of recommendations do opioids fall into and why? (not tramadol)

conditionally recommended against - they have high abuse potential and OA is chronic - not good to keep them on forever

true or false DMARDS used in RA patients have NO place in OA patients

TRUE - it's not an autoimmune disease

true or false biologics, methotrexate, and hydroxychloroquine are strongly recommended against in OA patients

true

how can acetaminophen be used in OA? is it recommended?

conditionally recommended --in case of patients who have intolerance or contraindication to NSAIDS for short term/PRN use

patients who receive acetaminophen on a regular basis should be undergoing what?

regular monitoring for hepatotoxicity (liver)

state the max daily dose for acetaminophen for extra strength tabs (500mg) and regular strength (325mg)

X strength - 3000mg (3g) reg - 3250mg

compare the efficacies for treating OA pain for ibuprofen vs acetaminophen

for mild-moderate pain - both are comparable for severe pain - ibuprofen better

what is the PRESCRIPTION max daily dose of acetaminophen

acetaminophen is used with caution in which patients? in which patients is it avoided?

used in caution - pts with liver disease avoided - chronic alcohol abuser

who is considered a chronic alcohol abuser

someone who has greater than 3 drinks a day

what is the max dose of acetaminophen in ETHANOL DRINKERS or those with liver disease??????

true or false if used at equivalent doses, ALL NSAIDS are equally effective for treating OA pain

true

what are some safety concerns with NSAIDS

they inhibit COX1 -- responsible for producing GI protective prostaglandins can cause stomach ulceration

TRUE OR FALSE COX1 inhibitors are easier on the stomach than COX2 inhibitors

FALSE- other way aorund however, COX2 inhibitors have concern because blocking PGI2 formation -- clot concern

what is the recommended dosing for NSAIDS to treat osteoarthritis pain

use lowest effective dose if synovitis - start at mod-high dose

name a non acidic NSAIDS

nabumetone

if someone has an allergy to an NSAID, can we give them an NSAID but in a different class? ie: allergic to an oxicam, can we give a propionic acid

there can still be cross reactivity, but we can possibly try it

the main concern with NSAIDS is _____ toxicity

name some adverse events of NSAIDS and how to prevent (not serious toxicities)

nausea dyspepsia abdominal pain flatulence diarrhea TAKE WITH FOOD OR MILK

name some SERIOUS NSAID toxicities

gastric and duodenal ulcers, and gastric perforation (bleeding) as a complication

what are some signs and symptoms of an ulcer/perforation

blood in stool, dizziness, fatigue, hemoglobin drop, dyspepsia

as mentioned, a serious toxicity of NSAIDS is gastric and duodenal ulcers how can this be prevented

by taking another drug to provide protection, such as misoprostol or a PPI

which are better at protecting the GI and giving with an NSAID - PPI or H2 antagonist

PPI

as mentioned, misoprostol can be given with an NSAID to reduce the risk of bleeding what is the issue with this

it can give diarrhea

true or false if an OA patient has a history of GI issues, they should stay away from NSAIDS

true

name some risk factors for having a GI complication when taking NSAIDS

greater than 65 y/o previous GI issue using steroids at same time taking oral platelets/anticoag upper GI comorbidities smoking and alc use H. pylori infection - can cause ulceration in itself

how does taking anti platelets/anticoags with NSAIDS increase the risk of GI complications

additive effect these drugs make the blood flow better by themselves

true or false CV disease is a risk factor for having NSAID GI complications

true