Saad - Osteoarthritis Part 1 Flashcards
true or false
osteoarthritis is the least common form of arthritis
FALSE - most common
osteoarthritis increases with ___
is the incidence higher in women or men
age
higher in women
the incidence rates of symptomatic hand, hip and knee OA increase rapidly around _______ years of age and level off after age ______
50, 70
true or false
OA is a costly condition for the US
true - because of replacements mainly
true or false
increasing age is a non modifiable risk factor for OA
true
true or false
genetic mutations are a modifiable risk factor in OA
false
non modifiable
true or false
being female is a nonmodifiable risk factor for OA
true
true or false
excess body weight is a modifiable risk factor for OA
true
is repetitive joint use considered a modifiable OA risk factor
yes
___ tear is a risk factor for OA
meniscus
joint _____ is a risk factor for OA
morphology
leg length inequality is a risk factor for OA
how can this be controlled?
by using orthotics
name the 3 joints most affected by OA
knees
hips
distal interphalangeal joints
the diagnosis of OA is made through what 4 things?
history
physical exam
radiographic findings
lab tessting
what is crepitus
cracking sound when the joint is moved
sign of OA
how is stiffness a sign of OA
lasting less than 30 mins in the morning, or after a long period of not moving
true or false
swelling is not a sign of OA
false - it is
true or false
bony hypertrophy is a sign of OA
true
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
in a person with OA, what might the XRAY findings show?
decreased joint space
loss of cartilage
bony spur formation
what is ESR
erythrocyte sedimentation rate
is ESR normal or elevated in OA patients?
NORMAL
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
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
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
4g
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??????
2g
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
GI
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
