Treatments for OA Flashcards
What are the risk factors for OA
- genetic predisposition
- hereditary factors
- age
- joint injury previously
- Gender
- joint immobilization
- obesity
- overuse of the joint
- high intensity sport
describe the viscous cycle of OA
- There is altered mechanical loading n the cartilage, bone and ligaments
- this causes proteolytic destruction of cartilage matrix and chondrocyte death
- this leads to remodelling of the bone osteophytes, angiogenesis, and subchondral sclerosis
- there is abnormal synovial fluid and thus reduced viscosity
- leaving to synovial inflammation and angiongesi
- peripheral and central sensitisation and nociceptor activation causing pain
- this leads to a reduced in exercise, muscle weakness which leads to altered mechanical loading of cartilage, ligaments and bone
What are the health outcomes of OA
- Joint destruction
- Severe pain
- loss of joint function
- disability
- social isolation
- depression
- reduced quality of life
What is OA
OA is a metabolically active repair process and causes localised loss of cartilage and remodelling of adjacent bone
- results in varying degrees of functional limitation and a reduction in quality of life
what are the areas that are commonly affected by osteoarthritis
- knees
- Hips
- Small hand joints
- knees and hips as they are weight bearing joints
describe characteristics of OA
- not always caused by ageing
- not always progressive (some people get it worse than others)
What are the Clinical symptoms of OA
- Joint pain (with use)
- morning stiffness lasting less than 30 minutes
- joint instability or buckling
- Loss of function
- Crepitus (creaking or cracking of the joint - marker that cartilage is lost or it is cracked) on motion
What are the clinical signs of OA
- Bony enlargement at affected joints
- limited range of motion
- muscle atrophy/weakness
- Mal-alignment and or joint deformity
- crepitus on motion
What is crepitus a marker for
creaking or cracking of the joint - marker that cartilage is lost or it is cracked
How should you educate someone with OA
- offer accurate verbal and written information
- patient centred
- individualised self management strategies agreed between patient and healthcare professionals
what are some lifestyle changes that people with OA can make
Exercise – swimming
Weight loss if obese
Use of suitable footwear
Walking at an appropriate speed and pacing
describe the OA pyramid of treatment
- every one is given information and advice
- everyone is given self help ideas such as lifestyle changes
- then you have NSAIDs, physiotherapy, occupational therapy
- advanced - non surgical interventions, injections
- surgery - total joint replacement or partial joint replacement
- surgery joint preserving
what is the non pharmacological care that can be given to patients with OA
Exercise – core treatment
- Local muscle strengthening
- General aerobic fitness
- Weight loss
Transcutaneous electrical nerve stimulation (TENS) as an adjunct for pain relief
Aids and devices
- Orthopaedic insoles
- Walking stick
lifestyle changes
diet
Thermotherapy
- use of local heat or cold
Nutriceuticals
- increase intake of omega 3 rich foods
- Chondroitin sulphate and glucosamine supplements – no longer recommended that they should be recommended or approved
what is better then changing just exercise
Exercise and diet
arthritis prevalence increased with
body weight - the more obese you are the higher the chance you have of getting OA
What are the oral analgesics that can be used for OA treatment
- paracetamol and/or topical NSAID
what happens when paracetamol and topic NSAIDS are not ineffective
- give oral NSAID or COX-2 inhibitor
- used at lowest effective dose for shortest possible period
- start with NSAID then go onto the COX-2 inhibitor such as celecoxib
- Co-prescribe with PPI due to the gastric problems caused
name an example of a COX -2 inhibitor
celecoxib
what happens when the oral NSAID and COX-2 inhibitor is not effective
- give intra-articular injections = corticosteroid injections
where does the topical NSAID go
concentrated into the synovial fluid so it gets into the joint where the pain is
when do you refer patients for surgery in OA
- referred when the patent wakes during the night because of the pain
- this shows that they pain stiffness and reduced function have a substantial impact on quality of life
Name some surgery options for OA
Arthroscopic lavage – not used, soemtiems they do it to have a look inside
Arthroscopic lavage plus debridement – normally lavage plus now
Microfracture
Mosiacplasty (osteochondral transplant)
Chondrocyte grafts
Joint replacement
what happens in a Arthroscopic lavage plus debridement
- After they have done an MRI, CT or X ray they still need to look in the joint and see how badly affected the articular cartilage is as these imaging techniques will not tell you this
- then they washout the synovial fluid - put back artificial synovial fluid until it re-establishes
- and debride the surface at the same time - this involves getting rid of any of the loose or damaged edges of the cartilage
describe the benefits
Arthroscopic lavage plus debridement
80-90% of patients who had debridement and washout, pain free at 1 year compared to 14% of patient who just had washout
