W32 Osteoarthritis And Rheumatoid Arthritis Flashcards
What are the medicines used for Osteoarthritis and Rheumatoid arthritis?
- Paracetamol
• NSAIDs
• Ibuprofen, Naproxen, or Diclofenac, or a Coxib (such as Celecoxib or Etoricoxib)
• Opioids
• Glucocorticoids
-Prednisolone, methylprednisolone and triamcinolone
• Conventional Disease Modifying Anti-Rheumatic Drugs (cDMARDs)
-Methotrexate, Leflunomide, Sulfasalazine, Hydroxychloroquine
• Tumor Necrosis Factor Alpha (TNFα) Inhibitors
• Biological Disease Modifying Anti-Rheumatic Drugs (bDMARDs)
What is Arthritis?
● ‘inflammation of joint‘
● In common terms, arthritis is used to describe one of two conditions affecting joints:
o Osteoarthritis
-Common, slowly progressive deterioration in joints
o Rheumatoid arthritis
-An autoimmune disease of the joints
What is osteoarthritis?
• OA is the most common cause of arthritis, the most common disease of synovial joints, and is a major cause of disability.
• Age-related, progressive disorder
• Commonly affects weight bearing joints
• Knees, hips, spine, (hands)
• Characterized by:
• Progressive deterioration and loss of articular cartilage
• Pain and limitation of motion
• Progressive disability
• Inflammation may or may not be present
• Joint pain often eased by rest
• Pain worsens at end of the day
Diagnostics of Osteoarthritis:
What are the OA risk factors? (6)
- Age
- Obesity
- Injury
- Occupational overuse
- Female gender
- Family history
Which joints are affected in OA?
Any joint can be affected by OA
Joints most affected:
- Neck, lower back, hips, base of thumb, ends of fingers, knees, base of big toe
What are the treatment goals in osteoarthritis? (4)
- relieve pain;
- maintain mobility and function;
- prevent further joint damage;
- improve the patient’s mental health and quality of life
=Minimise impact on ADL & QoL
What is the management of Osteoarthritis?
- Patient education and counselling
- Physical therapies
- Physiotherapy and occupational therapy
- Correction of exacerbating factors
- Pharmacotherapy
- Simple analgesic (Paracetamol, Aspirin)
- NSAIDs (Topical vs systemic)
Non-pharmacologic approaches in OA?
- Weight loss - critical
- Physiotherapy, exercise programs,
-Strengthen supporting muscles - Massage, hot or cold packs (?acupuncture)
- Devices and aids (e.g., walking sticks)
- Surgery (e.g., joint debridement or joint replacement,)
-30% of patients - Not effective: Magnets & copper bracelets
Pharmacologic management – General principles in OA? (goals)
- Relieve symptoms (pain and stiffness)
- Improve joint function
- OA mainly affects older people
-co-existing conditions
-use conservative approach - Individualise therapy based on stage and severity of disability
Medication options for OA?
- Paracetamol
- Topical preparations
- Opioids
- NSAIDs
- Intra-articular corticosteroids
- Intra-articular hylans
-For knee (not usually recommended) - Anti-depressant
- Glucosamine & Chondroitin
Summary of OA management
Simple analgesics
* (e.g., Paracetamol)
Topical or oral NSAIDs PRN
* Consider topical capsaicin
Higher dose NSAIDs (plus Paracetamol) or Opioids (plus Paracetamol)
Corticosteroids (in severely affected joint that is inflamed)
* Intra-articular corticosteroid injection
Antidepressants (to alleviate depression associated with chronic pain and improve analgesic response)
Rheumatoid Arthritis (RA)
A joint affected by rheumatoid arthritis has what features? (3)
Osteoarthritis? (2)
- Inflamed synovium spreading across joint surface
- Thinning of cartilage
- Erosion into corner of bone
- Thinned cartilage
- Bone ends rub together
Short description of RA?
- RA – a chronic, progressive, inflammatory, systemic disease that primarily affects synovial joints.
- In the UK, about 1% of the population is affected.
- RA is 2–4 times **more common in women than in men
- Approximately one–third of people stop work because of RA within 2 years of its onset and this increases thereafter.
Immunopathology of RA?
➢Inflammation is the hallmark of active RA
➢ Activation of T cells by macrophages and unidentified antigens cause cytokine
release.
➢ Cytokines are also produced by synovial fibroblasts.
➢Primary problem is inflammation of the synovium – if uncontrolled –> bone erosions and structural damage to the joints
➢TNFa and IL-1, IL-2, IL-4 and IL-8 are important in the initiation and maintenance of inflammation and cartilage and bone damage and synovitis.
Clinical presentation of RA?– usually symmetrical
*Stiffness
*Usually, ~1 hour in the morning
*Swelling
*Tissue around joint may feel soft and spongy
*Red and warm
*Loss of function
*(e.g., grip strength)
*Systemic manifestations
*Eyes, lungs, heart, nerves….
*Often initial presentation is nonspecific inflammation
*Fever, malaise, weakness etc.
