OA Flashcards
Risk Factors
- obesity * biggest
- <45 years men, >45 women
- occupation
- sports (wrestling, soccer, football)
- hx of joint injury or surgery
- genetic predisposition (AA men)
Signs associated w/ OA
- 1 or more joint, asymmetrical
- local tenderness
- limited motion w/ passive/active movement
- bone proliferation or synovitis
Symptoms associated w/ OA
- pain/deep aching
- stiffness in affected joint
- last <30 mins
- weather (cold more symptoms)
- limited joint motion
*common sites= hands, knee, hips
Primary vs Secondary OA
- Primary: most common, no identifiable cause
- Secondary: associated w/ known cause: inflammation, trauma, metabolic/ endocrine disorders
distinguish factors OA vs RA
age: OA >50yrs
onset: OA gradual
joint symptoms: OA localized
joint involvement: OA larger, weight joints
joint stiffness: brief <30
joint pain: OA with use
symmetry: OA unilateral
auto-antibodies: OA absent
nonpharm options OA
- takes longer to achieve efficacy
- patient education
- exercise
- weight loss if overweight (for knee and hip)
-brace/orthoses (knee and hand) - Do not use electrical stimulation
NSAIDS selection, duration, AE
- Selective: Celecoxib and Valdecoxib for less GI and platelet inh
-AE: GI, CV, kidney - lowest dose for shortest duration possible
-Topical: diclofenac (knee, foot, ankle)- 4 grams QID, (hand, wrist, elbow)- 2 grams QID
Counseling points for topical NSAIDs
- Wash hands a/f use
- Avoid contact w/ open wounds
- Avoid touching face directly a/f use
- Less AEs + DDIs due to systemic absorption
Intra-articular corticosteroid injections indication, ae
- For knee and hip
- pain relief a/f 2-3 days last 4-8 weeks; Q3 months at most
-AE: cartilage loss
Intra-articular corticosteroid injections relative CIs
Suspected joint inf
Active skin tissue inf
Unstable coagulopathy
Uncontrolled DM
broken skin at inj site
acetaminophen pearl
dec risk of gi effects than NSAIDs
recommended conditionally in all
Tramadol pearls and who gets it
recommended conditionally in all
- pts who failed APAP or topical NSAID, have CIs to oral NSAIDs, cant do intraartericular injs, or as add on to Apap +/- oral NSAIDs
Duloxetine AE, place in therapy, effect
- AE: n/v, constipation
- Add on or mono therapy
- 4 weeks to see dec pain
Topical Capsaicin which type of OA to avoid
Avoid in hand OA due to inc eye contamination
Topical capsaicin pearls
2 weeks to see effect
available as patch, cream, solution, gel
may see inc in pain acutely then dec
