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Clinical 2.0 winter > OA > Flashcards

OA Flashcards

1
Q

joints primarily affected

A

hands, hips, knees

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2
Q

primary OA

A

idiopathic

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3
Q

secondary OA

A

due to somethign

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4
Q

protective features of the joint

A

synovial fluid reduces friction
ligaments and tendons allows for the right tension
bone - shock absorbing
cartilage - thin coating at two opposing ends of bones

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5
Q

general pathophys

A

complex interaction of may extra and intracellular molecules
bone turnover favors cartilage destruction

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6
Q

risk factors for osteo

A 
ethnicity 
age
gender (men at first then women)
bone density 
nutritional 
joint injury 
obesity 
occupation 
joint biomechanics
muscle weakness
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7
Q

clinical diagnosis

A

> 45
activity related joint pain
morning stiffness <30min
lab tests only to rule out other causes

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8
Q

symptoms **

A

stiffnes in morning or after periods of inactivity <30min
localized to affected joint
pain worse with activity or prolonged use

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9
Q

signs ***

A

often unilateral
joints not tender or inflamed
joint instability
no systemic symptoms

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10
Q

cause of pain

A

not due to destruction of catilage
from activation of nociceptive nerve endings within the joint by mechanical and chemical irritants
may be due to distension of the synovial capsule

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11
Q

what do we see in xrays

A

narrowing of joint space
osteophytes
bone cysts

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12
Q

when do we do xrays

A

not needed for intial usual presentation of OA or follow up

symptoms dont correlate with image abnormalities

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13
Q

nodes in OA

A

heberden

bouchard

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14
Q

reasons for further evaluation in patient complaining of new onset joint pain

A 
duration > 1week 
recent significant trauma 
fever, infection, rash
injury 
muscle weakness
burning, numbness, tingling
inflammation or stiffness >1hr
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15
Q

goals of therapy***

A

relieve or eliminate pain
improve/restore joint function adn mobility
improve muscel strength to protect the structures
prevent and reduce damage to the joint structures
max quality of life
educate the patient to promote adherence

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16
Q

algorithm for treatment

A
  1. non pharm, topical analgesics
  2. acetaminophen
  3. asses GI and CV risks and choose a nsaid
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17
Q

low GI and CV risk

A

low dose non selective nsaid

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18
Q

low GI and high CV

A

naproxen + gastroprotection

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19
Q

high GI high CV

A

naproxen + gastroprotection +
low dose celecoxib ?
avoid

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20
Q

high GI low CV

A

low dose NSAID + gsatroprotection or low dose celecoxib

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21
Q

high GI and CV factors, previous ulcers, use of oral corticosteroids or anticoagulants (including low dose ASA)

A

low dose celecoxib + gastroprotection

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22
Q

options for hand OA

A

topical capsaicin or nsaids

oral nsaids

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23
Q

options for knee OA

A

acetaminophen
topical and oral nsaids
intraarticular corticosteroids injections
not topical capsaicin

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24
Q

options for hip OA

A

acetaminophen first line
intrarticular corticosteroid injections
oral nsaid
not topical capsaicin

25
Q

non pharms

A 
strength training and aerobic exercise 
weight loss
joint protection 
supportive footwear
assistive devices 
social support 
heat and cold therapy 
massage
surgery
26
Q

acetaminophen dosing

A

325-100mg every 4-6 hrs for 2 weeks

max 4g/day

27
Q

acetaminophen role

A

first line

28
Q

acetaminophen efficacy

A

same as nsaids in mild non inflammatory

less effective in advanced

29
Q

safety of acetaminophen

A

max 3.2g/day in elderly
avoid in >3 drinks per day
warfarin
hepatotoxicity

30
Q

capsaicin dosin

A

apply tid-qid for 3-4 weeks

31
Q

capsaicin role

A

first line in hand

32
Q

capsaicin onset

A

2 weeks to take effect

33
Q

safety of capsaicin

A

tingling, burning, redness

34
Q

topical diclofenac role

A

first line in hand or knee

35
Q

safety of topical diclofenac

A

minimal systemci safety concerns

36
Q

NSAID role

A

alternative for hand if cant toleracte skin reactions or inadequate relief
in knee and hip if fail or contraindication to acetaminophen

37
Q

safety of nsaids

A

nausea, abd pain, diarrhea

ulcer, GI bleed, kidney disease, hepatitis

38
Q

what is considered high CV risk

A

on lose dose ASA

high 10yr CV risk

39
Q

methylprednisone dosing

A

10mg per joint, 20-80 for large

max 3 injection/joint/year

40
Q

IA steroids role

A

alternative first line for knee and hip when pain control with acteaminophen or nsaids suboptimal

41
Q

efficacy of IA

A

superior to placebo in alleviating pain but relatively short duration (4-6 weeks)

42
Q

safety og IA steroids

A

inexpensive, safe, effective

hyperglycemia, edema, increase BP, flushing

43
Q

sodium hyaluronate dosing

A

injection once or weekly for 3-5week

44
Q

role of IA hyluronic aicds

A

not recommended

limited efficacy and serious events

45
Q

IA hyluronic acid safety

A

increased pain, joint swelling, stiffness

pseudogout

46
Q

duloxetine dose

A

60mg daily

47
Q

duloxetine role

A

adjunctive in partial response to first line analgesics

second line in patients with neuropathic pain as well

48
Q

duloxetine efficacy

A

as an add on shown effiacy

reduction of pain occurs in 4 weeks

49
Q

safety of duloxetine

A

nausea, vomit, constipation

CI in liver disease and severe renal impairment

50
Q

tramadol dose

A

25mg AM titrate 25mg to reach 100tid

51
Q

tramadol role

A

alternative first line in knee/hip who failed everything else
can add on to acet or nsaid

52
Q

tramadol efficacy

A

mod improvement as add on

reduction in pain occurs in 4 weeks

53
Q

tramadol safety

A

nausea, vomiting, dizzy, constipation, headache

taper

54
Q

cox 2 inhibitors gastroprotective effects are negated by

A

ASA

55
Q

glucosamine chondroitin efficacy

A

not shown to improve pain control and function

studies that showed any benefit were short duration

56
Q

risk factors for UGI event

A 
>65yo
use of anticoagulants
use of steroids
history of PUD
high dose NSAID
presence of hpylori
57
Q

bottom line for corticosteroids shots

A

reduce pain at 6 weeks but then less and less

long term pain relief uncertain but serious events are very rare

58
Q

adequate trial of duloxetine

A

if min response at 6 weeks probably wont get a beter one

59
Q

monitoring

A 
decrease in pain daily 
pain relief daily 
hepatotoxicity baseline and annual 
blood in vomit or stool 
BP iwithin 1 week of nsaid therapy 
renal function - edema, scr

Clinical 2.0 winter (28 decks)

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