Module 1 Flashcards
Osteoarthritis (OA), also known as
degenerative joint disease (DJD) or “wear and tear” arthritis, is the most common articular disease in adults older than age 45. It is the most widespread form of arthritis and is a significant cause of functional impairment, chronic pain, and disability in the older population.
OA risk factors
In addition to age, risk factors include genetics, female sex, joint injury, past trauma, advancing age, obesity, and mechanical stress
Principal sites for OA are
the distal interphalangeal (DIP) joints, the proximal interphalangeal (PIP) joints, and the carpometacarpal (CMC) joint of the thumb in the hand; the first metatarsophalangeal or great toe joint; and the hips, knees, and cervical and lumbar spine.
OA symptoms
Osteoarthritis affects the distal interphalangeal joints (Heberden’s nodes) and PIP joints (Bouchard’s nodes) and presents with swelling, stiffness, pain, and deformity.
RA symptoms
usually presents as bilateral pain, swelling, and stiffness of the metacarpophalangeal and PIP joints with characteristic deformities and spares the DIP joints. Generally, other systemic complaints will occur, and joints other than just those in the hand will be affected as well
OA subjective presentation
slowly developing, localized gradual pain in affected joints
early morning stiffness which subsides after 30 mins “gel phenemenon”
OA objective presentation
minimal or no swelling of affected joints
tenderness on direct palpation
reduced passive/active ROM
crepitus
often asymmetrical
OA DI
Primarily clinical dx
Can use plain XR to r/o other condition- may reveal bony cysts, sclerosis, asymmetrical joint space narrowing
OA tx focus
Control pain
Manage symptoms
Maximize functional independence/mobility
minimize disability
core tx for all OA pts
land based exercise
strength training
weight management
water based exercise
self management
education
non pharm OA tx
Education
weight loss
physical therapy, OT
heat, ice, US
accupuncture, supplements
OA hand pharm tx
*Topical capsaicin
*Topical NSAIDs
*Oral NSAIDs
*Tramadol
knee OA pharm tx
*Acetaminophen
*Oral NSAIDs
*Topical NSAIDs
*Tramadol
*Intra-articular corticosteroid injections
hip OA pharm tx
*Obesity management (moderate evidence)
*Nonnarcotic management (strong evidence): oral NSAIDs improve short-term pain function
*Physical therapy (strong evidence)
*Intra-articular corticosteroid injections (strong evidence)
*Mental health disorder (moderate evidence): management of depression, anxiety, and psychosis impact pain relief, function, and ADL
tramadol contra
etoh, hypnotics, other narcotics, SSRI
steroid injection OA
knee, hip if under fluro
lidocaine typically mixed with steroid
rest joint x1 day, limit activity for 2-3 days
no more than 3-4/yr
can accelerate joint deterioration, increase risk of avascular necrosis
OA most affective sx intervention
total joint replacement
Osteoporosis is a
generalized skeletal disorder characterized by normal bone mineralization but low bone mass (bone mineral density [BMD]) and disruption of the bony architecture, both of which result in an increased risk of fractures
osteoporosis clinical manifestations
vertebral, hip fractures
osteomalacia
, which denotes a decrease in actual bone mineralization
of women older than 50 in USA who will experience hip, spine, wrist fracture
4 in 10
Women have a two to four times greater lifetime risk of sustaining an osteoporotic fracture than men do because
of the loss of BMD following the cessation of ovarian estrogen production at menopause
most rapid bone loss women age
decade after menopause
risk for repeat fracture if already had one
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