OA

Question 1

What is Osteoarthritis?

Answer 1

(Degenerative Joint Disease) Non-inflammatory disorder primarily observed in weight-bearing joints

• Loss of articular cartilage with formation of bony spurs
• Unilateral presentation (asymmetric)
• Reported evening pain

Question 2

What are risk factors of OA? (7)

Answer 2

• Age (positive correlation)
• Gender (2:1 older women to older men at knee and hand)
• Obesity (INC body weight strongly associated with OA)
• Activities (daily repetitive use, trauma)
• Genetics (certain types of OA have predisposed alteration in cartilage matrix)
• Race (2X likely Knee OA in African-American women)
• OSTEOPOROSIS (inverse relationship between bone density and OA; less dense = better distributed load across joint)

Question 3

What are the major functions of cartilage?

Answer 3

• Enable movement within required ROM
• Distribute loading across joint tissues (prevent damage)
• Stabilized joint during use

Question 4

What is the pathophysiology of OA?

Answer 4

• Damage to collagen fiber network
• DEC collagen interaction leads to loss of cartilage, bony growth, severe pain
• End phase: joint failure
• Two Types: Primary OA and Secondary OA

Question 5

What is Primary OA?

Answer 5

(idiopathic) failure of the cartilage in the absence of any known underlying predisposing factor

Question 6

What is Secondary OA?

Answer 6

Occurs due to other disease states/trauma (e.g. metabolic, endocrine, congenital)

Question 7

What is Non-drug TX for OA? (5)

Answer 7

• Rest PT
• ROM
• Muscle Strengthening
• Assistive devices
• Diet-weight loss

Question 8

What is the goal of drug TX for OA?

Answer 8

To relieve pain and inflammation (DOES NOT PREVENT PROGRESSION OF DISEASE)

Question 9

What analgesics are utilized in TX OA?

Answer 9

• Acetaminophen
• NSAIDs
• Topical capsaicin
• Glucosamine
• Chrondroitin Sulfate
• Intra-articular injections
  
  • Corticosteriods
  • Viscosupplementation
• Opiates
• Tramadol

Question 10

How does Topical Capsaicin function?

Answer 10

Inhibits release of Substance P in peripheral nerves (reduces pain in periarticular structures – REMEMBER: Substance P not found in cartilage)

Question 11

What are ADRs observed with Topical Capsaicin?

Answer 11

Initial Application: burning and stinging (subsided with continued use)

Question 12

How is Glucosamine prepared?

Answer 12

From shells of crab and other crustaceans (substrate for the production of articular cartilage – glycosaminoglycans)

Question 13

How is Chondroitin sulfate prepared?

Answer 13

From bovine/porcine cartilage sources (Mucopolysaccharides used in synthesis of cartilage)

Question 14

What are corticosteroids (2) utilized in short-term TX OA?

Answer 14

• Triamcinolone acetonide
• Methylprednisolone

Question 15

What limitation, if any, exist TX OA with corticosteroids?

Answer 15

• MAX 3-4 injections per year (more frequent TX could precipitate progressive cartilage damage
• Oral corticosteriods NOT recommended in OA

Question 16

How does Hyaluronic Acid function?

Answer 16

• Naturally-occurring glycosaminoglycan (assist in production of articular cartilage)
• Intraarticular injection (acts as viscous lubricant – may reduce need for NSAIDs)

Question 17

What are recommendations for Hand OA?

Answer 17

• Use one or more of the following:
  
  • Topical capsaicin
  • Topical NSAIDs (preferred for patients ≥75Y/O)
  • Oral NSAIDs (COX-2 inhibitors)
• DO NOT USE
  
  • Intra-articular injections
  • Opiate analgesics

Question 18

What are recommendations for Hip OA?

Answer 18

• Recommend one of the following:
  
  • APAP
  • Oral NSAIDs
  • Tramadol
  • Intra-articular injections (corticosteroids)
• DO NOT USE:
  
  • Glucosamine/Chondroitin

Question 19

What are recommendations for Knee OA?

Answer 19

• Recommend one of the following:
  
  • APAP
  • Oral NSAIDs
  • Topical NSAIDs
  • Tramadol
  • Intraarticular injections (corticosteroids)
• DO NOT USE:
  
  • Glucosamine/Chondroitin
  • Topical Capsaicin