Osteoarthritis (1)

Question 1

Clinical OA

Answer 1

Joint pain/tenderness
Decreased range of motion
Weakness
Joint instability
Disability

Question 2

Osteoarthritis – Prevalence

Answer 2

Vary depending on age, gender, ethnic group, and the specific joint involved
Increasing Age
Women
25% white 20% blacks 11% Asians

Question 3

OA common risk factors

Answer 3

age
weight
gender
occupation/sports
joint injury/surgery
genetic predisposition

Question 4

important preventable risk factor for OA

Answer 4

Weight
strong link to knee OA, also in Hip, hand and wrist OA
due to adverse metabolic and inflammatory effects

Question 5

every five unit increase in BMI

Answer 5

Risk of knee OA increases 35%

Question 6

Occupations

Answer 6

excessive mechanical stress

Question 7

Sports

Answer 7

participation in activities such as wrestling, soccer, weight-lifting, football and hockey – typically pros

Question 8

Trauma

Answer 8

Increases the risk of knee OA over a 10-year period

Question 9

Genetic factors

Answer 9

30% of risk genetically determined
Heberden nodes - 10 times more prevalent in women
Chrom7Q22 locus highly significantly associated with knee OA

Question 10

Articular cartilage

Answer 10

Smooth, white tissue
covers the ends of bones to form joints
Shock absorbency during rapid movements-load support

Question 11

Pathophysiology of OA

Answer 11

Increase in chondrocyte activity to remove and repair the damage
Balance between breakdown and re-synthesis of cartilage is lost

Question 12

Subchondral bone pathologic changes

Answer 12

May happen before, during or after damage to the articular cartilage
Loss of cartilage = joint space narrowing
Leads to brittle, stiffer bones with decreased weight-bearing ability
Development of sclerosis and microfractures

Question 13

Diagnosis of Osteoarthritis (Hip OA)

Answer 13

Pain in the hip + 2 of the following:
Erythrocyte sedimentation rate <20 mm/hr
Joint space narrowing on radiography

Question 14

Diagnosis of Osteoarthritis (Knee OA)

Answer 14

Pain in the knee + osteophytes on radiography + 1 of the following:
Morning stiffness no more than 30 minutes

Question 15

OA Age

Answer 15

Usually occurs in older adults (≥65 years of age)

Question 16

OA Gender

Answer 16

Age <45 years more common in men
Age >45 years more common in women

Question 17

OA Symptoms

Answer 17

Pain - Deep, aching
Pain on motion
Stiffness in affected joints
Resolves with motion, recurs with rest (“gelling phenomenon”)
Duration <30 minutes
Often related to weather
Limited joint motion
May result in limitations of activities of daily living
Instability of weight bearing joints

Question 18

OA Goals of therapy

Answer 18

Treatment may relieve pain or improve function but does not reverse preexisting damage to the joint

Educate the patient, family members and caregivers
Relieve pain and stiffness
Maintain or improve joint mobility
Limit functional impairment
Maintain or improve quality of life

Question 19

OA Non-pharmacologic Treatment

Answer 19

Exercise
Weight loss
Patient Education

Question 20

Exercise

Answer 20

Should be encouraged for all patients with OA

Question 21

Day 1 post surgery exercise

Answer 21

decreased LOS after surgery and less pain

Question 22

Hip and Knee OA first line pharm treatment

Answer 22

Acetaminophen (3-4g/day)
Topical NSAIDs
Intraarticular corticosteroids
tramadol
Oral NSAIDs

Question 23

Hand OA first line pharm treatment

Answer 23

Oral NSAIDs (less than 75 yo)
Topical NSAIDs
Topical capsaicin
tramadol

Question 24

Acetaminophen

Answer 24

First line for HIP and KNEE OA
do not exceed 3-4g

Question 25

Oral NSAIDs

Answer 25

First-line for Hand OA/Second-line for Knee and Hip OA

Question 26

Oral NSAIDs interactions

Answer 26

anticoagulants lithium, oral hypoglycemics, methotrexate ACE inhibitors, β-blockers, and loop diuretics Aspirin’s wait 30 minutes after ASP P450 inducers reduce celecoxib levels Patients receiving warfarin and celecoxib should be followed closely Celecoxib is a sulfonamide severe sulfa allergies

Question 27

Topical diclofenac

Answer 27

Lower Limb: Apply 4 grams of gel to the affected area four times daily Upper Limb: Apply 2 grams of gel to the affected area four times daily Dose measuring cards provided by the manufacturer As effective as oral NSAIDs

Question 28

Intra-articular steroids

Answer 28

Alternative first-line treatment for both Knee and Hip OA when pain control with acetaminophen or NSAIDs is suboptimal no more than once every 3 months

Question 29

Tramadol

Answer 29

Alternative first-line treatment of Knee, Hip and Hand pain due to OA Can be added to partially effective acetaminophen or oral NSAID therapy

Question 30

Topical Capsaicin

Answer 30

Alternative first-line treatment for Hand OA

Question 31

Duloxetine

Answer 31

Alternative second-line treatment of Knee OA ONLY Avoid using with other serotonergic medications including tramadol

Question 32

Glucosamine & Chondroitin

Answer 32

Alternative medication Evidence for efficacy and recommendations regarding use are conflicting

Question 33

Cannabidiol

Answer 33

No good evidence that CBD helps chronic pain

Question 34

OA therapy wrap up

Answer 34

acetaminophen (≤4 g/day)/topical analgesics PRN Consider oral NSAIDs GI Risk? Consider Celecoxib increased risk for cardiovascular, renal events or poor pain control? Consider tramadol, intra-articular corticosteroids or duloxetine