Osteoarthritis Flashcards
(30 cards)
what is pathogenesis?
- degenerative changes that occur in cartilage (a metabolically dynamic tissue) and
the associated bone - characterized by increased destruction and subsequent proliferation of cartilage
and bone; regenerated articular surfaces do not possess the same qualities and
architecture as the original joint.
what is incidence?
- Observed more commonly in older patients
- almost 85% of patients > 75 years
- F > M
- Joints most commonly affected:
- Distal interphalangeal joint (DIP)
- Hips
- Knees
what is etiology?
what are the risk factors for OA?
- Increasing age
o Obesity
o Congenital/anatomical defects
o Muscle weakness
o Female gender
o Repetitive stress
o Major joint trauma
o Heredity
What are the clinical manifestations/ presentation of OA?
o pain
o pain worse with activity
o AM stiffness is brief (< 1 hour)
o crepitus
o inflammation is observed in more advanced disease / pain at rest
o asymmetric involvement
o muscle atrophy
o no systemic symptoms
o instability of weight bearing joints
o Herberden’s nodes
o Bouchard’s nodes
What are the goals/ desired outcome of therapy?
o Relief of pain and discomfort
o Maintain function and strength of joint
what is the non-pharmacologic treatment of OA?
▪ psychological support
▪ education
▪ rest
▪ physical activity / exercise
▪ heat / ice
▪ PT
▪ OT
▪ weight loss
what are the guidelines for hip/knee OA?
what are the guidelines for hand OA?
what are the monitoring parameters for patients with OA?
- pain (pain at rest)
- joint stability and function
- risk of fall
- ROM
- X-rays
- degree of disability
- weight
- ADRs from medications
- compliance with non-drug
measures - QOL issues
what is the purpose of joint replacement/ resurfacing surgery?
- relieves pain
- restores function to joint
what is the pipeline for medications in clinical trials?
- intra-articular injections
- disease modifying osteoarthritis drugs / biologics
- nerve growth factor blocker
- all-trans retinoic acid
- fibroblast growth factors
Tell me all information related to Menthol/ camphor/ oil of wintergreen (mechanism of action/ adverse effects/ dose/ important notes).
topical counter irritant
* apply sparingly
* dose: aaa tid-qid
* avoid contact with eyes
Tell me all information related to capsaicin cream (mechanism of action/ adverse effects/ dose/ important notes).
mechanism of action: depletes substance p
* dose: aaa tid-qid
* wait 2 - 4 weeks to evaluate maximum effect
* educate patient about proper application procedures
* adverse effects: burning, stinging, and redness (leaves with continued use)
Tell me all information related to diclofenac gel (mechanism of action/ adverse effects/ dose/ important notes).
mechanism of action: local inhibition of COX-2 enzymes
* dose: 2-4g aa qid (16g max; 32g/body daily)
* not recommended in combination with systemic NSAID therapy
* adverse effects: pruritus, burning, pain, and rash
Tell me all information related to diclofenac solution (mechanism of action/ adverse effects/ dose/ important notes).
- knee only
- dose: 40drops to each knee qid (10 drops at a time
–> two pumps (40mg) bid - adverse effect: local reaction
Tell me all information related to tylenol (mechanism of action/ adverse effects/ dose/ important notes).
- mechanism of action: inhibits synthesis of prostaglandins
- dose: 1g q6h
- Maximum dose per day: 3-4g per day
- Patients at risk for hepatotoxicity:
– heavy alcohol intake
– pre-existing liver condition
Tell me all information related to NSAIDs (mechanism of action/ adverse effects/ dose/ important notes).
- mechanism of action: blocks prostaglandin synthesis by inhibition of COX enzymes
- selection based on: cost, side effects, dosing convenience, other medical conditions,
other medications, risk of bleeding, risk of PUD - dosing: analgesic dose vs. anti-inflammatory dose
–> naproxen 200 or 440mg q8-12h - 1-2 week trial for pain and 2-4 week trial if inflammation exists
Tell me all information related to tramadol (mechanism of action/ adverse effects/ dose/ important notes).
mechanism of action: affinity for µ receptor; inhibits norepinephrine and serotonin
* dose: 25-50mg q4-6 (titrate to 200-300mg/day)
* adverse effects/precautions: nausea, vomiting, dizziness, constipation
Tell me all information related to duloxetine (mechanism of action/ adverse effects/ dose/ important notes).
adjunct to first line
* appropriate for neuropathic and musculoskeletal pain
* dose: 30mg/d day for 1 wk; max 60mg
* avoid with tramadol
* adverse effects: gi – nausea, vomiting, constipation
Tell me all information related to glucosamine/ chondroitin (mechanism of action/ adverse effects/ dose/ important notes).
mechanism of action: stimulate proteoglycan synthesis from articular cartilage
* dose: 500mg tid (glucosamine); 400mg tid (chondroitin)
* slow onset
* adverse effects: gas, bloating, cramping, nausea, inc. bleeding with glucosamine
* concern about standardization of products
* some concern about use in patients with DM, HTN, hyperlipidemias due to increased
insulin resistance
Tell me all information related to intra-articular corticosteroid injections (mechanism of action/ adverse effects/ dose/ important notes).
- only used for isolated joints
- no more often than every 4-6 months
- peak pain relief in 7-10 days
Tell me all information related to hyaluronate injections (mechanism of action/ adverse effects/ dose/ important notes).
- mechanism of action: temporarily increase viscosity of joint
- dose: injected once weekly x 3 - 5 weeks into joint (minor swelling)
- maximum benefit in 8-12 weeks
when are opioid analgesics used for OA?
- used PRN for breakthrough pain
- watch total dose of APAP very closely
- dosing: start low and go slow; use SR or IR
- adverse effects/precautions: nausea, constipation, dizziness, somnolence
