Flashcards in Osteoarthritis Deck (19):
what ratio of people over 65 suffer with osteoarthritis.
1 in 8
What are the 2 distinctive features of osteoarthritis?
-degenration of cartilage
-reparation of bone
is osteoarthritis metabolically active?
Describe the degenerative process of osteoarthritis?
During inflammation there is a rise in the concentration of Interleukin-1, this cytokine then causes the production of other chemicals such as NO production, PG synthesis and causes synovial cells + chondrocytes to produce Matrix MetalloProteinases this substances are involved in cartilage degeneration. Once degenerated the cartilage surface undergoes structural failure and begins to uptake water, water uptake causes the cartilage to swell and split which forms fissures and fragmentation of cartilage this results in narrowing of joint space and formation of cysts in bone!
Describe the reparative process of osteoarthritis?
Increased osteoblast activity results in the formation of new bone at the periphery of the joint a process known as lipping and the bony outgrowth is known as osteophytes.
Describe primary osteoarthritis?
-no known precipitating factors
-may be hereditary
-more common in postmenopausal women
Describe secondary arthritis?
-Trauma and or mechanical problems
-could be caused by obesity or occupational hazards.
How is osteoarthritis diagnosis achieved?
-No lab or diagnostic tests
-ACR clinical classification criteria.
What are the clinical features of NSAIDs
1)mono- or polyarticular pain with characteristic distribution patterns: (obese women with bilaterally affected knees + middle-aged men with one hip)
2)pain is usually localised, aggravated by motion and relieved by rest
3)patients stiffen after sitting or rest: a process known as gelling.
4)Joints are tender with a loss of full range of movement.
5)Joints are unstable particularly sideways movement of the knee.
6)Bony enlargements occur but heat and swelling are absent.
describe osteoarthritis disease management in terms of:
2)the disease management categories
-minimising disability and handicap
-reducing risk of disease progression
-specific drugs and physical therapy
-surgical treatment of advanced disease
what are the major classes of drug used to treat osteoarthritis?
-simple and compound analgesics
-NSAIDs: oral and topical
list the analgesics used in osteoarthritis treatment
-single use products
*low dose products
*Full dose products
Discuss paracetamols role in osteoarthritis treatment based on recent findings?
lancet meta analysis 2016:
-paracetamol does not meet the minimum standard of clinical effectiveness in reducing pain or improving physical function in patients with knee and hip osteoarthritis
-no role in the treatment of patients with osteoarthritis irrespective of dose
discuss the use of NSAIDs for treatment of osteoarthritis?
-most effective short term pain relief
-exerts anti-inflammatory effect which:
*decreases gel phenomenon
*less painful joint function after activities
*faster recovery from joint pain after activities
-co prescribed with a PPI
When prescribing NSAIDs one should?
-Use lowest dose for shortest possible duration
-Co-prescribed a PPI
Explain NSAID selection progress
analgesic effect within a week
anti-inflammatory effect within 3 weeks
if no effect after 3 weeks select another NSAID of different chemical class
What are the factors affecting the choice of NSAID
-previously prescribed drugs
Discuss the use of topical NSAIDs for treatment of osteoarthritis
provides NSAID- mediated benefit with minimum side effects. e.g.ibuprofen,diclofenac and ketoprofen.
Consider for pain relief in addition to core treatment for people with hand or knee osteoarthritis
generally well tolerated
Capsaicin cream 0.025% - considered as an adjunct to core treatment for knee or hand osteoarthritis.