What is the pathogenesis of OA?
Degenerative changes that occur in cartilage and the associated bone
What is OA 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
In what population is OA more common?
- Older (85% of patients >75 years old)
- Female
What joints are most commonly affected by OA?
- Distal interphalangeal joint (DIP)
- Hips
- Knees
What are risk factors for OA?
- Increasing age
- Obesity
- Congenital/anatomical defects
- Muscle weakness
- Female gender
- Repetitive stress
- Major joint trauma
- Heredity
How does OA present?
- Pain in joints (worse with activity)
- AM stiffness is BRIEF
- Crepitus
- Asymmetric involvement
- Muscle atrophy
- Herberden’s nodes
- Bouchard’s nodes
- Instability of weight bearing joints
Goals of treatment for OA
- Relief of pain and discomfort
- Maintain function and strength of joint
- Prevent deformities and progressive changes
- Can NOT reverse damage
What is the step-wise treatment for OA?
Step 1: Non-pharmacologic Step 2: Acetaminophen Step 3: NSAIDs Step 4: Opioid analgesics Step 5: Surgery
What are non-pharmacological treatment options for OA?
- Psychological support
- Education
- Rest
- Physical activity/exercise
- Heat/ice
- Physical therapy
- Occupational therapy
- Weight loss
What patients are at an increased risk of nephrotoxicity with NSAIDs?
- CHF
- HTN
- Renal dysfunction
- Dehydration
What is a potential benefit of COX-2 inhibitors?
-Lower incidence of severe GI bleeding
What are potential risks associated with COX-2 inhibitors?
- Increased risk of CV disease
- Increased costs
- Same impact on renal functions and INR
How long do new joints last after surgery?
10-15 years