Osteoarthritis Study Materials: A Comprehensive Overview of Treatment Goals, Risk Factors, and Management Strategies

Major types

Primary

-idiopathic

-multiple joints

Secondary

-traumatic injury or congenital diseases

-single joint

Non-modifiable risk factors

-older than 70 (concern older than 40)

-Female more at risk

-Genetics

-History of trauma

Modifiable risk factors

-weight (10% increase each kg of IBW)

-occupation

-high impact athletic activities

-sedentary lifestyle

Key signs and symptoms

-pain with use

-a joint randomly gives

-stiffness upon walking or periods of inactivity

-crepitus

-restricted movement

-bony enlargement

OA

-inflammation

-onset

-systemic symptoms

-little if any

-develops over time

-none

Goals of Treatment

-improve function and motility

-improves range of motion

-reduce stiffness

-decrease pain

-improve quality of life

-reduce need for elective surgery

Non-pharm treatment for hand

-exercise

-hand brace

-heat

Non-pharm treatment for hip

-exercise/weight loss

-cane/walker

-heat

non-pharm treatment for knee

-exercise/weight loss

-cane/walker

-brace

-heat

When is weight loss recommended? What is associated with disease progression?

-BMI>25

-weak/deteriorating muscles

(improve muscle strength)

Suggested Pharm Options

-acetaminophen

-NSAIDs

-tramadol

-IA steroids

-duloxetine

-capsaicin

-chondroitin

Acetaminophen Points

-4 gram daily

-mild benefit of hip and knee

-caution with max dose and other products

Topical NSAIDs

-why recommended?

-where to use

-main products

-preferred in >75 years old

-superficial joints (avoid hips, shoulders and back/neck)

-diclofenac 1% gel

-trolamine salicylate 10% cream

Diclofenac Gel

-Brand name

-Directions (with max)

-Contraindicated

-Voltaren

-4 times daily (2 gram above waist and 4 gram below)

-Do not use in peri-operative pain in CABG surgery

Trolamine Salicylate

-Brand name

-Directions

-Contraindication

-Aspercreme

-Apply 3-4 times daily

-Do not use history of allergy to salicylate

Topical Capsaicin

-Where to use

-MOA

-Directions

-only use on knee

-initial burning but prolonged exposure results in decreased receptor function

-TRPV1 agonist

-effect seen in 2-4 weeks

Educational points of topical capsaicin

-do not wrap area

-do not apply heat

Systemic NSAIDs points

-use for hand, hip or knee

-pain relief in hours but inflammatory 2-3 weeks