OA- Heeter

What is the most important preventable risk factor of OA?

a. occupation

b. prevent joint trama

c. participating in certain sports

d. obesity

What is the most important preventable risk factor of OA?

a. occupation

b. prevent joint trama

c. participating in certain sports

d. obesity

d

Which of the following activities do not increase your risk of OA? SATA

a. football

b. walking

c. jogging

d. squatting heavy objects

b, c

1. Primary OA is caused by:

2. Secondary OA is caused by:

1. no known cause/idiopathic

2. associated with a known cause/other condition

When you start to lose cartilage in your joints, what happens to the joint space?

narrows

True or False: The pain in OA is related to the change in cartilage.

false- assoc w/ irritants in the joint space

In earlier stages of OA, deep aching pain of the joint is with _______.

a. motion

b. rest

a

A patient that has OA is going to complain of experiencing what every morning?

joint stiffness

IMPORTANT: Does OA have asymmetrical or bilateral joint involvement?

asymmetrical

A patient that is suspected to have early mild OA, gets an xray done. What is most likely going to be seen on the scan?

• narrowing of the joint space

• bone hardening (subchondral bone sclerosis)

• bone spurs (marginal osteophytes)

IMPORTANT: Does OA treatment reverse preexisting damage to cartilage?

NO!!!!!!!!!!!

Main symptoms of OA:

• deep, aching pain

  • with motion

• joint stiffness

  • morning stiffness

  • resolves w/ motions

IMPORTANT: What is the only treatment that can delay the progression of OA?

nonpharmacological therapy

Which of the following is not a nonpharmacological therapy of OA?

a. prevent patients from unproven treatments

b. THR

c. diet and exercise

d. bicep strengthening

d

Pharmacologic Therapy is targeted at relief of ___________.

SATA

a. inflammation

b. redness

c. pain

d. prutitus

C only

What is the first line for knee/hip OA?

a. DMARD

b. NSAID

c. APAP

d. Tramadol

c- acetaminophen

For acetaminophen:

• MDD

• dosing requirements (how many g/how many hr)

• MDD= 4g/day

• 1000mg q6hr

IF acetaminophen is contraindicated, I’m 77, and I have knee OA, what is the first line treatment for me?

topical NSAID

Of our alternative first-line treatments for Knee and Hip OA, which has the most potential for abuse and is our last option?

Tramadol

If >75 avoid which alternative first line treatment for knee and hip OA?

Oral NSAIDs

Name the 4 alternative 1st-line agents:

hint- “tito”-

1. T________ __________s

2. I___________ _______________s

3. T____________

4. O_______ __________s

1. Topical NSAIDs

2. Intraarticular Corticosteroids

3. Tramadol

4. Oral NSAIDs

Knee OA treatment:

• 1st line

• alt 1st line

• alt 2nd line

• 1st line- APAP

• alt 1st line- topical NSAID, Intraarticular CS, Tramadol, Oral NSAID

• alt 2nd line- opioids, duloxetine, surgery

Hip OA treatment:

• 1st line

• alt 1st line

• alt 2nd line

• 1st line- APAP

• alt 1st line- Intraarticular CS, Tramadol, Oral NSAID

• alt 2nd line- opioids, surgery

Hand OA treatment >75 years old:

• 1st-line agents

• Alt regimens

• 1st line- topical NSAIDs, topical capsaicin, Tramadol

• Alt- combination therapy of 1st-lines

Hand OA treatment <75 years old:

• 1st-line agents

• Alt regimens

• 1st line- Oral, topical NSAIDS, topical capsaicin, Tramadol

• Alt- combination therapy of 1st lines

Who is at increased risk for GI adverse effects of OA treatment?

• elderly

• history of bleeding

• multiple NSAID use

• use of anticoags or corticosteroids

4 things to reduce risk of GI Adverse effects of OA treatments:

1. take lowest possible dose/ and only when needed

2. misoprostol

3. PPI or H2 receptor antagonist

4. COX-2 selective inhibitor

Answer the following about Misoprostol

• contraindication in

• dosing frequency

• ADRs

• Pregnancy (can cause abortion)

• 4 times daily w/ food

• diarrhea, abdominal pain

Example of H2- receptor antagonist:

Famotidine

3 Examples of PPIs:

• omeprazole

• esomeprazole

• pantoprazole

(all end in -prazole)

A COX-2 selective inhibitor reduces GI side effects, but has increased risk of _____ effects.

CV (thrombosis, stroke, MI)

If you have to use an oral NSAID for OA, what is the preferred one because studies suggest it might have lower CV risks?

naproxen

First line therapy for a 77-year-old patient presenting with mild OA of the hand is:

a. celecoxib tablet

b. Diclofenac gel

c. ibuprofen infusion

d. APAP tablet

b

Capsaicin counseling points:

• must be used regularly to be effective

• may take up to 2 weeks to see effects

• wash hands after use

Example of topical NSAID used for OA pain:

diclofenac gel

Diclofenac gel dosing requirements:

• 4 times daily

• 4gm for lower extremities

• 2gm for upper extremities

• dosing card allows for accurate measurements

Is glucosamine/chondroitin typically used for OA pain?

NO! (It’s safe but don’t use, no efficacy proven)

2 Steroids usually used in intraarticular injections:

• triamcinolone

• methylprednisolone

Are oral steroids recommended for use in OA?

Are topical steroids recommended for use in OA?

NO!!!! NOOO!!!!

What is the limit of steroid injections that a patient with OA can receive a year?

3-4 per year

Are hyaluronate injections recommended for second-line alt treatment of hip/knee OA?

NOOOOO

Duloxetine can be beneficial as a 2nd-line alternative treatment for:

• which OA (mainly)?

• what type of symptoms?

• knee OA

• neuropathic pain