Osteoarthritis (Dr. Lewis)

etiology and risk factors of osteoarthritis

obesity

age

gender

occupation

sports

joint injury or surgery

genetics

knee hip and hand are the most important for what

osteoarthritis

family history of OA leads to what

higher risk of developing OA later on in life

diagnosis of osteoarthritis

history, physical history, radiographic findings, labs

general features of osteoarthritis

age >50

morning stiffness (<30 mins)

crepitus

ESR normal

RF negative

less inflammation

popping or clicking sounds of the joints is what (no cartilage)

crepitus

bony enlargements of the middle joints of the fingers is what

Bouchard’s nodes

bony enlargement of the joint closest to fingertip is what

herberden’s nodes

osteoarthritis is progressive (continuous will get worse with time) : t/f

true

autoimmune

inflammatory

age between 30-60

what kind of disease

rheumatoid arthritis

degenerative

results of wear and tear on joints

develops later in life

what kind of disease

osteoarthritis

• variable and depends on joint involved

• if weight bearing joint or spine involvement considered morbidity and disability are possible

• if secondary OA, prognosis depends on underlying cause

• treatment of OA may relieve pain or improve function, but it does not reverse preexisting damage to the joint.

prognosis of osteoarthritis

do we have a medication that prevent progression of OA ?

no

will ESR or CRP be elevated in a patient with OA?

prob not

self efficacy and self management programs is what

strong non pharm for hand, knee, and hip

1st carpometacarpal orthosis is what

non pharm for hand osteoarthritis

weight loss,

tai chi

, cane

is for what

strong non pharm for hip osteoarthritis

weight loss

tai chi

cane

tibiofemoral brace

is what

strong non-pharm for knee osteoarthritis

what is strongly recommended for hand OA

oral NSAIDs

strong recommended for hip OA

oral NSAIDs

intra-articular steroids

strong recommended for knee OA

oral NSAIDs

topical NSAIDs

intra-articular steroids

short to moderate acting NSAIDs are preferred in OA

true

avoid what in patients with asthma who are aspirin intolerant

oral NSAIDs

indomethacin

piroxicam

ibuprofen

naproxen

sulindac

ketoprofen

ketorolac

nonselective NSAIDs

celecoxib is what kind of NSAIDs

selective COX 2 inhibitor

etodolac

nabumetone

meloxicam

diclofenac

partially selective NSAIDs

which NSAIDs is not for patients with sulfa allergy

celecoxib (Celebrex)

nausea, dyspepsia, abdominal pain, flatulence, diarrhea, GI bleeding are adverse effects of what

oral NSAIDs

great risk of what if taking anti platelets, anticoagulant, oral cs, SSRIs, SNRIs, history of GI bleed

GI bleeding with Oral NSAIDs

increase blood pressure, heart failure for what drug

oral NSAIDs

monitor BMP for increase SCr, BUN, K so acute renal failure doesn’t happen in what

• higher risk for patients monitor BMP at baseline and within 3-7 days after initiation of treatment

taking oral NSAIDs

what is the Black box warning for oral NSAIDs

increased risk of serious cardiovascular thrombotic events, MI, stroke

avoid oral NSAIDs in what serum clearance

CrCl: <30

drug induced hepatitis for NSAIDs are what drugs

diclofenac and sulindac are implicated

contraindication for oral NSAIDs is what

coronary artery bypass grapft (CABG)

selective NSAIDs as a class were associated with lower risk of ulcer complications than nonselective NSAIDs naproxen, ibuprofen

• celecoxib> naproxen + ibuprofen

true

risk of serious GI adverse effects higher with naproxen than ibuprofen

• GI risk —> naproxen > ibuprofen

true

partially selective NSAIDs meloxicam and etodolac associated with lower risk of ulcer related complication and symptomatic ulcer vs various nonselective NSAIDs

true

celecoxib and nonselective NSAIDs ibuprofen and diclofenac were associated with an increase risk of CV adverse effects compared with placebo

true

which NSAID is best for patients with high CV risk

naproxen

which NSAID is best for patients with HIGH GI risk

Celebrex

do not use if CrCl< 50 is what combo med

ibuprofen/famotidine

do not use if CrCl <30 is what combo med

vimovo (naproxen/esomeprazole)

advise patients not to use other NSAIDs or ASA if taking what

combo meds

ACR recommends patients on ASA take NSAIDs for OA other than ibuprofen or cox 2 selective as these may block aspirin cardioprotective effects

true

oral DDI with NSAIDs

lithium

warfarin, NOACs, antiplatelets

methotrexate

ACEI

BB

Diuretics

first line for knee OA is what

topical NSAIDs

second line for hand OA is what

topical NSAIDs

what is the best topical NSAIDs (most effective)

diclofenac

should monitor for symptoms of bleeding when used with anti platelets agents or anticoagulants with what; but lower than oral NSAIDs

topical NSAIDs

do not recommend PO and topicals NSAIDs be used together

true

do not shower/rash area for 1 hour after application

wait for at least 10 mins before covering treated area with clothe

diclofenac gel

only approved for knee OA

diclofenac solution

used for pain

do not wear in shower

wash hands

may tape edges if peel off

diclofenac patch

intraarticuar glucocorticoids is used for what

alternative first line for knee and hip OA

can be given with concomitant oral analgesics is what

intraarticular glucocorticoids

no more than every 3 months because it can cause risk for systemic se

intraarticular corticosteroids

what are the intraarticular glucocorticoids

triamcinolone (kenalog)

methylprednisolone (depo-medrol)

what is the 1st and only FDA approved extended release intra-articular therapy for OA

• last line

triamcinolone acetonide ER (zilretta)

what is the second line for hand, knee, hip OA

acetaminophen

lower risk of GI and CV events than oral NSAIDs is what

acetaminophen

prescription products with acetaminophen limit drug content to 325 mg

true

adverse reaction effects with acetaminophen

hepatotoxicity

high doses interact with warfarin

risk of renal failure when combined with NSAIDs

second line for hand, knee, hip OA

• not monotherapy

  • not FDA approved for OA

tramadol

N/V, dizziness, constipation, drowsiness, seizures are adverse effects of what

tramadol

high risk of serotonin syndrome when used with serotonergic meds is what drug

tramadol

if you are stopping tramadol what do you need to do ?

taper off

if CrCl <30 , then what is the dose for tramadol

IR: max 200

ER: do not use

max dose for tramadol is what

400mg (if over 75 years old max dose is 300mg)

addiction, respiratory depression, use with opioids/benzos, neonatal withdrawal syndrome are black boxed warning for what

tramadol

what is the brand name for tramadol

ultram

as adjunctive treatment for hand/knee/hip OA is what drug

duloxetine (Cymbalta)

approved for musculoskeletal pain
* also used for neuropathic pain, MDD, GAD, fibromyalgia

duloxetine (cymbalta)

if CrCl <30 what is the dose for cymbalta

do not use

alternative second line treatment for knee OA

topical capsaicin

may take 2 weeks to see effects

rare cases of severe burns have been reported

what drug?

topical capsaicin

not routinely recommended

• do not appear to provide clinically meaningful improvement in pain

• last line

• limited benefits for patient with knee OA

intraarticular hyaluronic acid

synvics one, monovisc, gel one infection only are what type of drugs

intraarticular hyaluronic acid

primary second line medication for knee and hip OA

• high risk for surgery, who have renal failure, CV disease are what drug

opioid analgesics

n/v, constipation, dry mouth, falls, respiratory depression, tolerance addiction for what drug

opioid analgesics

what are some supplements that can be taken

Glucosamine and chondroitin

allergic to fish what can they not take

glucosamine

what surgery is done for OA

anthroplasty: total joint replacement of knee/hip

20% of patients experience little or no improvement in pain, disability or QOL:

true

what are some supplements that can be taken for OA but not recomeneded

avocado-soybean

boswellia serrata

methylsulfonylmethane

sam-e

what is the most common supplement taken for OA

turmeric/curcumin

what does turmeric act as

may act as blood thinner and cause stomach discomfort

avoid if taking warfarin, other anticoagulants, surgery

what is the supplement that should be avoided with antidepressants medications

SAM-e

which supplement should be avoided if taking warfarin, anticoagulants or surgery

turmeric/Curcumin

progressive disease is what

osteoarthritis

degenerative is what

osteoarthritis

autoimmune is what

rheumatoid arthritis

treatment of OA may relieve pain or improve function, but it does not reverse preexisting damage to the joint

true

ESR and CRP wont be elevated in what

osteoarthritis

foods to avoid during osteoarthritis

sugar, fats, trans fat

what is first line for hand, knee and hip OA

oral NSAIDs

what drug should be avoided in patients with asthma who are aspirin intolerant

NSAIDs

what drug is selective COX 2 inhibitors

celecoxib

which NSAIDs not used in patients with sulfa allergy

celecoxib

what is the max dose for naproxen

660mg