Medical Management of OA

What is diagnosis based off of?

Clinical manifestation without lab testing or radiographs

When can dx be made based off clinical manifestation?

Patient is >45

Persistent usage-related pain in joints

Morning stiffness lasts less than 30 minutes

What is laboratory testing used for?

Rule out RA

What are radiographs used for?

Confirm the dx of OA

• Joint-space narrowing

• subchondral sclerosis

• cysts

• ostephytes

Is there a cure for OA?

NO

Goal of treatment of OA

Decrease pain

Improving/maintaining joint mobility

Nonpharm theapies for OA

Weight Loss

Heat and cold

Aerobic exercise

PT: ROM and muscle-strengthening

Ambulatory devices

Footwear (Lateral-wedged insoles)

OT

Joint protection

Assistive devices

When to use cold

swelling

When to use heat

pain and stiffness

Normal vs Osteoarthritis Bone

Subchondral bone cyst

Thickened capsule

Thickened and inflamed synovium

Worn-down cartilage

Narrowed joint space

Fibrillated cartilage

Osteophyte

Subchondral bone sclerosis

Pharm therapy

Acetaminophen 

Acetaminophen considerations

Do not exceed 4g/day

Hx of liver disease

Pharm tx when refractory to acetaminophen

NSAIDS

NSAID consideration

GI bleeding and ulceration

Renal

Bleeding - not with antiplatelet or anticoagulant

Pharm tx referactory to Acetaminophen and NSADIS

intra-articular injection of corticosteroids or hyaluronans