Therapeutics - OA 1
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What are the risk factors for OA from most to least associated risk?
- Joint trauma
- Genetic predisposition
Which disease RA or OA is associated with the synovium?
Which disease RA or OA is associated with the cartilage?
What is Creptius ?
Crackling or grating sound with joint movement caused by irregularity of joint surfaces
What are Heberden’s nodes?
Bony swelling(s) in the distal interphalangeal joint(s) caused by formation of osteophytes of the articular cartilage in response to repeated joint trauma
What are Bouchard’s nodes?
- Bony swelling(s) in the proximal interphalangeal joint(s)
- Sign of either OA (more common) or RA (less common)
What is Genu varum?
A physical deformity characterized by outward bowing of the leg in relation to the thigh
What are the Symptoms of OA?
- Pain in affected joints (hands, knees and hips, maybe spine)
- Pain with motion
- Joint stiffness at rest that RESOLVES WITH MOTION
- Usually in the morning may have <30 minute of joint stiffness
What are the Signs of OA?
- Limited range of motion
- Joint enlargement
- Abnormal radiograph
- Joint deformity (late-stage disease)
- Heberden’s nodes
- Bouchard’s nodes
- Genu varum
What are the diagnostic features of hip OA?
- Two of the following three:
- 1) Erythrocyte sedimentation rate (ESR) < 20 mm/h (indicating lack of inflammation)
- 2) Osteophytes on radiography
- 3) Joint space narrowing on radiography
What are the diagnostic features of knee OA?
- Knee pain, osteophytes on radiography, and at least one of the following:
- Age > 50 years
- Morning stiffness < 30 minutes
- Bony enlargement or tenderness
- Palpable warmth
What is the only treatment to actively effect the progression of the OA?
What is the non-pharmacologic treatment of OA?
- Diet and Exercise
- Heat treatment
- Physical/occupational therapy
What type of physical/occupational therapy is recommended for OA?
- Quadricep strengthening
What is the first line therapy for OA pain?
What is the dosing for APAP in treatment of OA?
- 325-650 mg Q4-6h ( Max 4 g in 24 hours)
- SCHEDULED not prn
What is the max dose of APAP if a patient has OA and hepatic disease or chronic alcohol intake?
2 grams/24 hours
What is the MOA for APAP?
Inhibits prostaglandin synthesis by interfering with COX in the central nervous system
What are the AE for APAP in treatment of OA?
- Renal toxicity
- GI bleed
What drug interactions does APAP have?
Food decreases serum concentration of APAP, but it does not decrease ________ of APAP.
Should you take APAP with or without food?
What is the second line drug for OA pain?
What are the AE for NSAIDs in the treatment of OA?
- GI toxicity
- CV toxicity
- HF exacerbation, edema
- Renal toxicity
- Prolong bleeding time
- CNS effects
- Hepatitis (rare)
How can you decrease minor complaints of GI distress for OA?
Take with food or milk
What NSAIDs have a lower risk of GI bleed?
What NSAIDs have high risk of GI bleed?
- SR formulations
What are the risk factors for NSAID induced GI bleed?
Hx of GI bleed, high dose, >70 years, anticoagulation or corticosteroids
Which NSAIDs have a higher risk of CV events?
- COX-2 selective = Celecoxib (> 400 mg/day), Rofecoxib
How do NSAIDs induce kidney damage?
Block vasodilators from afferent renal vessels
How should you monitor NSAIDs in the treatment of OA?
- SCr baseline and in 3-7 days if risk factors are present for renal dysfunction
- Pain control/ADL
What drugs can interact with NSAIDs ?
What would you like to do?
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