Osteoarthritis

This lecture by Dr. Alison Walton occurred on Thursday, Notvember 4th.

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Study Materials
Required reading: Handouts: Panopto:
 * Buys LM, Elliott ME. Osteoarthritis. In DiPiro JP, et al, eds. Pharmacotherapy, A Pathophysiologic Approach, 7th ed. New York, 2008: 1519-1537
 * American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Recommendations for the medical management of osteoarthritis of the hip and knee. Arthritis Rheum. 2000;43(9):1905-1915.
 * Lanza FL, Chan FK, Eamonn MM, et al. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol. 2009;104:728-738.
 * November 4th Panopto

Explain the Etiology and pathophysiology of osteoarthritis and recognize the common risk factors
Pathopysiolgy

Normal function of articular cartilage in joint space: Over time, events destabilize the normal cycle of synthesis and degredation involving articular artilage, chondrocytes, extracellular matrix, and subchondral bone.
 * lubrication with motion
 * shock absorbency
 * load support
 * reduce friction
 * Risk factors contribute to loss and/or damage of articular cartilage
 * biochemical, inflammatory, biomechanical, and immunologic factors are also involved.

Clinical Presentation

Symptoms Physical findings
 * Pain localized to affected joint
 * Early disease = pain with motion
 * Late disease = pain at rest
 * Joint stiffness
 * Limited range of motion
 * Crepitus (crackling or grating sound)
 * caused by irregular surfaces of the joint rubbing together
 * monoarticular - in young adult
 * Paurciarticular - in middle aged adults
 * affects large weight bearing joints
 * typically 1-4 joints involved
 * Polyarticular/Generalized OA - in middle aged or elderly adults
 * Most common
 * Affects many joints
 * Usually afflicts middle age adults 50+
 * Joint Involvement (Primarily weight-bearing Joints)
 * Hand
 * Distal Interphalangeal joint = Herberden's node
 * Proximal interphalangeal joint = Bouchard's Node
 * First carpometacarpal joint
 * Knee
 * Hip
 * Foot
 * First metatarsophalangeal joint
 * Cervical and Lumbar Spine
 * Often particularly painful


 * Physical examination of joints
 * Tenderness to palpitation
 * Effusions
 * Crepitus
 * Bony enlargement
 * Decreased range of motion
 * Malalignment
 * Laboratory Tests
 * There is no specific test to confirm the diagnosis of OA
 * Erythrocyte sedimentation rate (ESR) <20mm/hr
 * Rheumatoid factor negative
 * Evaluation of synovial fluid (WBC <2000 cells/mm3)
 * Making sure that the inflammation is mild and localized
 * Radiographic Findings
 * Joint space Narrowing
 * Osteophytes

Common risk factors for osteoarthritis include:

Obesity - the number one preventable risk factor for OA Occupation, Sports, Trauma related stress Genetic factors
 * Strongly associated with hip, knee, and hand OA
 * Often precedes OA and contributes to development
 * Weight loss decreases future risk
 * Activites involving repetitive motion
 * workers exposed to repetitive stress through manual labor
 * Associated with sports injuries or joint trauma (even injuries early in life can increase later risk)
 * There has been some progress in identifying and understanding the contributions of genetic variation
 * opens opportunities for new medications

Recommend appropriate adjunctive and/or nonpharmacologic therapy in patients with osteoarthritis
===For the following drugs, list the brand and generic names, therapetuic uses, usual starting doses, mechanism of action, monitoring parameters, common and or/clinically significant side effects, drug interactions and key points of patient education===

Acetaminophen (Tylenol)

 * Therapeutic use
 * Usual starting doses
 * mechanism of action
 * monitoring parameters
 * common/significant side effects
 * drug interactions
 * key points of patient education

Ibuprofen

 * Therapeutic use
 * Usual starting doses
 * mechanism of action
 * monitoring parameters
 * common/significant side effects
 * drug interactions
 * key points of patient education

Naproxen

 * Therapeutic use
 * Usual starting doses
 * mechanism of action
 * monitoring parameters
 * common/significant side effects
 * drug interactions
 * key points of patient education

Etodolac

 * Therapeutic use
 * Usual starting doses
 * mechanism of action
 * monitoring parameters
 * common/significant side effects
 * drug interactions
 * key points of patient education

Indomethacin

 * Therapeutic use
 * Usual starting doses
 * mechanism of action
 * monitoring parameters
 * common/significant side effects
 * drug interactions
 * key points of patient education

Meloxicam

 * Therapeutic use
 * Usual starting doses
 * mechanism of action
 * monitoring parameters
 * common/significant side effects
 * drug interactions
 * key points of patient education

Nabumetone

 * Therapeutic use
 * Usual starting doses
 * mechanism of action
 * monitoring parameters
 * common/significant side effects
 * drug interactions
 * key points of patient education

Sulindac

 * Therapeutic use
 * Usual starting doses
 * mechanism of action
 * monitoring parameters
 * common/significant side effects
 * drug interactions
 * key points of patient education

Celecoxib

 * Therapeutic use
 * Usual starting doses
 * mechanism of action
 * monitoring parameters
 * common/significant side effects
 * drug interactions
 * key points of patient education

Capsaicin

 * Therapeutic use
 * Usual starting doses
 * mechanism of action
 * monitoring parameters
 * common/significant side effects
 * drug interactions
 * key points of patient education

Diclofenac Gel

 * Therapeutic use
 * Usual starting doses
 * mechanism of action
 * monitoring parameters
 * common/significant side effects
 * drug interactions
 * key points of patient education

Glucosamine/Chondroitin

 * Therapeutic use
 * Usual starting doses
 * mechanism of action
 * monitoring parameters
 * common/significant side effects
 * drug interactions
 * key points of patient education

Sodium Hyaluronate

 * Therapeutic use
 * Usual starting doses
 * mechanism of action
 * monitoring parameters
 * common/significant side effects
 * drug interactions
 * key points of patient education

Tramadol

 * Therapeutic use
 * Usual starting doses
 * mechanism of action
 * monitoring parameters
 * common/significant side effects
 * drug interactions
 * key points of patient education

Flavocoxid

 * Therapeutic use
 * Usual starting doses
 * mechanism of action
 * monitoring parameters
 * common/significant side effects
 * drug interactions
 * key points of patient education

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