Which body parts does OA most affect?
- Synovial joints in the hands, hips and knees.
- Weight bearing joints of peripheral skeleton
What are some risk factors for OA?
- Previous damage
- Increased bone density
- Proprioceptive deficiencies
Describe primary OA
- DIP & PIP finger joints
- carpometacarpal thumb joint
- Hip, knee, metatarsophalangeal joint of big toe
- Cervical and lumbar spine
Describe secondary OA
Occurs in any joint following injury such as a fracture (acute), occupational overuse of a joint, metabolic disease or neurological disorders (chronic)
How does OA present?
- Insidious in onset
- Deep aching pain not well localised
- articular stiffness, worsened by movement, relieved by rest
How can you reduce the risk of OA?
- Rest inflamed joints
- Use the largest muscles for the job
- Use proper movement techniques
- Modify home gagets
What lifestyle modifications and non-medical inerventions can be implemented in OA?
- Exercise and physical therapy
- Weight reduction greater than 10% loss
- Ice packs (for minor inflammation)
- Heat pack (although can lead to inflammation and odema)
When can paracetamol be used in OA?
for mild to moderate knee or hip OA
When are NSAIDs used in OA?
What if they are unresponsive to one paticualr NSAID?
Relieves pain associated with tissue damage or inflammation
Try a diferent one after 2-3 weeks
How can adverse effects from NSAIDs be managed?
- By using concurrent paracetamol and minimising the NSAID dose
- Use for the lowest possible time
In a patient who has a high CV risk and high GI risk what would be an appropriate therapy?
Naproxen plus PPI
In a patient with an average risk of CV problems, and a high GI risk, what therapy should be used?
Cox-2 specific NSAID or non specific NSAID + PPI
When should opioids be prescribed?
- If paracetamol and topical NSAIDs are no good for pain relief or cannot be tolerated
- -If joint replacement surgery is delayed or contraindicated
Name four weak opioids
- dextroproxyphene (bad!!)
Name three strong opioids
What sort of dose should OA patients be started on?
Low dose and titrate up slowly. After this, SR formulations may be commenced
Name three intra-articular corticosteroids used for injection in OA
What do injections tend to do in OA patients?
Which joints is it best for?
How long do they last?
Improve pain, rather than loss of function
Best for knee OA
Lasts several weeks
What are three disadvantages to using injected steroids?
increase in pain, risk of nerve damage & infection
Progressive joint damage from repeated injections
Risk of deterioration if patient uses the joint soon after injection
How do glycosaminoglycans work?
They are injected into the knees and increase the lubricant and shock absorption
How does capsiacin cream help in OA?
Depletes substance P which is a neurotransmitter for sensory nerves. Neurons are desensitized ro other stimulation