Is primary (idiopathic) OA or secondary OA more common?
Primary (idiopathic) OA
What are the 4 possible causes of Secondary OA?
•Rheumatoid or another inflammatory arthritis
•Metabolic or endocrine disorders
S/s of what?
- Joint pain/tenderness
- Decreased ROM
- Joint instability
What is the name of the 2 classic physical exam findings of OA?
Heberden's nodes (distal joint)
Bouchard's nodes (proximal joint)
What is the primary objective of medication therapy for OA?
Pain from OA may result from distention of the synovial capsule caused by what 4 things?
- increased joint fluid
- periosteal irritation
- damage to ligaments, synovium, or the meniscus
What are the 3 non-pharmacologic options for OA?
What med is used initially for pain relief in knee and hip OA?
Other than Acetaminophen, what other 4 simple analgesics can be used in OA?
Narcotics (in selected cases)
Tx of OA:
Why is immobilization bad for joint health?
Movement allows nutrients to flow into the cartilage whereas immobilization reduces nutrient supply
Pharmacologic tx of OA:
Nonselective NSAIDs for patients at low risk for GI complications; Otherwise, consider addition of what 4 meds?
- proton pump inhibitor
- H2 antagonist
- COX-2-specific NSAID (coxib)
Which two intra-articular injections are alternative first line tx for both knee and hip in OA?
Hyaluronic acid injections
What 2 meds do you give if Acetaminophen fails?
Topical or oral NSAIDs (topical over knee, hands)
If Acetominophen fails, What medication is recommended for patients older than 75 to decrease the risks of systemic toxicity?
What 2 meds should you give patients w/ OA if Acetaminophen, topical NSAIDs, Topical Capsaicin and Ketoprofen all fail?
Oral NSAIDs or Celecoxib (COX-2 inhibitor)
(only after careful risk assessment)
Duloxetine is primarily effective as ____ therapy for OA
Although Acetaminophen may be modestly less effective than NSAIDs in the tx of OA, a trial is favored in all patients without underlying _____ disease in the tx of knee and hip OA
Without underlying hepatic disease
T/F: No NSAID has proven superior to another
NSAIDs pose a higher risk for what 3 adverse events in comparison to Acetaminophen
GI, Renal, and Cardiovascular events
Which 2 meds significantly reduce the occurance of GI adverse events in those taking NSAIDs
PPIs and misoprostol
Treatment of OA:
What is the NSAID of choice in patients with high cardiovascular risk?
Which 2 toxicities are reported for all NSAIDs?
What are the top 3 ADEs of NSAIDs and how do you monitor?
1. Ulcers or bleeding- monitor w/ CBC
2. liver failure (rare)- monitor w/ hepatic transaminase levels
3. Renal insufficiency, renal failure, hyperkalemia - monitor w/ SrCr
When are NSAIDs contraindicated?
What are 3 ways you can reduce risk of GI toxicity associated w/ NSAIDs?
1. Use the Nonacetylated salicylates (Choline salicylate and trisalicylate?)
2. COX-2 Selective inhibitors
3. Add Misoprostol or PPI
RA is MC in which 2 regions?
Feet and hands
OA is MC in what 4 regions?