Chapter 36 Osteoarthritis and Gout

What is primary osteoarthritis

Arises from physiologic changes that occur with normal aging.

What is the order of treatment according to EULAR for the hip

1st line: APAP 2nd line: NSAIDs +/ gastroprotection 3rd line: opioid +/ APAP IA steroids for flares unresponsive to analgesia and NSAIDs

What is the order of treatment according to EULAR for the knee

1st line: APAP, topical NSAIDs, capsaicin 2nd line: NSAIDs +/ gastroprotection 3rd line: opioid +/ APAP IA steroids for flares with effusions

What is the order of treatment according to EULAR for the hand

1st line: topical NSAIDs, capsaicin 2nd line: APAP 3rd line: NSAIDs IA steroids for painful flares

What dose of acetaminophen is recommended for osteoarthritis

650 mg every 4 to 6 hours or 1,000 mg every 6 to 8 hours around the clock.

What is the recommended order of treatment for osteoarthritis in the hip

APAP oral NSAIDs Tramadol IA steroids

What is the recommended order of treatment for osteoarthritis in the knee

APAP oral NSAIDs topical NSAIDs Tramadol; IA steroids

What are the combination therapies that can be used for gouty arthritis

Colchicine + NSAID Oral corticosteroid + colchicine Intra-articular steroid + (NSAID OR colchicine OR oral corticosteroid)

What are the goals of pharmacotherapy when treating osteoarthritis

Maintain function Prevent further joint damage Diminish associated pain

What are the Nonpharmacologic Therapies for Osteoarthritis

Moist heat to help diminish muscle spasm and relieve stiffness Weight loss if the patient is overweight Exercises to strengthen the muscles surrounding the involved joint(s) and a fitness program to maintain flexibility of the involved joint through swimming, walking, cycling, and isometric exercises Use of assistive devices to help with ambulation and activities of daily living

What classes of medications are used to treat osteoarthritis

NSAIDS Nonacetylated Salicylates

What is osteoarthritis

OA is a progressive disease that can result in chronic pain, restricted range of motion, and muscle weakness, especially if a weight-bearing joint is affected.

What are the risk factors for gout

Obesity Hypertension Thiazide diuretic use Alcohol intake

What are the modifiable risk factors for osteoarthritis

Obesity; prior joint injury Occupations requiring excessive mechanical stress or heavy lifting

What foods and beverages in increase uric acid level

Red meat: (specifically organ meat): Kidney; liver; sweetbreads Seafood: Sardines; shellfish High-fructose corn syrup: Sodas or sports drinks; foods containing high levels Alcohol: Especially beer; also wine and spirits

What are the goals of physical therapy for osteoarthritis

Reduce pain Improve motion; maintain functional ability

What other joints can be affected by gout

midtarsal joints, ankles, knees, fingers, wrists, and elbows.

What is the most common joint problem in the US

osteoarthritis

What are the types of osteoarthritis

primary (idiopathic) secondary

What are the adverse effects of the topical medications for tx of osteoarthritis

pruritus rash dry skin pain exfoliation

What is the recommended order of treatment for osteoarthritis in the hand

topical capsaicin topical NSAIDs oral NSAIDs

What is the first line treatment for osteoarthritis

Geared toward analgesia, specifically with acetaminophen (Tylenol).

What are the non-modifiable risks for osteoarthritis

Gender age race genetics

What is the most common type of inflammatory arthritis in the US

Gout

What joints are commonly affected

The joints commonly affected by OA include the knees, hips, cervical and lumbar spine, distal interphalangeal (DIP) joints, and the carpometacarpal joint at the base of the thumb.

How do the crystals form in gout

The monosodium urate crystals form due to hyperuricemia either from over production or under excretion of uric acid.

What is the most common joint affected with gout

The most common joint affected is the metatarsophalangeal joint.

What is secondary osteoarthritis

Usually results from traumatic injuries or inherited conditions and may present as hemochromatosis, chondrodystrophy, or inflammatory OA.

What is gout

an inflammatory condition that results from monosodium urate crystals precipitating in the synovial fluid between joints due to hyperuricemia.

what are the contraindications for diclofenac gel topical

damaged or unitact skin

What is the only approved topical NSAID to treat osteoarthritis

diclofenac

What are the precautions when using topical medications for the tx of osteoarthritis

do not apply to damage or nonintact skin same things apply that apply to PO NSAIDs