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