A477 Team 4 L3 by SHENAZ CHONG CAI XUAN

Osteoarthritis

200012571 — 2021-11-02 04:20:07 UTC

200012571 — 2021-11-02 04:21:08 UTC

- Most common type of joint disease
- Degenerative joint disease (progressively gets worse with time)
- "Wear and tear" disease
- Commonly affects the hands, knees, hips and spine
- Cartilage between joints break down, friction between joints would cause pain
- Can be treated with analgesics and NSAIDs

Risk factors

kukan2002 — 2021-11-02 04:21:32 UTC

Age > 45 years old
• Obesity
• Trauma
• Family history of OA
• Reduced levels of sex hormones
• Muscle weakness
• Repetitive use of joint
• Infection
• Diabetes mellitus

Non pharmacological treatments

200236311 — 2021-11-02 04:21:39 UTC

*Should be initiated at the same time as drug therapy; important for patient counselling

-Lose weight (for obese patients)
-Aerobic exercise or land based resistance exercise(Brisk walking, Running, Cycling)
-Aquatic exercises such as Swimming
-Use of supports and knee braces to offer pain relief and improve function
-Use of corrective footwear might help in patients with knee OA
-Hot/Cold packs for pain relief
-Transcutaneous electrical nerve stimulation(TENS)
-Acupuncture or massage to help with stiffness and pain reduction

Symptoms

kukan2002 — 2021-11-02 04:23:47 UTC

- Deep, achy joint pain made worse by extensive use
- Reduced range of motion and crepitus
- Stiffness during rest with morning joint stiffness
usually lasting less than 30 minutes

Pathophysiology for osteoarthritis

smichaeldm — 2021-11-02 04:26:47 UTC

Type 2 collagen:
-Type II collagen is what gives cartilage its tensile strength and elasticity, thereby enabling it to support the joints.

Proteoglycans:
-They bind water and provide the basis of the joint's ability to absorb high compressive loads

Cytokines:
-Causes inflammation

Diagnosis

kukan2002 — 2021-11-02 04:26:54 UTC

- Typically diagnosed with clinical and radiographic findings
- Radiography (common) --> because its the more cost-effective and fastest
- it shows the Joint-space loss (cartilage loss)

Surgical Interventions

smichaeldm — 2021-11-02 04:29:08 UTC

Should pharmacologic therapy fail, surgical procedures are done as a last resort to treat OA.

Examples of said procedures are:
1. Arthroscopy
- Surgeons insert a narrow tube attached to a fiber-optic video camera through a small incision through the affected joint.
- The view provided by the camera is used to repair joint damage caused by OA and similar joint conditions

2. Osteotomy
- A procedure where the surgeon removes or sometimes adds, a wedge of bone near a damaged joint.
- This shifts the weight from an area where there is damaged cartilage to an area where there is more or healthier cartilage

3. Arthroplasty (for knee or hip OA)
- A surgical procedure to restore the function of a joint. A joint can be restored by resurfacing the bones. (Making it smooth)
- An artificial joint (called a prosthesis) may also be used

4. Fusion
- Conducted to permanently hold a joint in a fixed position by fusing together the two bones that make up the joint.
- Fusion strengthens and stabilizes the joint and prevents any movement between the bones.

Decreasing order of preference

kukan2002 — 2021-11-02 04:32:45 UTC

Supplementation

200236311 — 2021-11-02 04:33:37 UTC

Natural Health Products such as Glucosamine and Chondroitin Sulphate are advertised to help in cartilage repair in OA.

If patients wish to take Glucosamine and Chondroitin Sulphate as supplements, they should monitor condition and discontinue after 3 months of use if there is no improvement

Glucosamine supplements

200236311 — 2021-11-02 06:07:00 UTC

Dose: 1.5g/day
Contraindications: Shellfish allergy
Side effects: nausea,abdominal pain, dyspepsia,flatulence, diarrhoea, constipation, drowsiness, headache, fatigue

Key pointers

200012571 — 2021-11-02 06:16:04 UTC

- Gout and OA have different causes and treatments
- Always offer non-pharmacological advice to prevent worsening of OA

Medications: Pharmacological therapy

smichaeldm — 2021-11-02 07:41:53 UTC

*Objective: Relieve pain and improve joint function

Diagnosis, Risk Factors, and Symptoms

smichaeldm — 2021-11-02 07:44:21 UTC

Management of osteoarthritis

smichaeldm — 2021-11-02 07:46:05 UTC

What is osteoarthritis (OA)?

smichaeldm — 2021-11-02 07:54:38 UTC

Pathophysiology

smichaeldm — 2021-11-02 07:56:08 UTC

Lifestyle management

200236311 — 2021-11-02 07:57:12 UTC

First line: Paracetamol

200012571 — 2021-11-02 08:22:58 UTC

- Pharmacological class: Non-opioid analgesic
- Dosing: 0.5g - 1g TDS, max 4g a day
- Well-tolerated and generally safe for most people to take

Second option: Topical/oral NSAIDs

200012571 — 2021-11-02 08:24:35 UTC

Topical NSAIDs:
- Ketoprofen gel/patch to be recommended to elderly
- Dosing: Gel - apply to affected area BD
Patch - apply 1 patch to the affected area BD
Oral NSAIDs:
- Should be used at the lowest dose
- Dosing for Celecoxib: 200mg once to twice a day, max 600mg a day

Third option: Tramadol

200012571 — 2021-11-02 08:24:50 UTC

- Pharmacological class: Opioid analgesic
- A lower dose is recommended for elderly as tramadol has a higher likelihood of causing drowsiness
- Dosing: 50mg to 100mg every 4 to 6 hours PRN, when necessary

Fourth option: Intra-articular corticosteroid injections

200012571 — 2021-11-02 08:25:07 UTC

- NOT to be used in hand OA
- Used when the pain does not subside when paracetamol and NSAIDs are taken
- One injection would consist of 50mg of prednisone
- Limited to 3 to 4 injections per year

Differences between OA and Gout

200236311 — 2021-11-02 08:27:23 UTC

OA

200236311 — 2021-11-02 08:27:56 UTC

-commonly affects (hands,knees,hip and spine) joints
-inflammation may or may not be present
-swelling and redness may or may not be present
-deep achy pain
-morning stiffness which lasts <30mins

Gout

200236311 — 2021-11-02 08:28:21 UTC

-commonly affects (big toe,knee,finger ,wrist, ankle, instep) joint
-inflammation always present
-swelling and redness is always present
-pain attack that comes abruptly and reach maximum intensity within 8 -12 hours

200236311 — 2021-11-02 08:33:51 UTC

different symptoms so they are not similar and cannot be used interchangeably!

Failure of Pharmacological therapy

smichaeldm — 2021-11-02 08:37:38 UTC