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OA Management
Management of Osteo Arthritis
| Question | Answer |
|---|---|
| Which type of cartilage is affected in OA? | Hyaline |
| What are the signs and symptoms of OA? | Gradual onset, involves few joints, unilateral, joints include, joint pain worsened by activity, relieved by rest, limited morning stiffness, reduced joint movement, joint swelling, bony enlargements (herbeden nodes, bouchard's nodules) |
| Which joints are typically affected in OA? | DIP, PIP, first CMC joints, knees, hips, cervical and lumbar spine |
| How is OA diagnosed? | History, symptoms and physical examination of affected joint (s) |
| What are the aims of treatment for OA? | Reduce pain, increase mobility, reduce disability |
| what are the non-pharmacological treatsments for OA? | Weight reduction, physiotherapy, exercise, hydrotherapy, rest, OT, education |
| What is the first line drug treatment for OA? | Paracetamol 1g qid or Paracetamol SR 1330 mg tds Oral NSAID (if not C/I) With or without topical nsaid/capsaicin |
| Which are the topical nsaids used in OA? | Diclofenac, ibuprofen, piroxicam Applied up to 4 times daily |
| How often is topical capsaicin applied? | Up to 4 times daily |
| When are oral nsaids used? | In moderate to severe OA |
| How are intra-articular injections used in OA? | When paracetamol, oral and topical nsaids aren't offering enough relief |
| How are intra-articular steroids used in OA? | For short term pain relief Steroids used include triamcinolone, betamethasone, dexamethasone, methylprednisolone |
| How long do intra-articular injections offer relief for? | Up to 8 weeks pain relief in knee |
| What is the Australian Guideline on Use of intra-articular steroid injections? | No more than 4 injections in a single joint over a year Avoid further injections if there is no response after two consecutive injections A single injection may provide relief for 4-12 weeks for patients |
| How is intra-articular hyaluronic acid used in OA? | Acts as a lubricant to reduce pain relief, swelling, and stiffness |
| How is intra-articular hyaluronic acid given? | As a single injection, or as a weekly injection for 3-5 weeks depending on formulation |
| How do the intra-articular injections compare? | Hyaluronic acid is more expensive and has a slower onset of action, but has a longer duration of pain relief compared to corticosteroids. |
| What are regenerative intraarticular injections? | Platelet rich plasma, adipocyte cell suspensions or mesenchymal stem cell injections. Not recommended due to limited evidence. |
| What are the complementary medicines associated with OA? | Glucosamine and Chondroitin, krill oil and curcumin |
| What is the dose for glucosamine? | 1.5 mg daily as sulfate or HCl salt -sulfate more effective. |
| What are the precautions for glucosamine? | Conflicting evidence, anticoagulant use, shellfish allergy, impaired glucose tolerance (diabetics) |
| What is the dose for chondroitin? | 800-1200mg d |
| What is the precaution for chondroitin? | Anticoagulant use |
| What are the levels of evidence for complementary medicine use in OA? | Conflicting levels of evidence for glucosamine and chondroitin Limited evidence for turmeric (curcumin) No evidence for Krill oil |
| When is surgery used in OA? | Arthroplasty is reserved for those who: Do not respond to treatment Have significantly impaired joint function X-ray shows joint damage, mainly used in knee and hip OA |
Created by:
LDM
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