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Osteoarthritis

Pharmacology

QuestionAnswer
Arthritis Joint inflammation and is a chronic illness
characteristics of arthritis joints 1. Bone ends to rub against each other. 2. Thinned cartilage. 3. Swollen inflamed synovial membrane. 4. Bone erosion.
Osteoarthritis - Medically called as osteoarthroses or degenerative joint disease. - due to the breakdown of the cartilage. -causes pain, stiffness loss of movement and bones rub against each other.
Hyaline Cartilage - Designed to bear and distribute loads. ( Low friction). - Low metabolic activity - no blood supply/nerve supply/ lymphatic drainage.
Causes of Osteoarthritis- 7 1. Heredity 2. Joint injury 3. Repeatedly overuse of certain joint. 4. Aging 5. Lack of physical activity 6. Overweight 7. Nerve injury.
Pathogenesis of OA - 4 mechanisms 1. Metalloproteinase degrades cartilage components- collagen & proteoglycans 2. Inflammatory mediators (IL-1 & TNFa) will stimulate MMP & inhibit collagen production. 3. Deficiency of growth factors-IGF & TGF impairs matrix repair. 4. Genetic factor.
Symptoms-3 1. Feeling pain and stiffness- after inactivity / excessive use. 2. Grating/ "catching" sensation during joint movement. 3 Bony growth at the margins of affected joints.
Diagnosis of OA- 6 1. Medical History taking. 2. Examination. 3. Joint injury - X-ray 4. MRI 5. Joint Aspiration- fluid taken out. 6. Blood test.
Clinical feature- Joint affected -4 1. Hand interphalangeal joints. 2. Knees 3. Hips 4, Spine
Clinical feature- symtoms Joint pain worsen with use and is alleiated with rest, stiffness, functional impairment.
clinical feature- signs limp, deformity, alteration in joint shape, weakness, bony swelling, tenderness.
Investigation 1. FBC and ESR normal. 2. Rheumatoid factor- negative 3. positive low-titre tests 4. x rays- narrowing of the joint space. - cyst formation -osteophytes 5. MRI- early cartilage changes.
Non pharmacology treatment 1. exercise 2. weight loss 3. Electrotherapy 4. Braces and wedges of the shoes- reduce pain, assist function and prevent disease progression.
Paracetamol - first line treatment -taken regularly to relieve pain
Topical NSAIDs - consider to use before oral NSAID - can be considered as first line.
NSAIDs and COX 2 - take if paracetamol and topical NSAIDs not effective. - take at lowest effective dose. - increase GI prob. - give PPI if Nsaids taken regularly
Intra-articular injection- corticosteroids - shld not injected more than once every 3 months. Examples: 1. Dexamethasone 0.3-3mg 2. Hydrocortisone 5-50mg 3. PRednisolone 5-25mg
Glucosamine Sulphate - nutraceutical - stimulate chondrocytes to produce proteoglycans. - may possibly inhibit cartilage catabolic enzymatic activity.
Created by: staffi