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This lecture by Dr. Alison Walton occurred on Thursday, Notvember 4th.

Back to RX 413 - Therapeutics

Study MaterialsEdit

Required reading:

  • Buys LM, Elliott ME. Osteoarthritis. In DiPiro JP, et al, eds. Pharmacotherapy, A Pathophysiologic Approach, 7th ed. New York, 2008: 1519-1537

Handouts:

Panopto:

ObjectivesEdit

Explain the Etiology and pathophysiology of osteoarthritis and recognize the common risk factorsEdit

Pathopysiolgy

Normal function of articular cartilage in joint space:

  • lubrication with motion
  • shock absorbency
  • load support
  • reduce friction

Over time, events destabilize the normal cycle of synthesis and degredation involving articular artilage, chondrocytes, extracellular matrix, and subchondral bone.

  • Risk factors contribute to loss and/or damage of articular cartilage
  • biochemical, inflammatory, biomechanical, and immunologic factors are also involved.

Arthritis joint

Clinical Presentation

Symptoms

  • Pain localized to affected joint
    • Early disease = pain with motion
    • Late disease = pain at rest
  • Joint stiffness
  • Limited range of motion
  • Crepitus (crackling or grating sound)
    • caused by irregular surfaces of the joint rubbing together

Physical findings

  • monoarticular - in young adult
  • Paurciarticular - in middle aged adults
    • affects large weight bearing joints
    • typically 1-4 joints involved
  • Polyarticular/Generalized OA - in middle aged or elderly adults
    • Most common
    • Affects many joints
    • Usually afflicts middle age adults 50+

Arthritis hand nodes

  • Joint Involvement (Primarily weight-bearing Joints)
    • Hand
      • Distal Interphalangeal joint = Herberden's node
      • Proximal interphalangeal joint = Bouchard's Node
      • First carpometacarpal joint
    • Knee
    • Hip
    • Foot
      • First metatarsophalangeal joint
    • Cervical and Lumbar Spine
      • Often particularly painful
  • Physical examination of joints
    • Tenderness to palpitation
    • Effusions
    • Crepitus
    • Bony enlargement
    • Decreased range of motion
    • Malalignment
  • Laboratory Tests
    • There is no specific test to confirm the diagnosis of OA
    • Erythrocyte sedimentation rate (ESR) <20mm/hr
    • Rheumatoid factor negative
    • Evaluation of synovial fluid (WBC <2000 cells/mm3)
      • Making sure that the inflammation is mild and localized
  • Radiographic Findings
    • Joint space Narrowing
    • Osteophytes


Common risk factors for osteoarthritis include:

Obesity - the number one preventable risk factor for OA

  • Strongly associated with hip, knee, and hand OA
  • Often precedes OA and contributes to development
  • Weight loss decreases future risk

Occupation, Sports, Trauma related stress

  • Activites involving repetitive motion
  • workers exposed to repetitive stress through manual labor
  • Associated with sports injuries or joint trauma (even injuries early in life can increase later risk)

Genetic factors

  • There has been some progress in identifying and understanding the contributions of genetic variation
  • opens opportunities for new medications

Describe the clinical presentation and know the goals fo therapy for osteoarthritisEdit

Develop and alter a treatment plan for pharmacologic and nonpharmacologic management of osteoarthritisEdit

Design a treatment plan in patients with risk factors for gsatrointestinal, renal, or cardiovascular toxicity with NSAIDSEdit

Identify drug and disease state interactions in patients with osteoarthritisEdit

Recommend appropriate adjunctive and/or nonpharmacologic therapy in patients with osteoarthritisEdit

For the following drugs, list the brand and generic names, therapetuic uses, usual starting doses, mechanism of action, monitoring parameters, common and or/clinically significant side effects, drug interactions and key points of patient educationEdit

Acetaminophen (Tylenol)Edit

  • Therapeutic use
  • Usual starting doses
  • mechanism of action
  • monitoring parameters
  • common/significant side effects
  • drug interactions
  • key points of patient education


IbuprofenEdit

  • Therapeutic use
  • Usual starting doses
  • mechanism of action
  • monitoring parameters
  • common/significant side effects
  • drug interactions
  • key points of patient education


NaproxenEdit

  • Therapeutic use
  • Usual starting doses
  • mechanism of action
  • monitoring parameters
  • common/significant side effects
  • drug interactions
  • key points of patient education


EtodolacEdit

  • Therapeutic use
  • Usual starting doses
  • mechanism of action
  • monitoring parameters
  • common/significant side effects
  • drug interactions
  • key points of patient education


IndomethacinEdit

  • Therapeutic use
  • Usual starting doses
  • mechanism of action
  • monitoring parameters
  • common/significant side effects
  • drug interactions
  • key points of patient education


MeloxicamEdit

  • Therapeutic use
  • Usual starting doses
  • mechanism of action
  • monitoring parameters
  • common/significant side effects
  • drug interactions
  • key points of patient education


NabumetoneEdit

  • Therapeutic use
  • Usual starting doses
  • mechanism of action
  • monitoring parameters
  • common/significant side effects
  • drug interactions
  • key points of patient education


SulindacEdit

  • Therapeutic use
  • Usual starting doses
  • mechanism of action
  • monitoring parameters
  • common/significant side effects
  • drug interactions
  • key points of patient education


CelecoxibEdit

  • Therapeutic use
  • Usual starting doses
  • mechanism of action
  • monitoring parameters
  • common/significant side effects
  • drug interactions
  • key points of patient education


CapsaicinEdit

  • Therapeutic use
  • Usual starting doses
  • mechanism of action
  • monitoring parameters
  • common/significant side effects
  • drug interactions
  • key points of patient education


Diclofenac GelEdit

  • Therapeutic use
  • Usual starting doses
  • mechanism of action
  • monitoring parameters
  • common/significant side effects
  • drug interactions
  • key points of patient education


Glucosamine/ChondroitinEdit

  • Therapeutic use
  • Usual starting doses
  • mechanism of action
  • monitoring parameters
  • common/significant side effects
  • drug interactions
  • key points of patient education


Sodium HyaluronateEdit

  • Therapeutic use
  • Usual starting doses
  • mechanism of action
  • monitoring parameters
  • common/significant side effects
  • drug interactions
  • key points of patient education


TramadolEdit

  • Therapeutic use
  • Usual starting doses
  • mechanism of action
  • monitoring parameters
  • common/significant side effects
  • drug interactions
  • key points of patient education


FlavocoxidEdit

  • Therapeutic use
  • Usual starting doses
  • mechanism of action
  • monitoring parameters
  • common/significant side effects
  • drug interactions
  • key points of patient education





Back to RX 413 - Therapeutics

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