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KEY CONCEPTS

KEY CONCEPTS

  • imageOsteoarthritis (OA) is a very common disease. OA prevalence increases with age and number of other chronic conditions, with women more commonly affected than men.

  • imageContributors to OA are systemic (age, genetics, hormonal status, obesity, occupational or recreational activity) and/or local (injury, overloading of joints, muscle weakness, or joint deformity).

  • imageOA is primarily a disease of cartilage that reflects a failure of the chondrocyte to maintain proper balance between cartilage formation and destruction. This leads to loss of cartilage in the joint, local inflammation, pathologic changes in underlying bone, and further damage to cartilage triggered by the affected bone.

  • imageThe most common symptom associated with OA is pain, which leads to decreased function and motion. Pain relief is the primary objective of medication therapy.

  • imageManifestations of OA are local, affecting one or a few joints; the knees are most commonly affected, as well as the hips and hands.

  • imageNonpharmacologic therapy is the foundation of the treatment plan for all patients with OA. Nonpharmacologic therapy should be initiated before or concurrently with pharmacologic therapy.

  • imageBased upon efficacy, safety, and cost considerations, scheduled acetaminophen, up to 4 g/day, should be tried initially for pain relief in knee and hip OA. If this fails, nonsteroidal anti-inflammatory drugs (topical or oral) are recommended, if there are no contraindications.

  • imageTopical NSAIDs, in lieu of oral NSAIDs, are recommended for patients older than 75 years of age to decrease the risks of systemic toxicity.

  • imageStrategies to reduce NSAID-induced GI toxicity include the use of nonacetylated salicylates, COX-2 selective inhibitors, or the addition of misoprostol or a proton pump inhibitor.

  • imageOther agents useful in treating knee OA include intra-articular injections of corticosteroids, duloxetine, or tramadol.

PATIENT CARE PROCESS

Patient Care Process for the Management of Osteoarthritis*

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Collect

  • Patient characteristics (eg, age, weight, height, race, sex, pregnant)

  • Patient history (past medical, family, social—trauma, diet, exercise, alcohol use)

  • Symptom information: type and location of pain, duration, effect of motion and rest, range of motion and limitations on activities, joint instability

  • Current and past medications, including nonprescription agents and dietary supplements, and medications’ relief of symptoms

  • Objective data

    • Physical examination, appearance of joints

    • Radiologic evaluation—changes in joints, subchondral bone sclerosis, effusions

    • Body mass index (presence of overweight or obesity)

Assess

  • Distribution and severity of joint involvement

  • Impact of symptoms on patients’ movements, health-related quality of life, amount of disability

Plan

  • Patient education about disease, prognosis, treatment options, application and use of topical products

  • Nonpharmacologic therapy (see Table 106-1)—weight loss (if overweight or obese), exercise, surgery (for severe pain or functional disability)

  • Drug therapy regimen including specific analgesics, dose, route, frequency, and duration; specify the continuation and discontinuation of existing therapies (see Figs. 106-4 and 106-5 and Tables 106-2 and 106-3)

  • Monitoring parameters including efficacy (eg, symptom relief), safety (medication-specific adverse effects) (see Table 106-3)

  • Self-monitoring of symptoms, exercise, and weight—where and how to record results

  • Referrals to other ...

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