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CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK
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For the Chapter in the Schwinghammer Handbook, please go to Chapter 2, Osteoarthritis.
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KEY CONCEPTS
Osteoarthritis (OA) is a common disease. OA prevalence increases with age and number of other chronic conditions, with women more commonly affected than men.
Contributors 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).
OA 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.
The most common symptom associated with OA is pain, which leads to decreased function and motion. Pain relief is the primary objective of medication therapy.
Manifestations of OA are local, affecting one or a few joints; the knees are most commonly affected, as well as the hips and hands.
Nonpharmacologic therapy is the foundation of the treatment plan for all patients with OA. Nonpharmacologic therapy should be initiated before or concurrently with pharmacologic therapy.
Based 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 (NSAIDs; topical or oral) are recommended, if there are no contraindications.
Topical NSAIDs, in lieu of oral NSAIDs, are recommended for patients older than 75 years of age to decrease the risks of systemic toxicity.
Strategies to reduce NSAID-induced gastrointestinal (GI) toxicity include the use of nonacetylated salicylates, COX-2 selective inhibitors, or the addition of misoprostol or a proton pump inhibitor.
Other agents useful in treating knee OA include intra-articular injections of corticosteroids, duloxetine, or tramadol.
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BEYOND THE BOOK
This activity is designed to build skills in developing a safe-and-effective patient-specific PLAN as part of the patient care process.
Create a table of drug treatment options for a patient with knee, hip, and hand osteoarthritis and a history of a myocardial infarction.
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Osteoarthritis (OA) is the most common joint disease and one of the leading causes of disability in the United States.1 Knee OA alone is as important a contributor to disability as cardiovascular (CV) disease and more important than other comorbidities. OA is a common co-occurrence with other chronic health conditions that adversely affect quality of life.1
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The progressive destruction of articular cartilage has long been appreciated in OA, but OA involves the entire diarthrodial joint, including articular cartilage, synovium, capsule, and subchondral bone, with surrounding ligaments and muscles also playing important roles. Changes in structure and function of these tissues produce clinical OA, characterized by joint pain and tenderness, with ...