Osteoarthritis

Osteoarthritis - Chronic
Rahul Soman, M. Pharm

 

 

Definition  

The clinical and pathologic result of various disorders that cause degeneration of synovial joints, characterized by the loss and erosion of articular cartilage, changes in subchondral bone, meniscal breakdown, limited inflammatory response, and overgrowth of bone and cartilage

 

Medical History  

* Family history of Osteoarthritis

* Aging

* Generalized obesity

* Past medical history of Joint injury

* Sports injury

* Congenital deformity of hip joint

* Muscle weakness

 

Findings  

* Arthralgia

* Joint stiffness

* Joint laxity

* Limitation of joint movement

* Acquired deformity of finger joint

* Impaired joint position sense

* Effusion of joint

* Bone crepitus

 

Tests  

 

Suspected osteoarthritis  

* Joint X-ray: Radiographs can reveal joint space narrowing, subchondral bony changes, and osteophyte formation; however, symptomatic disease may be present with negative x-rays .

 

Exclusion of diagnoses other than osteoarthritis  

* Magnetic resonance imaging: MRI may be beneficial in identifying other causes of joint pain, such as osteochondritis dissecans and avascular necrosis .

* Synovial fluid analysis: Synovial fluid from osteoarthritic joints typically has less than 2,000 WBC/mm3, is clear, and has normal viscosity .

 

Differential Diagnosis  

* Post-traumatic osteoarthritis

* Inflammatory osteoarthritis

* Rheumatoid arthritis - Chronic

* Post-infective arthritis

* Inflammatory polyarthropathy

* Psoriasis with arthropathy

* Ankylosing spondylitis - Chronic

 

Treatment  

 

Drug Therapy  

 

Acute pain  

 

ACETAMINOPHEN

Adults: 650 to 1000 mg orally every 4 to 6 hours as needed (maximum 4 g/day)

 

IBUPROFEN

Adults: 200 to 800 mg orally every 6 to 8 hours as needed (maximum 3.2 g/day)

 

NAPROXEN

Adults: 250 to 500 mg orally every 12 hours as needed

 

HYDROCODONE BITARTRATE/ACETAMINOPHEN  

Adults: Hydrocodone 5 to 20 mg/acetaminophen 325 to 1000 mg orally every 4 hours as needed (maximum 4 g acetaminophen/day)

 

ACETAMINOPHEN/OXYCODONE HYDROCHLORIDE  

Adults: Oxycodone 5 to 20 mg/acetaminophen 325 to 1000 mg orally every 4 hours as needed (maximum 4 g acetaminophen/day)

 

 

Intra-articular steroid injection for osteoarthritis  

 

TRIAMCINOLONE ACETONIDE  

Adults (large joint): Inject 5 to 40 mg intra-articularly initially; may repeat every 3 months for up to 2 years

Adults (medium joint): Inject 2.5 to 20 mg intra-articularly initially; may repeat every 3 months for up to 2 years

Adults (small joint): Inject 2.5 to 10 mg intra-articularly initially; may repeat every 3 months for up to 2 years

 

METHYLPREDNISOLONE  

Adults (large joint): Inject 20 to 80 mg intra-articularly initially; may repeat every 3 months for up to 2 years

Adults (medium joint): Inject 10 to 40 mg intra-articularly initially; may repeat every 3 months for up to 2 years

Adults (small joint): Inject 4 to 10 mg intra-articularly initially; may repeat every 3 months for up to 2 years

 

BETAMETHASONE  

Adult: Inject 3 to 12 mg intra-articularly, depending on the size of the joint

 

Intra-articular hyaluronate injection for osteoarthritis  

 

HYALURONATE SODIUM  

Adults: Inject 30 mg/2 mL intra-articularly into the knee once weekly for a total of 3 or 4 injections

 

Procedural Therapy  

 

Osteoarthritis  

* Rehabilitation therapy: Physical therapy can play an integral role in reducing pain and improving functional capacity in patients with osteoarthritis .

* Surgical procedure: Patients should be referred for joint replacement surgery if they are not receiving adequate pain relief and functional gains with other nonpharmacologic and pharmacologic therapy .

 

Non-Procedural Therapy  

 

Osteoarthritis  

* Weight Reduction and Exercise