Podcast
Questions and Answers
The best advice (non-pharm) for patients with OA is to keep moving
The best advice (non-pharm) for patients with OA is to keep moving
True (A)
Weight loss is NOT effective in the treatment of OA
Weight loss is NOT effective in the treatment of OA
False (B)
What is the strongly recommended treatment for OA?
What is the strongly recommended treatment for OA?
- Topical NSAIDs
- Oral NSAIDS (correct)
- Acetaminophen
- Topical Capsaicin
What is the MAX dose for daily acetaminophen to avoid hepatoxicity?
What is the MAX dose for daily acetaminophen to avoid hepatoxicity?
NSAIDs are strongly recommended as first-line options in majority of cases of OA. What should be avoided?
NSAIDs are strongly recommended as first-line options in majority of cases of OA. What should be avoided?
COX-1 inhibitors OR COX-2 inhibitors. Both of them can block arthritis. Which one will protect your stomach? (1/2)
COX-1 inhibitors OR COX-2 inhibitors. Both of them can block arthritis. Which one will protect your stomach? (1/2)
What is an example of a COX-2 inhibitor?
What is an example of a COX-2 inhibitor?
Which of the following NSAIDs will lead to worse GI impacts (burning a hole in mucosal lining), and therefore should not be used for pain?
Which of the following NSAIDs will lead to worse GI impacts (burning a hole in mucosal lining), and therefore should not be used for pain?
What condition could make you stay away from Celecoxib?
What condition could make you stay away from Celecoxib?
Ketorolac (Toradol) IM shots dosed greater than 30 mg can lead to:
Ketorolac (Toradol) IM shots dosed greater than 30 mg can lead to:
Patients taking NSAIDs are at risk for renal toxicity. What are contributing factors for this?
Patients taking NSAIDs are at risk for renal toxicity. What are contributing factors for this?
A patient has been taking NSAIDs (such as Ibuprofen) for their OA pain with no relief. What is an alternative treatment option that works as a weak opiate/SSRI?
A patient has been taking NSAIDs (such as Ibuprofen) for their OA pain with no relief. What is an alternative treatment option that works as a weak opiate/SSRI?
When are hydrocodone, oxycodone, codeine (opioids) appropriate for treating OA pain?
When are hydrocodone, oxycodone, codeine (opioids) appropriate for treating OA pain?
What OTC topical agent is mainly used in OA knee pain by inhibiting the release of substance P in peripheral nerves?
What OTC topical agent is mainly used in OA knee pain by inhibiting the release of substance P in peripheral nerves?
What topical can be used modest and short term pain relief?
What topical can be used modest and short term pain relief?
What topical can be used for local inhibition of COX-2 enzymes for for OA in the elbows, hands, wrist, knees, ankles, and feet?
What topical can be used for local inhibition of COX-2 enzymes for for OA in the elbows, hands, wrist, knees, ankles, and feet?
You should ALWAYS wash your hands after using Diclofenac Gel
You should ALWAYS wash your hands after using Diclofenac Gel
Intra-Articular injections with corticosteroids can give 3 weeks of relief (or even longer), but does not solve the pathology.
Intra-Articular injections with corticosteroids can give 3 weeks of relief (or even longer), but does not solve the pathology.
If a patient is still experiencing pain of the knee after trying other therapies, Hyaluronic Acid Derivatives Injections can be used. What cautions do you need to consider?
If a patient is still experiencing pain of the knee after trying other therapies, Hyaluronic Acid Derivatives Injections can be used. What cautions do you need to consider?
Joints respond more quickly than ligaments when you give a patient an injection of Platelet Rich Plasma (PRP).
Joints respond more quickly than ligaments when you give a patient an injection of Platelet Rich Plasma (PRP).
What drug is FDA approved for the treatment of chronic musculoskeletal pain due to OA in the knees, hips and hands?
What drug is FDA approved for the treatment of chronic musculoskeletal pain due to OA in the knees, hips and hands?
Escalation of therapy to narcotic or narcotic-like agents may be required for severe pain unresponsive to first-line agents.
Escalation of therapy to narcotic or narcotic-like agents may be required for severe pain unresponsive to first-line agents.
The best order to follow for knee and hip pain is oral NSAIDs, then topical ones, and lastly steroid injections.
The best order to follow for knee and hip pain is oral NSAIDs, then topical ones, and lastly steroid injections.
Tylenol has limited benefit for pain in OA.
Tylenol has limited benefit for pain in OA.
Study Notes
Osteoarthritis (OA) Treatment
- The best advice for patients with OA is to keep moving, as physical activity is essential for their well-being.
- Weight loss is not an effective treatment for OA.
Acetaminophen and NSAIDs
- The strongly recommended treatment for OA is NSAIDs (non-steroidal anti-inflammatory drugs) as first-line options in most cases.
- The maximum daily dose of acetaminophen to avoid hepatotoxicity is not specified.
- COX-1 inhibitors and COX-2 inhibitors should be avoided, as they can block arthritis.
- COX-2 inhibitors, such as Celecoxib, protect the stomach.
NSAIDs and GI Impacts
- NSAIDs that can lead to worse GI impacts (burning a hole in mucosal lining) and should not be used for pain are not specified.
- Conditions that may make you avoid using Celecoxib include sulfa allergy.
- Ketorolac (Toradol) IM shots dosed greater than 30 mg can lead to renal toxicity.
Renal Toxicity
- Patients taking NSAIDs are at risk for renal toxicity, with contributing factors including:
- Dehydration
- Heart failure
- Renal insufficiency
- Diuretic use
Alternative Treatment Options
- For patients taking NSAIDs with no relief, an alternative treatment option is Tramadol, which works as a weak opiate/SSRI.
- Opioids (such as hydrocodone, oxycodone, and codeine) are appropriate for treating OA pain in severe cases or when other treatments fail.
Topical Agents
- The OTC topical agent mainly used in OA knee pain is Capsaicin, which inhibits the release of substance P in peripheral nerves.
- Topical agents for modest and short-term pain relief include lidocaine and tetracaine.
- Topical agents used for local inhibition of COX-2 enzymes in OA include diclofenac gel, which requires hand washing after use.
Intra-Articular Injections
- Intra-Articular injections with corticosteroids can give 3 weeks of relief (or even longer) but do not solve the underlying pathology.
- Hyaluronic Acid Derivatives Injections can be used for patients still experiencing pain after trying other therapies.
- Cautions to consider when using Hyaluronic Acid Derivatives Injections include:
- Joint infection
- Allergy to hyaluronic acid
- Pregnancy
Platelet Rich Plasma (PRP)
- Joints respond more quickly than ligaments when using PRP injections.
FDA-Approved Treatment
- The FDA-approved drug for the treatment of chronic musculoskeletal pain due to OA in the knees, hips, and hands is Sarilumab.
Therapy Escalation
- Escalation of therapy to narcotic or narcotic-like agents may be required for severe pain unresponsive to first-line agents.
- The best order to follow for knee and hip pain is oral NSAIDs, then topical ones, and lastly steroid injections.
- Tylenol has limited benefit for pain in OA.
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Description
Learn about the best non-pharmaceutical advice for patients with Osteoarthritis (OA) which is to keep moving. Discover how physical activity can help in managing OA symptoms and improving quality of life.
