24 Questions
The best advice (non-pharm) for patients with OA is to keep moving
True
Weight loss is NOT effective in the treatment of OA
False
What is the strongly recommended treatment for OA?
Oral NSAIDS
What is the MAX dose for daily acetaminophen to avoid hepatoxicity?
4 g
NSAIDs are strongly recommended as first-line options in majority of cases of OA. What should be avoided?
Ketorolac (Toradol) IM shots or following follow with Toradol 10 mg tabs
COX-1 inhibitors OR COX-2 inhibitors. Both of them can block arthritis. Which one will protect your stomach? (1/2)
2
What is an example of a COX-2 inhibitor?
Celecoxib
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?
ALL of the above
What condition could make you stay away from Celecoxib?
Post-MI
Ketorolac (Toradol) IM shots dosed greater than 30 mg can lead to:
GI toxicity
Patients taking NSAIDs are at risk for renal toxicity. What are contributing factors for this?
ALL of the above
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?
Tramadol
When are hydrocodone, oxycodone, codeine (opioids) appropriate for treating OA pain?
Reserved for patients who fail single- or multiple- analgesic therapy
What OTC topical agent is mainly used in OA knee pain by inhibiting the release of substance P in peripheral nerves?
Capsaicin
What topical can be used modest and short term pain relief?
Rubefacients (methylsalicylate, trolamine salicylate)
What topical can be used for local inhibition of COX-2 enzymes for for OA in the elbows, hands, wrist, knees, ankles, and feet?
Diclofenac Gel 1%
You should ALWAYS wash your hands after using Diclofenac Gel
True
Intra-Articular injections with corticosteroids can give 3 weeks of relief (or even longer), but does not solve the pathology.
True
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?
patients with allergies to avian proteins, feathers, or egg products
Joints respond more quickly than ligaments when you give a patient an injection of Platelet Rich Plasma (PRP).
True
What drug is FDA approved for the treatment of chronic musculoskeletal pain due to OA in the knees, hips and hands?
Duloxetine
Escalation of therapy to narcotic or narcotic-like agents may be required for severe pain unresponsive to first-line agents.
True
The best order to follow for knee and hip pain is oral NSAIDs, then topical ones, and lastly steroid injections.
True
Tylenol has limited benefit for pain in OA.
True
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.
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.
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