Osteoarthritis seminar
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What is the primary purpose of paracetamol in osteoarthritis treatment?

  • It provides anti-inflammatory effects.
  • It is primarily an analgesic. (correct)
  • It facilitates joint injections.
  • It acts as a chondroprotective agent.
  • Which of the following statements about NSAIDs is correct?

  • NSAIDs are only used in severe osteoarthritis.
  • NSAIDs function by inhibiting COX-3 only.
  • NSAIDs are the first choice for chondroprotective treatment.
  • NSAIDs provide both analgesic and anti-inflammatory effects. (correct)
  • What is a significant risk associated with paracetamol overdose?

  • Severe allergic reactions including anaphylaxis.
  • Hepatocellular necrosis due to toxic metabolite formation. (correct)
  • Excessive dehydration leading to renal failure.
  • Increased blood pressure and cardiovascular complications.
  • Which treatment is categorized under chondroprotective treatment for osteoarthritis?

    <p>Platelet-rich plasma (PRP). (C)</p> Signup and view all the answers

    What is the mechanism of action of paracetamol theorized to involve?

    <p>Inhibition of COX-3 at the CNS level. (D)</p> Signup and view all the answers

    What is a primary benefit of platelet-rich plasma (PRP) in sports medicine?

    <p>Encourages formation of growth factors through activated platelets (C)</p> Signup and view all the answers

    Which of the following statements about Resiniferatoxin (RTX) is correct?

    <p>RTX functions by activating the vanilloid receptor 1 involved in nociception (D)</p> Signup and view all the answers

    What is the expected duration of effect for hyaluronic acid (HA) when administered in the synovial space?

    <p>It remains effective from 1 to 6 months depending on MW and enzyme activity (C)</p> Signup and view all the answers

    Which aspect of PRP treatment highlights its safety profile?

    <p>Its autologous nature leads to low incidence of infections and inflammation (D)</p> Signup and view all the answers

    What distinguishes hyaluronic acid (HA) from other treatment options mentioned?

    <p>HA has unique antiangiogenic and tissue repair-promoting properties (A)</p> Signup and view all the answers

    What is a significant characteristic of diacerein in its use for arthritis treatment?

    <p>It is a prodrug that is converted to an active metabolite Rhein. (A)</p> Signup and view all the answers

    What common gastrointestinal side effect is associated with prolonged use of diacerein?

    <p>Diarrhea (C)</p> Signup and view all the answers

    Which statement about hyaluronic acid as a treatment for osteoarthritis is true?

    <p>It acts as a lubricant and is a main component of synovial fluid. (B)</p> Signup and view all the answers

    Which aspect of the combination of chondroitin sulfate and glucosamine is accurate?

    <p>It increases both analgesic and anti-inflammatory effects. (B)</p> Signup and view all the answers

    What is one of the mechanisms through which diacerein works in treating osteoarthritis?

    <p>It directly inhibits IL-1β and modulates the inflammatory cascade. (C)</p> Signup and view all the answers

    What is the mechanism of action for tramadol?

    <p>Centrally acting μ-agonist and SNRI (C)</p> Signup and view all the answers

    Which of the following analgesic medications has a risk of developing less tolerance compared to other opioids?

    <p>Tramadol (D)</p> Signup and view all the answers

    What is a significant side effect associated with the use of NSAIDs?

    <p>Gastro-lesive effects (C)</p> Signup and view all the answers

    Which medication is administered directly into the affected joint to minimize systemic effects?

    <p>Intra-articular corticosteroids (C)</p> Signup and view all the answers

    What is a potential interaction concern when taking NSAIDs with oral anticoagulants?

    <p>Gastrointestinal bleeding (B)</p> Signup and view all the answers

    What is the primary goal of intra-articular corticosteroid injections?

    <p>Inhibition of inflammatory mediators (D)</p> Signup and view all the answers

    Which of the following NSAIDs has a long half-life allowing for once daily dosing?

    <p>Meloxicam (B)</p> Signup and view all the answers

    What is a notable adverse drug reaction (ADR) associated with tramadol?

    <p>Hypotension (B)</p> Signup and view all the answers

    What is the primary cause of osteoarthritis?

    <p>Imbalance in cartilage matrix synthesis and degradation (C)</p> Signup and view all the answers

    Which statement accurately describes the epidemiology of osteoarthritis?

    <p>It is more common in women than in men, particularly after age 60. (C)</p> Signup and view all the answers

    What role do chondrocytes and synoviocytes play in osteoarthritis?

    <p>They are the primary producers of collagen and hyaluronic acid. (C)</p> Signup and view all the answers

    How does osteoarthritis manifest in patients?

    <p>Pain, bone deformation, and loss of joint function. (C)</p> Signup and view all the answers

    What is one of the consequences of osteoarthritis on a person’s professional life?

    <p>Reduction of working days. (C)</p> Signup and view all the answers

    How does the inflammatory process relate to osteoarthritis?

    <p>It causes activation of degradative enzymes and proinflammatory mediators. (A)</p> Signup and view all the answers

    What distinguishes osteoarthritis from rheumatoid arthritis?

    <p>Osteoarthritis results from mechanical stress and cartilage degradation rather than autoimmune factors. (B)</p> Signup and view all the answers

    Which of the following is NOT a characteristic of articular cartilage?

    <p>Has a high cellularity (B)</p> Signup and view all the answers

    Which of the following mechanisms of action is attributed to Chondroitin sulfate in the treatment of osteoarthritis?

    <p>Reduction of catabolic activity of chondrocytes (A)</p> Signup and view all the answers

    What distinguishes SYSADOA from traditional NSAIDs in terms of treatment effect duration?

    <p>SYSADOA maintains effect even for months after treatment withdrawal (B)</p> Signup and view all the answers

    Which of the following statements about glucosamine sulfate is true?

    <p>It is an amino-monosaccharide important in cartilage biosynthesis (B)</p> Signup and view all the answers

    Which adverse effect is a potential concern when using SYSADOA therapies?

    <p>Immunosuppression and increased possibility of infection (C)</p> Signup and view all the answers

    What role does hyaluronic acid play in intra-articular administration?

    <p>Enhances synovial fluid viscosity to improve joint function (B)</p> Signup and view all the answers

    Which of the following statements accurately describes the nature of SYSADOAs?

    <p>They are typically slow-acting but have long-term benefits (C)</p> Signup and view all the answers

    Which inflammatory factors are inhibited by Chondroitin sulfate?

    <p>Tumor necrosis factor-alpha and interleukin-1beta (C)</p> Signup and view all the answers

    What characterizes the administration routes of glucosamine sulfate?

    <p>Can be administered orally or intra-articularly (C)</p> Signup and view all the answers

    Flashcards

    Paracetamol

    A type of medication that relieves pain without reducing inflammation. It's commonly used for mild osteoarthritis.

    Analgesic Drugs

    A group of drugs that target a specific enzyme (COX-3) in the central nervous system (CNS) to reduce pain.

    Hepatic Metabolism

    The process by which the body breaks down and removes drugs, usually in the liver.

    COX-3

    A drug target, a protein that catalyzes chemical transformations in the body.

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    N-acetylbenzoquinone Imine

    An extremely toxic metabolite of paracetamol that can lead to liver failure if not neutralized.

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    Tramadol

    A type of opioid used to manage moderate to severe osteoarthritis pain. It works by stimulating opioid receptors in the brain, decreasing pain signals and potentially affecting mood.

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    NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

    A class of drugs that block the production of prostaglandins, reducing inflammation and pain. Examples include diclofenac, aceclofenac, piroxicam, and meloxicam.

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    Celecoxib

    A specific type of NSAID that selectively inhibits COX-2, an enzyme involved in inflammation. It's often used for its pain-relieving properties.

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    Intra-Articular Corticosteroid Injections

    A group of medications that have powerful anti-inflammatory and immunosuppressive properties. They are directly injected into joints to control inflammation and pain.

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    Symptomatic Treatment

    The process of reducing pain signals and inflammation in the body using medications.

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    Pharmacological Treatment

    A category of treatment used to manage osteoarthritis that involves medications like tramadol and NSAIDs.

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    What is osteoarthritis?

    Osteoarthritis is a chronic, degenerative joint disorder that causes pain, stiffness, and loss of joint function.

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    What causes osteoarthritis?

    Osteoarthritis is characterized by progressive cartilage breakdown, leading to inflammation and pain. This process can cause significant disability.

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    What is cartilage?

    Osteoarthritis is a disease that affects the joints, primarily the cartilage. Cartilage is a type of connective tissue that helps to cushion and protect the bones.

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    How is osteoarthritis different from rheumatoid arthritis?

    Osteoarthritis is different from rheumatoid arthritis, which is an autoimmune disease. Osteoarthritis is primarily caused by mechanical wear-and-tear of the joints, while rheumatoid arthritis is caused by an immune response that attacks the joints.

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    Who is most affected by osteoarthritis?

    Osteoarthritis is more common in women than in men, especially after the age of 60. It is the 6th leading cause of disability globally.

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    What is the etiology of Osteoarthritis?

    Osteoarthritis is caused by an imbalance in the production and breakdown of the extracellular matrix of cartilage, leading to chronic inflammation. Mechanical stress on the joints can contribute to this imbalance.

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    What is articular cartilage?

    Articular cartilage is a type of connective tissue that covers the ends of bones in a joint. It is composed of cells called chondrocytes that produce and maintain the extracellular matrix of cartilage.

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    What are chondrocytes and synovial cells?

    Chondrocytes and synovial cells are key players in maintaining the health of joints. They both produce collagen and hyaluronic acid, which are essential for cartilage function.

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    What are SYSADOAs?

    Drugs that slow down the progression of osteoarthritis, particularly helpful in reducing pain and improving joint function.

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    How do SYSADOAs work?

    SYSADOAs are generally considered to work by promoting the synthesis of proteoglycans, which are essential components of cartilage, while inhibiting the breakdown of cartilage.

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    What is Chondroitin Sulfate?

    Chondroitin sulfate is a sugar molecule that is a key component of cartilage, helping to give it its structure and flexibility.

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    What is Glucosamine?

    Glucosamine is a naturally occurring amino sugar that plays a vital role in the production of cartilage.

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    How do Chondroitin Sulfate and Glucosamine work together?

    Chondroitin sulfate and glucosamine work together to support the health of cartilage and slow down the progression of osteoarthritis.

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    What is Diacerein?

    Diacerein is an oral medication that helps to reduces inflammation and pain in the joints affected by osteoarthritis.

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    What is Hyaluronic Acid Viscosupplementation?

    Hyaluronic acid is a natural substance found in the joints that helps to lubricate and cushion cartilage. Viscosupplementation involves injecting hyaluronic acid into the joint to restore lubrication.

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    Are SYSADOAs generally safe?

    SYSADOAs are generally considered to be safe and well-tolerated, with few side effects.

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    Chondroitin Sulfate + Glucosamine Combination

    A synthetic drug that combines chondroitin sulfate and glucosamine. It's used to treat osteoarthritis, potentially helping to rebuild cartilage and reduce inflammation. It takes a few weeks for it to start working and can stay effective for a while after stopping the treatment, although the exact way it works is unclear.

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    SYSADOA (Disease-Modifying Osteoarthritis Drugs)

    A group of drugs used to treat osteoarthritis that work by modifying the disease process, often by reducing inflammation and protecting cartilage.

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    Diacerein

    A drug that works by slowing down the inflammatory process in the joints. It's a prodrug, meaning it's transformed into its active form (rhein) inside the body. Diacerein can take a few weeks to start working and its effects can last for a few months even after stopping the treatment.

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    Hyaluronic Acid (HA)

    A vital component of synovial fluid, providing lubrication and shock absorption to joints. In osteoarthritis, hyaluronic acid can get broken down, leading to reduced joint lubrication and increased risk of damage.

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    Viscosupplementation

    A type of medicine that involves injecting hyaluronic acid directly into the joint space. This can help to improve lubrication and cushioning in osteoarthritic joints.

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    Platelet-Rich Plasma (PRP)

    A blood-derived product containing a high concentration of platelets. When activated, platelets release growth factors that stimulate tissue regeneration and repair.

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    Resiniferatoxin (RTX)

    A naturally occurring capsaicin analog used to treat pain associated with osteoarthritis (OA). It works by targeting sensory neurons involved in pain perception.

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    Vanilloid Receptor 1 (TRPV1)

    A receptor found on certain sensory neurons that is activated by capsaicin and RTX, contributing to pain sensation.

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    Non-Opioid Drug

    A type of medication that does not belong to the opioid family. Examples include RTX, which is currently in Phase III trials for OA pain.

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    Study Notes

    Osteoarthritis (OA)

    • OA is a progressive, disabling joint disorder
    • It's caused by a chronic, degenerative inflammatory process
    • Significantly reduces patient quality of life
    • Results in pain, bone deformation, and loss of joint function

    Etiopathogenesis of OA

    • OA has a multifactorial origin
    • The primary driving force is an imbalance between cartilage synthesis and degradation
    • This creates a chronic inflammatory process

    Epidemiology of OA

    • Symptomatic OA is more prevalent in women than men (especially after age 60)
    • It's the sixth leading cause of disability worldwide
    • Work restrictions are more significant in those with OA compared to healthy individuals
    • Reasons include reduced working days and premature work abandonment due to disease progression

    Risk Factors for OA

    • Systemic: Age, sex hormones, ethnicity, genetics, congenital/developmental conditions
    • Local: Obesity, injury/surgery, employment, mechanical factors

    Diagnosis of OA

    • Three key factors for diagnosis: patient history, objective examination, and X-ray
    • Physical/gait evaluation: complete examination in both standing and supine positions includes range of motion (active and passive)
    • Radiography: essential for definitive diagnosis of knee OA; identifies joint space reduction and osteophytes

    Kellgren and Lawrence Classification of OA

    • System for grading OA severity based on X-ray findings
    • Grades range from 1 (doubtful) to 4 (severe)
    • Grades are determined by the presence and severity of osteophyte formation and joint space reduction

    Treatment of OA

    • Preventive Treatment

      • Weight loss
      • Physical exercise
      • Physiotherapy
    • Pharmacological Treatment

      • Symptomatic: Analgesics (paracetamol, tramadol), NSAIDs (diclofenac, meloxicam), COXIB (celecoxib), intra-articular corticosteroid injections.
      • Chondroprotective: Symptomatic slow-acting drugs for osteoarthritis (SYSADOA) (e.g., glucosamine sulphate, chondroitin sulphate, diacerein, hyaluronic acid viscosupplements)
    • Surgical Treatment

      • Conservation: Symptomatic treatment, arthroscopy, joint surface repair procedures, Autologous chondrocyte transplant (ACT), Autologous osteochondral transplantation (OCT), bone microfracture, and aberration arthroplasty, joint alignment procedure, osteotomy
      • Replacement: Unicompartmental, Total knee arthroplasty

    New Therapies

    • Platelet-rich plasma (PRP): Autologous plasma with growth factors for treating OA
    • Resiniferatoxin (RTX): New experimental non-opioid drug for pain and improving joint functionality

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