Osteoarthritis seminar

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Questions and Answers

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?

Platelet-rich plasma (PRP). Signup and view all the answers

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

Inhibition of COX-3 at the CNS level. Signup and view all the answers

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

Encourages formation of growth factors through activated platelets Signup and view all the answers

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

RTX functions by activating the vanilloid receptor 1 involved in nociception Signup and view all the answers

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

It remains effective from 1 to 6 months depending on MW and enzyme activity Signup and view all the answers

Which aspect of PRP treatment highlights its safety profile?

Its autologous nature leads to low incidence of infections and inflammation Signup and view all the answers

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

HA has unique antiangiogenic and tissue repair-promoting properties Signup and view all the answers

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

It is a prodrug that is converted to an active metabolite Rhein. Signup and view all the answers

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

Diarrhea Signup and view all the answers

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

It acts as a lubricant and is a main component of synovial fluid. Signup and view all the answers

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

It increases both analgesic and anti-inflammatory effects. Signup and view all the answers

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

It directly inhibits IL-1β and modulates the inflammatory cascade. Signup and view all the answers

What is the mechanism of action for tramadol?

Centrally acting μ-agonist and SNRI Signup and view all the answers

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

Tramadol Signup and view all the answers

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

Gastro-lesive effects Signup and view all the answers

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

Intra-articular corticosteroids Signup and view all the answers

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

Gastrointestinal bleeding Signup and view all the answers

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

Inhibition of inflammatory mediators Signup and view all the answers

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

Meloxicam Signup and view all the answers

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

Hypotension Signup and view all the answers

What is the primary cause of osteoarthritis?

Imbalance in cartilage matrix synthesis and degradation Signup and view all the answers

Which statement accurately describes the epidemiology of osteoarthritis?

It is more common in women than in men, particularly after age 60. Signup and view all the answers

What role do chondrocytes and synoviocytes play in osteoarthritis?

They are the primary producers of collagen and hyaluronic acid. Signup and view all the answers

How does osteoarthritis manifest in patients?

Pain, bone deformation, and loss of joint function. Signup and view all the answers

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

Reduction of working days. Signup and view all the answers

How does the inflammatory process relate to osteoarthritis?

It causes activation of degradative enzymes and proinflammatory mediators. Signup and view all the answers

What distinguishes osteoarthritis from rheumatoid arthritis?

Osteoarthritis results from mechanical stress and cartilage degradation rather than autoimmune factors. Signup and view all the answers

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

Has a high cellularity Signup and view all the answers

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

Reduction of catabolic activity of chondrocytes Signup and view all the answers

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

SYSADOA maintains effect even for months after treatment withdrawal Signup and view all the answers

Which of the following statements about glucosamine sulfate is true?

It is an amino-monosaccharide important in cartilage biosynthesis Signup and view all the answers

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

Immunosuppression and increased possibility of infection Signup and view all the answers

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

Enhances synovial fluid viscosity to improve joint function Signup and view all the answers

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

They are typically slow-acting but have long-term benefits Signup and view all the answers

Which inflammatory factors are inhibited by Chondroitin sulfate?

Tumor necrosis factor-alpha and interleukin-1beta Signup and view all the answers

What characterizes the administration routes of glucosamine sulfate?

Can be administered orally or intra-articularly Signup and view all the answers

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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