CSB601 Osteoarthritis PDF

FACULTY OF HEALTH Dr. Katie Browne (Gillette) PhD, Bpharm, Bsci (Hons) [email protected] Selena Boyd BPharm, BSci (Hons) MPS Osteoarthritis WELCOME TO COUNTRY Acknowledgement of Traditional Owners In keeping with the spirit of Reconciliation, We acknowledge the Turrbal, Jagera/Yuggera, Ka...

FACULTY OF HEALTH Dr. Katie Browne (Gillette) PhD, Bpharm, Bsci (Hons) [email protected] Selena Boyd BPharm, BSci (Hons) MPS Osteoarthritis WELCOME TO COUNTRY Acknowledgement of Traditional Owners In keeping with the spirit of Reconciliation, We acknowledge the Turrbal, Jagera/Yuggera, Kabi Kabi and Jinibara Peoples as the Traditional Owners of the lands where QUT now stands – and recognise that these have always been places of teaching and learning. We wish to pay respect to their Elders – past, present and emerging – and acknowledge the important role Aboriginal and Torres Strait Islander people continue to play within the QUT community. www.reconciliation.qut.edu.au Qld University of Technology 2 Faculty of Health Learning Objectives For this lecture, we will: Discuss the pathophysiology and risk factors of OA Discuss the non-pharmacological management and treatment options of OA Discuss the pharmacology of the therapies available for OA Qld University of Technology 3 Faculty of Health Osteoarthritis- Background Osteoarthritis (OA) is the most common chronic joint problem, affecting over 2.2 million Australians in 2015 More common among females than males (reported in 18% of females compared with 10% of males) Because of its high prevalence & involvement of joints critical for daily functioning, the disease causes tremendous morbidity & financial burden Qld University of Technology 4 Faculty of Health Osteoarthritis classification (Information ONLY) Primary Osteoarthritis Secondary Osteoarthritis Localized (involving 1 or 2 Mechanical incongruity of joint sites) Congenital or developmental defect Posttraumatic Generalized (involving ≥3 sites) Prior inflammatory disease (rheumatoid arthritis, chronic gouty arthritis, pseudogout, infectious arthritis) Erosive Metabolic disorder (hemochromatosis, Wilson’s disease, Paget’s disease) Endocrinopathies (diabetes mellitus, obesity, sex hormone abnormalities) Neuropathic disorders Intra-articular corticosteroid overuse Avascular necrosis Bone dysplasia Table adapted from Pharmacotherapy Principles & Practice 5 What is OA? “Osteoarthritis is a metabolically active, ongoing process of degradation and synthesis involving the different tissue-types within the affected joint including cartilage, bone, synovium, ligaments and muscle” Sometimes considered “wear and tear” BUT there’s more to it than that: There is inflammation involved –mild/moderate at least intermittently As OA progresses, cartilage synthesis is disrupted by inflammation. Synovial fluid in the joint starts to thin and is produced in smaller quantities. – Results in the loss of joint lubrication and impaired ability to withstand weight loads – Cartilage and eventually bone is exposed and become damaged Qld University of Technology 6 Faculty of Health Pathophysiology: Damage to OA Joint 7 Presentation of Osteoarthritis General Patients are generally over age of 50 Spectrum of symptoms at diagnosis ranging from asymptomatic to severe joint pain & stiffness with limitations to daily functioning Joint involvement has an asymmetric distribution without systemic symptoms In contrast with some other forms of arthritis (e.g., rheumatoid arthritis & gout), inflammation is often absent (settled) & is mild & localized when present (flare) Qld University of Technology 8 Faculty of Health Presentation of Osteoarthritis Symptoms Cardinal symptoms are use-related joint pain (gradual onset), typically described as deep, aching in character, & stiffness In advanced cases, pain also may be present during rest Weight-bearing joints may be hindered by instability – Knees, hips, lower spine Stiffness generally lasts < 30 mins, limits range of joint motion, impairs daily activities, & may be related to weather Psychosocial aspects – depressed mood, loss of independence, anxiety Qld University of Technology 9 Faculty of Health Presentation of Osteoarthritis Symptom – Pain Can be categorised as either: – Acute pain, caused by an active inflammatory process, Or – Chronic pain, resulting from peripheral & central sensitisation that due to persistent pain Qld University of Technology 10 Faculty of Health Presentation of Osteoarthritis Signs One or more joints may be involved, usually in an asymmetric pattern. The following sites are most often involved in OA: – Distal finger joints (Heberden’s nodes) – Proximal finger joints (Bouchard’s nodes) – Wrist – Knees, hips, & lower spine – Big toe Qld University of Technology 11 Faculty of Health  Risk factors Woolcock K. Essential CPE: Osteoarthritis. Canberra (ACT): Qld University of Technology 12 Pharmaceutical Society of Australia; 2008. Faculty of Health Management Goals in management of patients with osteoarthritis are: Patient and caregiver education, about both the disease & its management Pain control Maintaining or restoring mobility Minimising functional impairment Altering the disease process and its consequences Improving quality of life Qld University of Technology 13 Faculty of Health Management – Non-pharmacological Weight reduction Exercise programs Physiotherapy Thermotherapy TENS Acupuncture Surgery Insoles Splints/wraps Mobility aids Qld University of Technology 14 Faculty of Health Management- Drug therapy 1st Line: PARACETAMOL – Given in REGULAR divided doses – Very important that the patient is aware of the need to REMAIN on this therapy and not use it “when required” Much more effective when used regularly as “background therapy” than as relief – Now have controlled release option that can be given three times a day rather than four Qld University of Technology 15 Faculty of Health Management- Drug therapy 2nd Line: NSAIDS – Always use lowest effective dose Lots of ADRs: GIT, kidney, cardiac – Can be topical or oral Rubs can be quite useful for many patients – Only to be used INTERMITTENTLY – e.g. before/after exercise or during flare of inflammation Should be on paracetamol for regular relief Qld University of Technology 16 Faculty of Health Management- Drug therapy 3rd Line: Opioids – ONLY use if 1st/2nd line don’t work or contraindicated Should avoid NSAIDs if patient has GORD/PUD, serious cardiac complications – Always start with a WEAK opioid Alternative therapy: – Intra-articular corticosteroid injection – Usually if only one large joint affected, e.g. knee or lower back Qld University of Technology 17 Faculty of Health References 1. AMH 2017 2. eTG online 3. Fundamentals of Pharmacology, 8th Ed. by Shane Bullock and Elizabeth Manias. (Available in both KG and GP libraries) Qld University of Technology 18 Faculty of Health