Transcript Osteoarthritis and Aging 50-80% of Americans 65 years or

Osteoarthritis and Aging
50-80% of Americans 65 years or older are affected by osteoarthritis. It is the most
prevalent form of arthritis in the US and is responsible for half of all disabilities. It is commonly associated
with pain, functional disability and being homebound.
Treatments
Definition
• Degenerative arthritis or
degenerative joint disease
• Mechanical abnormalities
– Degradation of the joints
• Articular cartilage
• Subchondral bone
Symptoms
• Most common:
– Pain
• Worse with exercise and
weight bearing
– Stiffness
• Over time rubbing, grating,
crackling
• Morning stiffness (≈ 30
minutes)
Potential Causes
Goals of treatment are pain relief and improvement or
maintenance of functional status
• Lifestyle changes:
• Weight loss
• Exercise
• Physical Therapy
• Medications
• Surgical Intervention – Last Resort
Drug
acetaminophen
Dose
325-500 mg
Frequency
Q4-6 hours
(Most effective
when dosed
around the clock)
ADE/Monitoring
Max of 3g/day
Liver toxicity
NSAIDS
Varying
Varying
Tramadol
50-100 mg
Q 4-6 hours
GI and renal toxicities
GI prophylaxis in
patients:
>75, hx of bleed, PUD,
warfarin use, long-term
steroid use
Sedation
Dose reduction required
for CrCl <30 mL/min
Capsaicin
0.1% cream
Apply QID
Burning, erythema
Should not be applied to
broken skin.
Wash hands thoroughly
after use.
Diclofenac
topical
2 grams-Hand
4 grams-Knee
Apply QID
6% systemic absorption
Should not be used with
oral NSAID therapy.
• Aging
• Wear and tear
– Bony spurs or formation of
extra bone
– Weakening and stiffening of
ligaments and muscles
around the joint
• Overweight
• Fractures or other joint
injuries
• Jobs
• Playing sports
• Bleeding disorders that cause
bleeding into joints
• Disorders that block blood
supply to the joint
• Gout, Pseudogout, or RA
Aging Q3 Osteoarthritis ACOVE Skill
Complete a functional assessment on ALL patients 65 and over.
MD Ask:
1. In the last 3 months, when patient was at his/her best, was
patient able to:
a. Walk across the room?
b. Do light housework (i.e.washing dishes, straightening
up, or light cleaning)?
c. Shower without assistance?
2. Did this assessment influence your clinical decision making
for this patient today?
YES
NO