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.
Definition
Potential Causes
Treatments
Symptoms
• Degenerative arthritis or
Most common:
• Subchondral bone
• Pain
• Worse with exercise and
weight bearing
• Stiffness
• Over time rubbing, grating,
crackling
• Morning stiffness (≈30
minutes)
Functional Status
Drug
acetaminophen
degenerative joint disease
• Mechanical abnormalities
– Degradation of the joints
• Articular cartilage
In the last 3 months, when
patient was at his/her best, was
patient able to:
NSAIDS
Dose
325-500 mg
Varying
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
Frequency
Q4-6 hours
(Most effective when
dosed around the
clock)
Varying
• Walk across room
• Do light housework
• Shower without assistance
Tramadol
50-100 mg
Q 4-6 hours
Capsaicin
0.1% cream
Apply QID
Diclofenac
topical
2 grams-Hand
4 grams-Knee
Apply QID
• Aging
• Wear and tear
– Bony spurs or formation of extra
bone
– Weakening and stiffening of
ligaments and muscles around
the joint
ADE/Monitoring
Max of 3g/day
Liver toxicity
• Overweight
• Fractures or other joint injuries
• Jobs
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
Burning, erythema
Should not be applied to
broken skin.
Wash hands thoroughly
after use.
6% systemic absorption
Should not be used with
oral NSAID therapy.
• Playing sports
• Bleeding disorders that cause
bleeding into joints
• Disorders that block blood supply
to the joint
• Gout, Pseudogout, or RA