Osteoarthritis (OA)

Last updated 20.09.12

 

Index

 

Definition

-  Chronic, slowly progressive degenerative joint disease

 

Features

-   

 

Risk Factors

-  Obesity

-  Knee & hip OA

-   

 

Causes

-   

 

Associated S/S

-   

 

Ix

-   

 

Mx

-  Goals

-  Reduce pain

-  Improve & maintain function

-  Prevent disability

-  Preserve QOL

-  Reduce modifiable risk factors

-  Self management techniques

-  Regular LMO R/V

-  Exercise

-  Structured low resistance exercise: swimming, walking, tai-chi

-  Aerobic

-  Strength & flexability

-  Reduces pain & improves function

-  Weight loss

-  Even modest weight loss can improve pain & function

-  Aim for 5%+ weight reduction over 6months

-  +/- splints for hand/thumb OA

-  Analgesia ladder

-  Thermotherapy: heat &/or ice

-  Pain management diary (NPS)

-  +/- Acupuncture, TENS, bracing, massage

-  Paracetamol regularly

-   1g QID or 1.3g TDS

-  Fish oil

-  Glucosamine

-  Evidence for knee OA

-  Trail for 3-6/12 1500-2000mg Daily

-  +/- NSAIDs PRN

-   Consider comorbidities

-  Then consider Tramadol OR other narcotics

-  Used with caution & trialled for short time

-  Intra-articular medications

-  Intra-articular Steroid/LA

-   May provide relief for up to 4/52 (or even 12/52 for hip & hands)

-   Particularly useful if improved function required for specific event

-   May fadcilitate exercise regimen

-   Rest for 24hrs post injection

-   Avoid injections >4/yr

-  Hyaluronan (Synvisc)

-   Single injection or weekly for 3-5 weeks

-   Variable clinical evidence

-   $$$

-  Referrals

-  Arthritis Australia: education, activities, social support

-  OT, Physio, podiatrists: self Mx, exercise

-  Orthopaedics

-  Surgery

-  Failure of conservative Mx

-  Best before significant functional decline

-  Arthroplasty

-  Arthroscopy

 

 

 

References

 

eTG: Osteoarthritis, accessed 12/03/2013