Day 3- Osteoarthritis

Osteoarthritis

Diagnosis

Infographic OA-The Curbsiders 177 Master Osteoarthritis with Tunhina Neogi MD PhD.png

  • This can be made on history and exam alone

  • Pain with weight bearing and worsening pain with activity

  • in most cases, imaging not required (plain radiographs can be insensitive)

Physical Exam

  • observe patients gait and alignment of joints

  • classic findings include crepitus, restricted or painful movement, joint line tenderness and bony enlargement

Treatment

Acute pain crisis requiring hospital admission:

  • Non pharm: Occupational therapy, physiotherapy, strength training, weight loss

  • Pharm:

    Make sure you prescribe standing and breakthrough pain management

    • topical NSAIDs (diclofenac)

    • Oral NSAIDs (make sure patient has no contraindication such as CKD, NSAID’s should be prescribed for a limited time only)

    • Tylenol

    • Morphine, hydromorphine (again, prescribed for a limited time only or right before physiotherapy sessions)

    • In severe cases, consider intra-articular corticosteroid injection

  • A typical order for in-hospital OA pain management might be:

    82 yo F, admitted to hospital as pain in bilateral knees so severe that she cannot get out of bed, previously on no pain medications, red flag causes ruled out, Creatinine 80

    • Tylenol 650mg PO BID

    • Ibuprofen 400mg PO BID x 72 hrs then reassess

    • Dilaudid 0.5mg PO qdaily PRN 1 hour before physiotherapy x 72 hrs then reassess

    • Diclofenac gel apply to affected knee BID PRN for breakthrough pain

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