OSTEOARTHRITIS (OA)
Osteoarthritis is also known as degenerative joint disease (DJD).
Large weight bearing joints such as the hips and knees and the hands are
most affected. This type of arthritis is insidious. Involved joints maybe
swollen and tender. It may be one-sided and will have absence of
systemic symptoms because it is not a systemic inflammatory disease.
Early morning stiffness lasting less than 30 minutes is the hallmark sign
osteoarthritis. In OA, there is erosion and damage of cartilage with joint
space narrowing and osteophyte formation. Bony nodules on the distal
interphalangeal joints (DIP) are Heberden’s nodes. Bony nodules on
the proximal interphalangeal joints (PIP) are Bouchard’s nodes.
Treatment: first line of Pharmacologic treatment is acetaminophen 325 mg to 650 mg every 4 to 6 hours with a maximum 4 g per day.
If there is no relief with acetaminophen, a short-acting NSAID, such as ibuprofen or naproxen, can be used. However, if a patient is at high risk for G.I. bleeding or has cardiovascular issues, avoid NSAIDs. Topical NSAIDs for treatment of osteoarthritis should be considered for patients greater then 75 years of age.
Nonpharmacologic management: includes weight loss and exercise for muscle strengthening, such as quadriceps strengthening for OA of the knee. Heat or ice may also be applied to the affected area to help decrease pain.