Internal Medicine

0521779407-16 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

1094 Osteoarthritis

elbows, shoulders, ankles), elevated ESR, positive rheumatoid factor,

erosive changes on radiograph

■Crystal-induced arthritis (gout, pseudogout): acute attacks w/

swelling, inflammatory synovial fluid, crystals in fluid

■Polymyalgia rheumatica: elderly patients, recent onset, predomi-

nant shoulder & hip girdle symptoms, prolonged morning stiffness,

elevated ESR

■Localized bone disorders near joint (eg, fracture, osteonecrosis,

Paget’s disease)

■Psoriatic arthritis: involvement of IP finger joints resembles OA,

younger age

➣Psoriatic skin or nail changes

■Localized musculoskeletal problems: localized to specific periar-

ticular structures (tendons, bursae), pain w/ specific maneuvers,

radiographs normal or only incidental age-related degenerative

changes

management

What to Do First

■Confirm diagnosis

■Assess degree of joint limitation, functional impairment

General Measures

■Modify activities to protect involved joint, but not total rest

■Local heat, other local pain relief measures

■Exercise to increase mobility, strength of periarticular muscles

■Walking program for knee involvement

■Weight loss w/ knee, hip & probably lumbar spine disease

■No known current therapy affects long-term outcome

Braces, canes or crutches as needed

specific therapy

Indications

■Pain & limitation of activity

■Asymptomatic or minimally symptomatic OA need not be treated

w/ specific measures

Treatment Options

■Analgesics: acetaminophen, tramadol, narcotics w/ caution in some

■Topical capsaicin

➣NSAIDs in low to moderate doses

➣Goal of therapy is pain relief