Internal Medicine

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

Osteoarthritis 1095

■Local corticosteroid injections

➣Useful in less severe disease

➣Limit to 4x/yr

■Local hyaluronic acid injections: series of 3–5 weekly injections

➣Approved only for knees

➣Benefit may last 6–12 months

Surgical Options

■Arthroscopic surgery: often useful in knees, shoulders

■Total joint arthroplasty for hips, knees, shoulders

■Fusion, osteotomy, for selected joints

Side Effects & Contraindications

■Analgesics: acetaminophen used w/ caution w/ liver disease, alcohol

use

■NSAIDs: renal impairment, salt & fluid retention

➣Caution: hypertension, heart failure, edematous states

➣GI hemorrhage

Risk factors

Previous peptic ulcer disease

Age >65

Concomitant use of oral steroids, anticoagulants

Protective measures

Misoprostol

Proton pump inhibitor

COX-2 selective NSAID (celecoxib)

■Steroid injections: transient local pain, infection (rare)

■Surgery: general surgical risks (cardiac, pulmonary, thrombosis)

➣Infection

➣Long-term loosening

follow-up

■Initial assessment of response to therapies (every 2–4 months)

■Long-term assessment for loss of response (every 6–12 months)

■Watch for complications of NSAIDs

complications & prognosis

■Progression to end-stage joint disease, but is usually slow (over 5–20

years)

■End-stage joint disease leading to severe disability most common in

knees, hips