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Osteoarthritis-Individualization of therapy

                         


    Kaleem Mohammed, Rph, PhD
Osteoarthritis (OA) is a progressive degenerative disease of weight-bearing joints and the leading cause of disability, pain and stiffness in elderly. 

Current management of OA includes weight management, exercise, nonsteroidal anti-inflammatory drugs (NSAIDs), tramadol, intra-articular corticosteroid injections, opiates and topical medications.
  


Gastrointestinal adverse effects with traditional NSAIDs and cardiovascular adverse effects associated with selective cyclooxygenase-2 (COX-2) inhibitors call for more effort to find a better NSAID with no or minimal adverse effects. 


Renal function should be monitored in the elderly on NSAIDs.  Tramadol can be used in chronic kidney disease patients
(GFR <30 ml/min: dose q 12 h; maximum tramadol dose 100 mg/day in advanced CKD)

In addition, prophylactic medications like omeprazole and ranitidine can be used to reduce risk of gastrointestinal ulceration, perforation and bleeding is recommended in patients > 60 years of age 




References:

1.       Pain management in patients with chronic kidney disease NDT Plus. 2009 Apr; 2(2): 111–118.

2. National Guideline Clearinghouse: Guideline Summary: American Academy of Orthopaedic Surgeons clinical practice guideline on the treatment of osteoarthritis of the knee, 2nd edition. (Summary of a guideline from American Academy of Orthopaedic Surgeons.) NGC website. Published 1996. Revised May 18, 2013.

 3. National Institute for Health and Care Excellence: Osteoarthritis: care and management in adults. NICE guideline CG177. NICE website. Published February 2014. 

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