Osteoarthritis Diagnosis and Management

NR GrandroundsA 75-year old female has pain brought by osteoarthritis in her right knee. She reports tenderness over joint line, pain with activities, and feels like giving away or locking at times. She also complains of limited activity and passive range of motion on right knee.

Case Study

This condition is characterized by the progressive loss of joint cartilage, which is detected on x-ray as a narrowing of the joint space (Workman & Rebar, 2018). Additionally, as the cartilage tries to regenerate, reactive changes take place at joint margins and the subchondral bone in the form of osteophytes. Early OA is characterized by weak correlation between joint pain and synovitis.

Criteria for Diagnosis

Osteoarthritis is a degenerative joint disease brought by joint dysfunction and is characterized by pain and limited range of motion (Kanamoto et al., 2020). It is the progressive joint weakening and loss of cartilage and bone.

Definition

The diagnosis of this condition is based on presenting symptoms, physical signs, x-ray, and laboratory tests (Chinese Orthopaedic Association, 2010). In laboratory assessment, the erythrocyte sedimentation rate (ESR) and high-sensitivity C-reactive protein (hsCRP) may be slightly high when secondary synovitis (synovial inflammation) occurs. ESR also tend to increase with age, infection, and other inflammatory disorders. Routine x-rays are useful imaging assessments for identifying structural joint changes. Additional imaging assessments include magnetic resonance imaging (MRI) and computed tomography (CT).

Diagnostic

Tests

OA management involves the use of non-pharmacological and pharmacological treatment. Some of the recommended non-pharmacological treatment measures recommended by the American College of Rheumatology include exercise, weight loss/control, joint positioning, heat or cold applications, and a series of complementary and alternative therapies (Kolasinski et al., 2020).

Non-pharmacological Treatment

One of the barriers to practice relating to the use of pharmacological treatment for OA is inconsistency in clinical practice guidelines as evidence changes with time (Egerton et al., 2016). Additional barriers include patient-related factors and beliefs about OA and its management, difficulties in long-term adherence, and lack of sufficient information.

Barriers to Practice

Pharmacological treatment is administered if non-drug treatment proves ineffective and based on the severity of the joint pain. An assessment of patient-related risk factors is carried out before the drugs are administered and dosage is individualized and kept at minimum (Chinese Orthopaedic Association, 2010).

Drug Use

OA management involves pharmacological treatment using topical drugs to help with temporary pain relief, and oral drugs. Commonly prescribed topical drugs include lidocaine %% patches (Lidoderm), aspercreme patch, gel, or cream, buspirone topical cream, and nonsteroidal anti-inflammatory drugs (NSAIDs). Other oral drugs include muscle relaxants such as cyclobenzaprine and hydrochloride (Flexeril) as well opioids. Surgical procedures like total joint arthroplasty (TJA) and total joint replacement (TJR) could be used.

Pharmacological Treatment

One of the expected outcomes of medication management is to relieve pain. Additionally, drugs are used to help enhance the cartilage-protective agents and disease condition. Follow-up care involves conducting blood tests to examine disease condition and based on a patient’s characteristics.