The most common form of disease of the joint is Osteoarthritis (OA). It affects people from all the races, ages, and geographical location. Osteoarthritis is a degenerative disease of the joints that usually lacks systemic manifestations. OA is more prevalent in older adults, affecting about 33% of people over 65 years and 14% of adults over 25 years. Other risk factors include genetics, race, weight, gender, occupation, and prior joint injury (Arcangelo, & Peterson, 2006). The key features of this disease include bone hypertrophy at the articular margins and cartilage degeneration. The pains that one experiences are usually reduced by rest. The onset phase of osteoarthritis is insidious with the stiffness of the articulations. This stiffness usually lasts for around fifteen minutes. Later, pain is felt on movement, and the pain is made worse through lifting or bearing weight. The proximal and distal interphalangeal joints are the major joints that are affected by osteoarthritis. The pains that one experiences are usually relieved upon weight reduction.
The diagnostic criteria of OA follow the guidelines published by the American College of Rheumatology. Therapy and management follow a thorough physical examination and evaluation of the patient’s history. The management of osteoarthritis is usually divided into non-pharmacological and pharmacological. The non-pharmacological approach is mainly used for those patients experiencing mild to moderate osteoarthritis of the joints which bear weight (Glyn-Jones et al., 2015). This approach usually precedes the initiation of drug therapy and involves physical activity. In this approach, a walking program, which is supervised, may result in improvement of the condition without causing an increase in the pain that is experienced at the joints. In obese patients, the loss of weight also results in improvement of the symptoms.
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Pharmacological management usually involves several drugs. Analgesics are the commonly used drugs for this disease. Acetaminophen is the first line analgesic recommended by the ACR. This is due to its relative safety and cost-effectiveness. This drug should be administered at a dosage of 650 mg for every 4 to 6 hours (Arcangelo, & Peterson, 2006). Chondroitin sulfate and glucosamine are also safe and effective, and they are used as cartilage and bone supplements. In the vents that a patient does not respond to acetaminophen, glucosamine, and chondroitin sulfate, then non-steroidal anti-inflammatory drugs should be considered. If a patient has knee osteoarthritis and effusion, triamcinolone injection (20-40 mg), is administered intra-articularly twice or thrice a year. Capsaicin cream 0.025% can be used to reduce the pain that is experienced without using NSAIDS if applied twice daily (Palazzo et al., 2016). In some instances, usage of estrogen replacement therapy is used to reduce the risk of hip and knee osteoarthritis. Other forms of therapy include total hip replacement and total knee replacement in the case of hip and knee osteoarthritis.
Age is a critical factor that is considered in the management of osteoarthritis. When managing patients with this condition, it is necessary to consider the elderly and the young. The elderly have reduced glomerular filtration of most drugs. Hence, most drugs will accumulate in the body for long thus raising their plasma levels (Palazzo et al., 2016). Also, most of the elderly are on several drugs, and there is likely to be drug-drug interactions with the various medications for other chronic conditions such as hypertension and diabetes. Due to their low rates of pharmacokinetics, topical agents such as capsaicin and topical NSAIDs may also be preferred in the treatment of older adults (Arcangelo, & Peterson, 2006). In the case of children, very young children have low rates of glomerular filtration. In addition, some of the drugs used to manage pain, such as the NSAIDS may have adverse effects on children. For example, aspirin may cause Reyes syndrome in children, which may be fatal.
In the management of osteoarthritis, it is essential to go through patient history and to be aware of the various drug allergies that the patient may be having. Besides, it is vital to be aware of the other drugs that the patient is using to predict the drug-drug interactions that are likely to occur. For patients with renal problems, the dosage of the drugs must be adjusted to ensure that the medicines do not accumulate to toxic levels.
References
Arcangelo, V. P., & Peterson, A. M. (Eds.). (2006). Pharmacotherapeutics for advanced practice: a practical approach (Vol. 536). Lippincott Williams & Wilkins.
Glyn-Jones, S., Palmer, A. J. R., Agricola, R., Price, A. J., Vincent, T. L., Weinans, H., & Carr, A. J. (2015). Osteoarthritis. The Lancet , 386 (9991), 376-387.
Palazzo, C., Nguyen, C., Lefevre-Colau, M. M., Rannou, F., & Poiraudeau, S. (2016). Risk factors and burden of osteoarthritis. Annals of physical and rehabilitation medicine , 59 (3), 134-138.
