Medical Insider
Dr. Cora Lim
For APRIL 30 2023

Applied Rheumatology Made Simple (A.R.M.S.)

(Part 5)

Let us now discuss the topic on OSTEOARTHRITIS. This is a
common subject matter being tackled by many.
Osteoarthritis Generalities:
We have listed below some generalities about osteoarthritis. The
list includes:

  • Cartilage degradation: loss of matrix integrity
  • Role of cytokines, enzymes, nitric oxide
  • Age as the strongest risk factor
  • Other risk factors: obesity, injury, muscle weakness
  • Knees and hips are most commonly affected
  • Heberden’s and Bouchard’s nodes;
  • Mechanical pain, no systemic features
    Please take note of the following: the typical stance of a patient
    with knee OA – elderly female; often overweight; with genu varum
    deformity; they usually complain of a “mechanical” knee pain;
    characteristically felt on initial standing from a prolonged sitting
    position; unlike RA, these patients do not have any systemic
    manifestations.

Osteoarthritis of the hands typically present as Heberden’s and
Bouchard’s nodes. These are more likely to cause cosmetic
rather than functional impairment.
Management of Osteoarthritis:
The non-pharmacologic management of osteoarthritis includes
the following:
 Heat and cold treatments
 Jooint protection (e.g. weight reduction, orthotics, assistive
devices
 Exercises e.g. isometrics. Stationary cycling
The pharmacologic management of osteoarthritis includes the
following:
 Analgesic
 systemic and topical
 Nonsteroidal anti-inflammatory drugs (especially specific
COX-2 inhibitors)
 Intra-articular steroid
 Intra-articular hyaluronate
 Disease-modifying drugs
Management of Knee OA
The management of Knee OA includes the following:
 Non-pharmacologic modalities
 Considering aspiration of Pee joint & intra-articular steroids
 Acetaminophen; if necessary, add capsaicin cream
 If inadequate. use low-dose ibuprofen or non-acetylated
salicylates
 If inadequate, use full-dose NSAID with gastric protectants
 If inadequate, joint lavage. or PY licker) st debridement
 If inadequate, surgery
Some of the exercise considerations of Hip or Knee
Osteoarthritis-1

 Maintain proper weight
 Maintain range of motion and flexibility
 Exercise in water, on a bicycle or a rowing machine
 Alternate weight-bearing and non-weight-bearing activities
 Use cane on contralateral side
Some of the exercise considerations in Hip or Knee
osteoarthritis-II
 Do not carry loads more than 10% body weight
 Minimize use of stairs, one-legged stance, low seating
 Walking speed should not exacerbate joint symptoms
 Select shoes and insoles for shock attenuation
 Warm-up prior to walking exercise
In our next issue, we will discuss the following topics: spectrum
gout, gouty arthritis generalities, gout associated factors,
treatment of gout, gout and diet, heperuricemia, monoarthritis, the
septic joint, and the arthritis-rash syndromes,