Limit progression of joint damage

■ Educate patients about OA and management (Zhang et al., 2008)

The OARSI Guidelines also recommend both nonpharmaco-logic and pharmacologic interventions. OARSI pharmacologic recommendations include the following:

■ Acetaminophen as first-line treatment: limit to 4 grams per day and reduce amount in patients with hepatic or renal disease or alcoholic patients.

■ NSAIDs provide better relief than acetaminophen but have significant, life-threatening, serious adverse effects. Long-term use should be avoided. See information in Section 2, Chapter 3 on risk benefits of NSAID use.

■ Topical medications, such as capsaicin, and topical NSAIDs, such as diclofenac, may also have risk-benefit recommendations related to side effect profile.

■ Trial opioid therapy when other agents are ineffective or contraindi-cated. The American Geriatrics Society endorses the use of opioids in older patients when severe pain, pain-related functional impairments, or decreased quality of life is due to pain (see Section 2, Chapter 4 for choices of opioids).

■ Glucosamine or chondroitin sulfate may provide some symptomatic relief.

■ Intra-articular injections may provide relief.

OARSI nonpharmacologic recommendations include the following:

■ Patient education on osteoarthritis and self-management

■ Physical therapy to decrease pain and improve function

■ Aerobic activity to maintain muscle strength, such as water aerobics

Was this article helpful?

0 0

Post a comment