Osteoarthrosis (osteoarthritis)

M13.00-19/M13.80-99/M15.0/M15.3/M15.8-9/M16.0-9/M18.0-5/M18.9/M19.00-09/M19.80-99

DESCRIPTION

A degenerative disorder typically affecting weight-bearing joints.

Signs and symptoms include:

  • pain usually with movement
  • post-rest stiffness
  • limited range of movement often with crepitus
  • joint may be swollen

GENERAL MEASURES

Non-pharmacological/general measures are as important as pharmacological management.

Educate patient and family on:

  • weight reduction
  • exercise
  • rest during acute painful episodes.

Recommend use of a walking stick or crutch to alleviate stress on weight bearing joint.

Physiotherapy and/or occupational therapy.

MEDICINE TREATMENT

Pain:

  • Paracetamol, oral, 1 g 4–6 hourly when required.
    • Maximum dose: 15 mg/kg/dose.
    • Maximum dose: 4 g in 24 hours.
  • Methyl salicylate ointment, topical, may provide some relief.

If patient responds to paracetamol reduce the dose to:

  • Paracetamol, oral, 500 mg, 6–8 hourly when required.

If no response and inflammation is present:

ADD

  • NSAID, e.g.
  • Ibuprofen, oral, 400 mg, 8 hourly with or after a meal, as needed for 7 days.

As many of these patients, particularly the elderly, have concomitant medical conditions such as cardiovascular, gastrointestinal disease or renal function impairment, NSAIDs must be used with caution.

Patients on aspirin for cardiovascular risk reduction should take aspirin 30 minutes before the 1st dose of ibuprofen in the morning, as taking aspirin and ibuprofen at the same time may reduce aspirin’s efficacy.

LoEIII [10]

In high-risk patients: > 65 years of age; history of peptic ulcer disease; or on concomitant warfarin, aspirin or corticosteroids:

ADD

  • Proton pump inhibitor, e.g.:
  • Lansoprazole, oral, 30 mg daily.

LoEII [11]

CAUTION: NSAIDS
Concomitant use of more than one oral NSAID has no additional clinical benefit and only increases toxicity.
Chronic use of all NSAIDs is associated with increased risks of gastrointestinal bleeding, renal failure, and cardiovascular events (stroke and myocardial infarction).
NSAIDs should be used judiciously at the lowest effective dose for the shortest duration. Explore and manage exacerbating factors for pain. See: Pain.
Do not use NSAID in pregnancy and breastfeeding.

REFERRAL

  • All cases with:
    • uncertain diagnosis
    • intractable pain
    • recurrent episodes of pain with inflammation
    • suspected infection
  • Consideration of joint replacement.