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Arthritis (Goals of Therapy (Relieve pain and stiffness, Improve or…

- - - - CBC, SCr, LFTs
    - - CBC, renal function, cytokines, infections, HF symptoms (EKG), LFTs
      - other considerations: what vaccines does my pt need before starting biologics?
    - - CBC, platelets, infection
    - - CBC, lipids, LFTs, platelets, skin
    - - rise in BG
- - - - Genetic predisposition
    - - Joint injury
      - Obesity
        
        most important preventable factor
      - RA
      - age
      - occupation (lots of sitting, lifting, repetitive motions)
      - athletic involvement
    - - loss of proteoglycans, damage to cartilage
      - loss of structural integrity
  - - - smoking, infections, toxin exposure
    - - damage to synovial tissue, autoimmune disorder attacks connective tissues
      - complement system activated
      - pro-inflammatory cytokines (IL1, IL6)
      - activated B cells (plasma cells) form antibodies
- - - - large, bulging bony calluses
- - - - NSAIDs
      - Acetaminophen
        
        First line for knee/hip
        
        typically max dose (4g/day)
      - Topical NSAID (used mostly in hands) - also preferred in older pts (over oral NSAIDs)
      - Capsiacin (can take weeks to work)
      - Tramadol
      - Corticosteriods
      - Opioid
        
        When fail acetaminophen, NSAID, and corticosteroid therapy
        
        Not recommended for OA in hand
      - Duloxetine
        
        Adjunct when partial responder to one of first line therapies
      - hyaluronic acid (specifically for knees)
      - OTC
        
        glucosamine/chondroitin (not a lot of good data here)
    - - Braces
      - Topical heat
      - Exercise (but avoid exercise with lots of joint strain)
      - Pt education
      - Weight loss (BMI < 30)
      - PT/OT
  - - - DMARDs
        
        Methotrexate
        
        Hydroxycholorquinolone
        
        Sulfasalazine
        
        Lefunomide
      - Biologics
        
        TNFalpha inhibitor
        
        Adalimumab
        
        Certolizaumab
        
        Etanercept
        
        Golimumab
        
        Infliximab
        
        Non-TNF
        
        Abatacept
        
        Tocilizumab
        
        Rituximab
        
        JAK inhibitors
        
        Tofacitinib
      - NSAIDs/APAP/Corticosteriods
        
        Symptomatic relief (not first line)
    - - Rest
      - OT/PT
      - Weight reduction
      - Surgery (tendon repair, joint replacement) - usually just in severe disease
      - assistive devices (splints, canes, etc.)
- - - - increased WBCs, may show crystallization