Panacea Pharmacy & Medic

Osteoarthritis & Rheumatoid Arthritis

Osteoarthritis and rheumatoid arthritis

 Osteoarthritis

Osteoarthritis (OA)   is is a common chronic condition of articular designeration. Secondary changes can occur in bone leading to pain, Decreased functioning  and even  disability. 55 Yaar elderly people are mostly affected by osteoarthritis disease. Early age from 35 years old and less than 35 also seen  affected by this disease. Women are more than three times greater affected by this osteoarthritis  than man.

Pathophysiology

-By developing this disease  with age the strength of tendons ligaments and muscles declines.

-By apoptosis and inhibiting Proliferation rate number of chondrocytes  decline

-Decrease proteoglycans

-Increase interleukin 1 that decrease matrix metalloproteins  (MMPs) Proteoglycans

– pain from ( Osteoplytes,  synovitis , bursitis ,Tendonitis)

 

Causes of risk factor

  • Female muscle weakness,
  • Obesity,
  • Joint trauma,
  • Heredity
  • Congenital or anatomical defects

Clinical presentation

– Deep localized pain in a joint

-Crackling noise heard in the joined upon moving

-Osteoarthritis most commonly affects hips, knees, spine, feet and hands.

Diagnosis

  1.  physical examination

Misshaped join, decrease range of joint motion, joint tenderness

  1. Laboratory test

for osteoarthritis has no specific laboratory test  allow

  • Reveal Synovial fluid
  • Increase Leukocytosis and mononuclear lymphocytes
  1. Radiography

– cartilage damage resulting narrowing of joint space

–  osteophyte and subchondral sclerosis are seen

 

Treatment

Treatment goal

– First goal to control pain

-Improve joint mobility

-Minimize functional disability

 

Pharmacological and Non-pharmacological both treatment are simultaneously important

 

Non pharmacological treatment

Non pharmacological treatment are most important for the osteoarthritis patient

It  may does by

-Patient education ( tips on joint protection and exercise program)

-Weight loss

– Aerobic exercise program to increase muscle strength

– Physical therapy

– Use  assistive device

– Acupuncture may reduce the pain

– Thermal therapy

 

Pharmacological treatment

 

Pharmacological treatment can divided by two groups ( Mild & Acute osteoarthritis )-

1. For mild pain when  initiate osteoarthritis

Medication 1

1.1 . Paracetamol

Dose :  500 mg for 4 times a day not more than 4 g a day

Or

1.2 .1. Non steroidal anti inflammatory drugs (NSAID)

Example of this medicine

1.2.1.1. Ibuprofen

Dose:  400 mg 3 times a day  not more than 3200 mg per day After meal

Or

  1. 2.1.2. Diclofenac

 

It is most effective medicine for NSAIDs group

Dose: 75 mg twice a day not more than 200 mg per day should be taken after meal.

 

Note:  People are mostly hyper gastritis symptoms or peptic ulcer disease or duodenal Ulcer disease or acute renal disease should not use this type of drug in oral form.

This type of medicine inhibit   platelet activation  resulted inhibit coagulation process. Ulcer patient, haemophilia or any other coagulation disorder patients should not take this medicine.

 

  1. Other analgesic

2.1. Tramadol

Dose:  50 mg 4 to 6  hours interval for 15 days

2.2. Pregabalin

Dose:  25 mg 1 or 2 times a day  Initial dose for three to five days Then increase the dose according to  tolerance.

 

2.3. Steroid  Anti Inflammatory drugs

Prednisolone

Dose:   5mg  2 times daily for 15 days.

Note : For severe diabetic patients it would be concerned about the use of this medicine.  It may increase the blood glucose level.

Prescription –

You can follow some prescription according to your physical condition. All prescription are for adult patient who are more than 16 years old or above.

Prescription N0 1 & 2.  for mild osteoarthritis :

Who don’t follow the prescription No. 1,2 & 3 ( Contraindication )-

Patient are suffering by post morbidity or mortality disease like

  1. Chronic diabetics
  2. Chronic kidney disease
  3. Chronic liver cirrhosis
  4. Peptic or Gastric ulcer patient and any other coagulation disorder patients like hemophilia.
  5. Heart failure patient

Prescription N0 1 for mild  osteoarthritis patient.

Prescription 1 for mild  osteoarthritis patient.
Prescription 1 for mild  osteoarthritis patient.

Prescription N0 2. :

Prescription 2 for mild osteoarthritis
Prescription 2 for mild osteoarthritis

 

Prescription N0 3.  for acute osteoarthritis :

Prescription N0 3.  for acute osteoarthritis :
Prescription N0 3.  for acute osteoarthritis :
Prescription for osteoarthritis patient who have specific co- morbidity or  mortality disease

Prescription No 4. for acute osteoarthritis patient who also  a peptic or gastric ulcer patient

Prescription No 4. for acute osteoarthritis patient who also  a peptic or gastric ulcer patient
Prescription No 4. for acute osteoarthritis patient who also  a peptic or gastric ulcer patient

Who don’t follow the prescription No. 4 ( Contraindication )-

Patient are suffering by post morbidity or mortality disease like

  1. Chronic kidney disease
  2.  Any other coagulation disorder patients like hemophilia.

 

Prescription No. 5 for mild osteoarthritis patient who have also a mild kidney disease-

Prescription No. 5 for mild osteoarthritis patient who have also a mild kidney disease-
Prescription No. 5 for mild osteoarthritis patient who have also a mild kidney disease-

Prescription No.6 for Acute osteoarthritis patient who have mild kidney disease

Prescription No.6 for Acute osteoarthritis patient who have mild kidney disease
Prescription No.6 for Acute osteoarthritis patient who have mild kidney disease

 

Prescription No.7 for mild and acute osteoarthritis patient who have acute kidney disease

Prescription No.7 for mild and acute osteoarthritis patient who have acute kidney disease
Prescription No.7 for mild and acute osteoarthritis patient who have acute kidney disease

 

Prescription No.8 for mild  osteoarthritis patient who have peptic or gastric ulcer and blood coagulation disorder

Prescription No.8 for mild  osteoarthritis patient who have peptic or gastric ulcer and blood coagulation disorder
Prescription No.8 for mild  osteoarthritis patient who have peptic or gastric ulcer and blood coagulation disorder

 

Prescription No.9 for acute  osteoarthritis patient who have peptic or gastric ulcer and blood coagulation disorder

Prescription No.9 for acute  osteoarthritis patient who have peptic or gastric ulcer and blood coagulation disorder
Prescription No.9 for acute  osteoarthritis patient who have peptic or gastric ulcer and blood coagulation disorder

Note : Prescription No 4, 5,6,7,8 & 9 is not contraindicated for diabetics patient but little conscious for liver cirrhosis patients.

  1. Disease modifying anti-rheumatic drugs ( DMARDs)

It is a first line therapy for osteoarthritis and  rheumatoid arthritis disease. Long time therapy more than eight months for getting effective results and withdrawal of  the medicine.  This therapy needs highly monitoring about the result of drug effects.

I suggest avoiding this medication for its lots of side effects and critical monitoring effects. If any patient is under a  physician with strict monitoring only that patient  can take these medicines.

It needs a combination therapy with two DMARDs or other DMARDs with anotherNSAIDs.

 

3.1. (DMARDs with others  DMARDs)

[ 8 months to 2 years ]

3.1.1  Methotrexate

Dose :  7.5 to 25  mg once weekly .

With

3.1.2.. Sulfasalazine

Dose :  500 mg  to 3g daily.

Side effects

Most side effects are

  • GI disturbance
  • Myelosuppression
  • Hepatotoxicity
  • Pneumonitis
  • Infections.

 

  1. Biological therapies

These drugs are used after failing DMARDs  drugs. Chief class of drugs target TNF- Alpha,  interleukins-1,  interleukin-6 that are cytokinins mediated activate T- cell release.

 

4.1. Infliximab

Dose: 3 mg/kg at weeks for 0,2 and 6 weeks then 8 weeks thereafter.

Administration rout : Intravenous (IV).

OR

4.2. Adalimumab

Dose:  40 mg every two weeks

Side effects

– Lymphoma

– Infection any organ

– Immunosuppressed

– Heart failure

 

 

Rheumatoid arthritis

Rheumatoid arthritis is one of the most common  inflammatory disorders with not only the joint but a wide range of extra articular organs. Early treatment is not possible and will lead to progressive joint deformity and increase morbidity and mortality.  It increased co- morbidity and mortality include infection renal impairment cardiovascular disease and lymphomas.

 

Etiology and pathophysiology

-Hormonal factor

– Genetic factor

– Environmental factors

– Cigarette smoking

-Infiltrate a variety of inflammatory cells into the joints.

 

Clinical manifestation

Disease  onset is usually insidious with the predominant symptoms being pain, stiffness and swelling.

Affected area are

– The metacarpophalangeal and proximal interphalangeal joints of the fingers.

-Interphalangeal joints of the thumbs.

-The warts

-Metatarsophalangeal  joints of the toes.

-Joints of upper and lower Limbs such as the elbows, shoulders and knees.

-Myalgia, fatigue, low grade fever, weight loss.

 

Diagnosis

Rheumatoid arthritis  diagnose made based on

– Patient history

– Presenting symptoms

– Clinical finding

– Ultrasound for the presence of synovitis and X-rays

– Later demonstrate joint destruction

 

American rheumatism Association made a criteria for the diagnosis of rheumatoid arthritis.

  1. Morning stiffness in and around the joints for at last 6 weeks lasting at least 1 hour before maximal improvement.
  2. Swelling of 3 or more joints for at least 6 weeks
  3. Swelling of the wrist,  metacarpophalangeal or Proximal interphalangeal joints For at least 6 weeks.
  4. Symmetric joint swelling for at least 6 weeks.
  5. Hard X rays changes typical of  rheumatoid arthritis that must include erosion or unequivocal bony decalcification around the joints.
  6. Rheumatoid subcutaneous nodules.
  7. Positive Rheumatoid factor

The presence of  at least  4 of these  indicator  a diagnosis of rheumatoid arthritis.

 

Treatment

Goals is the treatment of rheumatoid arthritis

  • Symptoms relief including pain control
  • Slowing or prevention of joint damage
  • Preserving and improving functional ability
  • Achieving and maintaining disease remission

 

Rheumatoid arthritis need two types of treatment simultaneously  like osteoarthritis

  1. Non pharmacological treatment
  2.  pharmacological treatment

 

Non pharmacological treatment

Non pharmacological treatment are most important for the rheumatoid arthritis patients.

It  may does by

-Patient education ( tips on joint protection and exercise program)

-Weight loss

– Aerobic exercise program to increase muscle strength

– Physical therapy

– Use  assistive device

– Acupuncture may reduce the pain

– Thermal therapy

 

Pharmacological treatment

Initially patient are treated by DMARDs  combination with other glucocorticoids, NSAIDs or simple analgesic.

1.Disease modifying anti-rheumatic drugs ( DMARDs)

It is a first line therapy for osteoarthritis and  rheumatoid arthritis disease. Long time therapy more than eight months for getting effective results and withdrawal of  the medicine.  This therapy needs highly monitoring about the result of drug effects.

I suggest avoiding this medication for its lots of side effects and critical monitoring effects. If any patient is under a  physician with strict monitoring only that patient  can take these medicines.

It needs a combination therapy with two DMARDs or other DMARDs with anotherNSAIDs.

 

1.1. (DMARDs with others  DMARDs)

[ 8 months to 2 years ]

1.1.1  Methotrexate

Dose :  7.5 to 25  mg once weekly .

With

1.1.2.. Sulfasalazine

Dose :  500 mg  to 3g daily.

2.1. (DMARDs with others  NSAIDs or SAIDs)

2.1.1  Methotrexate

Dose :  7.5 to 25  mg once weekly .

With

2.1.2. Diclofenac

Dose : 50 mg twice dayily for 15 days

or

2.1.3. Prednisolone

Dose: 5 mg twice daily for 15 days.

Side effects

Most side effects are

  • GI disturbance
  • Myelosuppression
  • Hepatotoxicity
  • Pneumonitis
  • Infections.

 

Other medication like analgesic, steroid or biological agent are used same as like as osteoarthritis treatment.

Pharmacological treatment by medication are similar like osteoarthritis.

Prescription N0 1 & 2.  for mild rheumatoid arthritis :

Who don’t follow the prescription No. 1 ( Contraindication )-

Patient are suffering by post morbidity or mortality disease like

  1. Chronic kidney disease
  2. Chronic liver cirrhosis
  3. Chronic infected patient
  4. Hematological disorder

Prescription N0 1 for mild  rheumatoid arthritis.

Prescription N0 1 for mild  rheumatoid arthritis.
Prescription N0 1 for mild  rheumatoid arthritis.

Or

Prescription N0 2 for mild  rheumatoid arthritis.

Who don’t follow the prescription No. 2 & 3 ( Contraindication )-

Patient are suffering by post morbidity or mortality disease like

  1. Chronic kidney disease
  2. Chronic liver cirrhosis
  3. Peptic or Gastric ulcer patient and any other coagulation disorder patients like hemophilia.
  4. Heart failure patient
  5. Chronic infected patient
  6. Hematological disorder
  7. Chronic diabetics patient

 

Prescription N0 2 for mild  rheumatoid arthritis.
Prescription N0 2 for mild  rheumatoid arthritis.

Or

Prescription N0 3 for mild  rheumatoid arthritis.

Prescription N0 3 for mild  rheumatoid arthritis.
Prescription N0 3 for mild  rheumatoid arthritis.

 

Prescription N0 4 & 5.  for mild osteoarthritis :

Who don’t follow the prescription No. 4,5 & 6 ( Contraindication )-

Patient are suffering by post morbidity or mortality disease like

  1. Chronic diabetics
  2. Chronic kidney disease
  3. Chronic liver cirrhosis
  4. Peptic or Gastric ulcer patient and any other coagulation disorder patients like hemophilia.
  5. Heart failure patient

Prescription N0 4 for mild rheumatoid arthritis..

Prescription 1 for mild  osteoarthritis patient.
Prescription 4 for mild rheumatoid arthritis.

Prescription N0 5. rheumatoid arthritis.:

Prescription 2 for mild osteoarthritis
Prescription 5 for mild rheumatoid arthritis.

 

Prescription N0 6.  for acute rheumatoid arthritis:

Prescription N0 3.  for acute osteoarthritis :
Prescription N0 6.  rheumatoid arthritis.
Prescription for rheumatoid arthritis patient who have specific co- morbidity or  mortality disease

Prescription No 7. for acute rheumatoid arthritis. patient who also  a peptic or gastric ulcer patient

Prescription No 4. for acute osteoarthritis patient who also  a peptic or gastric ulcer patient
Prescription No 7. for acute rheumatoid arthritis patient who also  a peptic or gastric ulcer patient

Who don’t follow the prescription No. 7 ( Contraindication )-

Patient are suffering by post morbidity or mortality disease like

  1. Chronic kidney disease
  2.  Any other coagulation disorder patients like hemophilia.

 

Prescription No. 8 for mild rheumatoid arthritis patient who have also a mild kidney disease-

Prescription No. 5 for mild osteoarthritis patient who have also a mild kidney disease-
Prescription No. 8 for mild rheumatoid arthritis patient who have also a mild kidney disease-

Prescription No 9. for Acute rheumatoid arthritis patient who have mild kidney disease

Prescription No.6 for Acute osteoarthritis patient who have mild kidney disease
Prescription No 9. for Acute rheumatoid arthritis patient who have mild kidney disease

 

Prescription No. 10 for mild and acute rheumatoid arthritis patient who have acute kidney disease:

Prescription No.7 for mild and acute osteoarthritis patient who have acute kidney disease
Prescription No.10 for mild and acute rheumatoid arthritis patient who have acute kidney disease

 

Prescription No.11 for mild rheumatoid arthritis patient who have peptic or gastric ulcer and blood coagulation disorder:

Prescription No.8 for mild  osteoarthritis patient who have peptic or gastric ulcer and blood coagulation disorder
Prescription No.11 for mild rheumatoid arthritis patient who have peptic or gastric ulcer and blood coagulation disorder

 

Prescription No.12 for acute rheumatoid arthritis patient who have peptic or gastric ulcer and blood coagulation disorder

Prescription No.9 for acute  osteoarthritis patient who have peptic or gastric ulcer and blood coagulation disorder
Prescription No.12 for acute rheumatoid arthritis patient who have peptic or gastric ulcer and blood coagulation disorder

Note : Prescription No 7, 8,9,10,11 & 12 is not contraindicated for diabetics patient but little conscious for liver cirrhosis patients.

 

Supplementary can be  co-administrate

 

4.1. Glucosamine sulfate

Dose: 7500 mg 2 times a day

4.2 . Diacerein

Dose:  50 mg  2 times a day

5.1.  calcium carbonate

Dose: 500 mg once daily

5.2. Vitamin D3

Dose:  200 IU once a day