Osteoarthritis

Lifestyle Modifications:

Self management, Exercise or Physical therapy, Weight loss
How to stay Active and Independent

Pain & functional assessment each visit

Acetaminophen up to 1 gm po QID

Knee - Consider Orthotics (lateral wedge [podiatry], taping [PT]), consider trial of glucosamine 1500 mg/d

Hands – thumb spica splint

Consider topical Capsaicin 0.025% cream to skin TID/QID
Aspercreme Cream (Trolamine Salicylate Cream)
Diclofenac Topical

Knee - If knee joint effusion present, consider aspiration and intra-articular corticosteroids e.g. Triamcinolone 40 mg

NSAID: Naproxen 250 - 500 mg po BID or
Naproxen Sodium 220-550 mg po BID or
Salsalate 1500 mg po BID

If GI risk factors may add omeprazole 20 mg po daily

If renal dz, no response, or age > 65, consider
Tramadol 50 mg daily to QID , or Opiates: Acetaminophen/codeine 30 mg QID or Acetaminophen/hydrocodone 5 mg 1-2 tabs QID

If no response, consider change of NSAID
Diclofenac 50 mg BID or
EC Aspirin 650 mg TID or
COX 2 inhibitor Celecoxib 200 mg daily

Knee – consider intra-articular
Synvisc(hylan GF 20)2 ml weekly X 3 weeks
Prior Authorization Criteria

Specialist referral

Caution

Cost Guide

References

¹Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthritis Rheum 2000;43(9):1905-1915.

²Brand C, Cox S. Systems for implementing best practice for a chronic disease: management of osteoarthritis of the hip and knee. Intern Med J 2006;36(3):170-179.