Osteoarthrosis (Osteoarthritis)

Description

General Measures

Medicine Treatment

Referral

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ICD-10 Code: 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.

LoE:III²⁹¹

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 

LoE:II²⁹²

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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 Chapter: Pain
- Do not use NSAID in pregnancy and breastfeeding

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LoE:III²⁹³

REFERRAL

• All cases with: 
  • Uncertain diagnosis
  • Intractable pain 
  • Recurrent episodes of pain with inflammation
  • Suspected infection 
• Consideration of joint replacement

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare Level, 2024 Edition