Question

What is early vs late presentations of osteoarthritis?

What instructions do we give patients taking bisphosphonates?

Answer 1

1. Osteoarthritis is the inflammation at the synovial joints that occurs as a result of wearing down of the protective cartilage at the end of the bone. Main sites of osteoarthritis are the knees, hips, hands, and spine. When osteoarthritis occurs before the age of 45 years, it is called early onset OA. There will be single or multiple joint involvement . Clinical features are pain, swelling, stiffness, deformity, instability and loss of function.

The changes in joint may manifest in the following order: Joint space narrowing, Osteophytosis, Subchondral cysts and Subchondral sclerosis

Stage wise clinical presentations of OA are:

Stage 0: Asymptomatic with no functional impairment

Stage 1: Minor bone spur growth may occur. Pain or discomfort may not be present.

Stage 2: Stage of Osteophytosis.. X ray reveals the spur growth at this stage. In this stage people starts experiencing the initial symptoms of pain by the end of day or after physical activities and stiffness while using a joint after a period of rest or immobility. In this stage the cartilage will be healthy and the space between bones will be normal.

Stage 3: Cartilages will be damaged and there will be narrowing in the space between bones. Frequency of pain increases, joint stiffness after prolonged sitting or while waking up in the morning and joint swelling may be present.

Stage 4: Is the stage of Subchondral sclerosis. Is also known as severe stage with increased pain and discomfort with mobility. Complete destruction of the cartilage occurs and joint will become stiff and immobile. There will be marked reduction in amount of synovial fluid level.

2. Bisphosphonates prevents bone resorption due to osteoclastic activity. It cannot be administered to patients with upper GI disease.

Patient's must be instructed to take bisphosphonate tablets on empty stomach to maximize its absorption because it's absorption is poor when taken in tablet form.

Advice the patient not to take food or drinks until one and half hour of tablet intake This is to improve the bioavailability of the drug which will otherwise be impaired due to retained gastric contents as a result of food or fluid (coffee, tea or juice) intake.

Advice to take the tablet with plenty of water to avoid the tablet getting stuck in the esophagus

Teach about signs of esophagitis and immediately discontinue the drug if any such symptoms occur

Advice the patient to remain in upright position for at least 30 minutes after intake of the drug to avoid risk of gastric reflux.

Advice to take supplemental doses of calcium and Vitamin D while on bisphosphonate therapy.