Pharmacology + dietary supplements

Objectives

Know the rationale, risks/harms, benefits, CPG recommendations, and dosages for common analgesia for OA (paracetamol, NSAIDS)
Know the rationale, risks/harms, benefits, CPG recommendations, and dosages for presciption analgesia for OA (anti-inflammatories, opiates)
Know the rationale, risks/harms, benefits, CPG recommendations, and dosages for injectables (Hyluronic acic, PRP, corstisone, stem cells)
Know the rationale, risks/harms, benefits, CPG recommendations, and dosages dietary supplements
Know risks with comobidities for analgesia, injectables and dietary supplements

Discussion of multiple interventions and their long term safety, including non pharmacological, pharmacological and surgical options: Charlesworth, J., Fitzpatrick, J., Perera, N. K. P., & Orchard, J. (2019). Osteoarthritis- a systematic review of long-term safety implications for osteoarthritis of the knee. BMC Musculoskeletal Disorders, 20(1), 151. doi:10.1186/s12891-019-2525-0

The Royal Australian College of General Practitioners. (2018). Guideline for the management of knee and hip OA 2nd edition. In (2nd ed.). East Melbourne: The Royal Australian College of General Practitioners.

Key references

Paracetamol: Leopoldino A., Machado, G., Ferreira, P., Pinheiro, M., Day, R., McLachlan, A., . . . Ferreira, M. (2019). Paracetamol versus placebo for knee and hip osteoarthritis. Cochrane Database of Systematic Reviews(2). doi:10.1002/14651858.CD013273 paracetamol vs placebo

Tramadol Toupin April, K., Bisaillon, J., Welch, V., Maxwell, L. J., Jüni, P., Rutjes, A. W. S., . . . et al. (2019). Tramadol for osteoarthritis. Cochrane Database of Systematic Reviews(5). doi:10.1002/14651858.CD005522.pub3

Other opioids: da Costa, B. R., Nüesch, E., Kasteler, R., Husni, E., Welch, V., Rutjes, A. W. S., & Jüni, P. (2014). Oral or transdermal opioids for osteoarthritis of the knee or hip. Cochrane Database of Systematic Reviews(9). doi:10.1002/14651858.CD003115.pub4

Dulextine Gao, S.-H., Huo, J.-B., Pan, Q.-M., Li, X.-W., Chen, H.-Y., & Huang, J.-H. (2019). The short-term effect and safety of duloxetine in osteoarthritis: A systematic review and meta-analysis. Medicine (Baltimore), 98(44), e17541. doi:10.1097/md.0000000000017541

NSAIDS: Smith, S. R., Deshpande, B. R., Collins, J. E., Katz, J. N., & Losina, E. (2016). Comparative pain reduction of oral non-steroidal anti-inflammatory drugs and opioids for knee osteoarthritis: systematic analytic review. Osteoarthritis and Cartilage, 24(6), 962-972. doi:10.1016/j.joca.2016.01.135