Have you or your loved ones been diagnosed with Osteoarthritis? If so, have you also been diagnosed and are trying to manage other chronic conditions such as Obesity, Diabetes, Hypertension, Cardiovascular Disease, Peptic Ulcer Disease, and or Chronic Kidney Disease? If so, you are not alone.
Studies have shown more than 25% of Americans suffer from more than one chronic condition. Understanding the complexity and importance of addressing all your health conditions is vital to the successful management of your health. Advocating for your health and making sure all your specialists and your primary care physician are aware of ALL of your diagnoses is a good first step. It is necessary to create one cohesive team to care for you as a whole person and not just for your condition.
Often, the presence of multiple chronic conditions affects the treatment options available to manage your osteoarthritis (OA). Especially when discussing pharmacological interventions, certain medications can have adverse reactions due to how your body is affected by your comorbidities and/or other related medications you are taking for those conditions.
For example:
- Diabetes Mellitus (DM):
- Intraarticular glucocorticoid (steroid) injections – These injections may cause an increase in blood sugar to hyperglycemic levels when treating OA in a diabetic patient.
- NSAIDs – Oral and topical NSAIDs are very commonly prescribed for pain management with OA. Diabetic patients should be prescribed NSAIDs cautiously and even avoided, especially if they suffer from added complications such as cardiovascular disease or kidney disease.
- Chronic Kidney Disease (CKD):
- NSAIDs can affect kidney function, and it is best to use topical agents rather than systemic agents in CKD patients with OA.
- Cardiovascular Disease (CVD):
- Opioids can increase the risk of myocardial infarctions (heart attacks) when used long term and is why it is considered a last resort and advised to use on a short-term basis in OA patients.
- Aspirin – For patients taking low-dose aspirin for cardio-protective reasons, they should best avoid NSAIDs, and if necessary, patients should take the aspirin a few hours before the NSAID.
- Hypertension:
- NSAIDs can generally increase blood pressure and is best to limit the use in those patients with poorly controlled hypertension, especially with weak kidney functions.
- It is also best to monitor blood pressures whenever using glucocorticoids.
- Peptic Ulcer Disease (PUD):
- For patients with increased risk of gastrointestinal bleeding, reoccurring ulcers, and perforations, it is advised to add a PPI (Gastro-protective agent –Proton Pump Inhibitor, ex. omeprazole) when taking NSAIDs.
- COX-2 inhibitors like Celebrex, a selective NSAID can be used to reduce the relative risk of GI bleeds compared to nonselective NSAIDs
- Obesity:
- Over 50% of Knee OA patients are classified as Obese. Obesity has a weight-bearing effect on the joints and can worsen the pain experienced with OA.
- Weight loss, whether through lifestyle modifications or medical interventions such as bariatric surgery, is one of the most effective ways to reduce pain and disability in OA patients.
- Drug interactions:
- Oral and topical NSAIDs can interact with other medications such as anticoagulants, aspirin, warfarin, heparin, diuretics, ACE- Inhibitors, ARBs.
- Opioids can interact with medications such as CNS depressants, hypnotics, and alcohol.
- Tramadol, in particular, can also interact with antidepressant medications like SSRI, SNRI, TCA, MAO-I, and Bupropion. Also can interact with alcohol and St. Johns Wort.
- It is vital to disclose all medications you are currently taking to all of your health care providers to avoid such interactions and potential adverse reactions.
- Alternative options:
- Surgery: For Advanced Knee and Hip OA, total joint replacement may be considered as an alternative. Of course, any surgery comes with its risk assessment and is best discussed with your physician to see if this option is right for you.
- Some patients have used other therapies like Acupuncture, CBD oils, and TENS- transcutaneous nerve stimulation effectively. Consult with your physician to see if this is a viable option for you, and ask how to incorporate these alternative therapies effectively into your OA management.
On top of these chronic conditions, management of osteoarthritis in older aged patients has increased risk of complications, including cardiovascular, renal, and gastrointestinal symptoms. Depression is also seen in about one-third of patients in OA over the age of 45, possibly due to increased fatigue, pain, and disability. It is important to consult with your mental health professional along with your Rheumatologist to manage medication use with OA.
Besides pharmacological interventions, increasing physical activity has been shown not only to help reduce symptoms of OA but also to help reduce the risk of other chronic conditions. Regular physical activity regiment can reduce the risk of obesity, depression, and heart disease. Physical activity can also aid in the management of other chronic conditions like diabetes mellitus.
As always, it is best to consult with your team of physicians before making any changes to your management of OA alongside other chronic conditions.
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