International Journal of Science and Research (IJSR) ISSN: 2319-7064 ResearchGate Impact Factor (2018): 0.28 | SJIF (2018): 7.426 Study on Osteoarthritis at Tertiary Care Centre and How to Diagnose and to Differentiate Primary from Secondary Osteoarthritis and Methods of Managements and Prevention and Rationale of NSAIDs Prescriptions in Osteoarthritis Samikrishnan Perumal1, Senthakrishna Thangaraj2 1Senior Assistant Professor of Rheumatology, Government Mohan Kumaramangalam Medical College, Salem-30, Tamilnadu, India Email: drsamipk[at]gmail.com 2Medical Officer, Urban Health Centre, Salem Municipal Corporation, Salem, Tamilnadu, India Abstract: Aim: To evaluate the most useful and easily available diagnostic approaches on osteoarthritis. To identify quite beneficial modalities of non-pharmacologic management in osteoarthritis. To identify the suitable pharmacologic treatments of OA in above middle ages and in old ages. Objective of the Study: As everyone aware, osteoarthritis is a commonest disability prone disease. As against in the past, quite large number of cases are presenting with this disease, not just in old but from above Middle Ages. All over the globe, in both sexes, the life expectancy is being appreciably increased. Likewise, because of the rise in affluency and easy reach of opulent diets, most of them appears plumb and bellies and unfortunately, it’s all, often being seen in young and in middle ages. Thus, it ultimately leads to secondary flat foot and increase in intra-articular hypertension, medial and lateral tibiofemoral compartmental stress and repetitive injuries to internal structures of joints. When any one of these modifiable, non-modifiable and perpetual and repetitive causes are not removed, then, one must welcome, early onset of osteoarthritis. There are numerous cases are coming with features of OA to rheumatology out-patient department, I have aimed to do this systematic and prospective study on osteoarthritis from August 2006 to July 2018 and it was conducted in two different centres, namely in rheumatology out-patient department of the Government Mohan Kumaramangalam Medical College and Hospital, Salem and another one in Akitha Hospital, Centre of Excellence for Autoimmune Diseases, Seelanaickenpatti, Salem. Results: More than a decade of my experiences on 3208 osteoarthritis cases from rheumatology out- patient department of Government Mohan Kumaramangalam Medical College and Hospital and from Akitha Hospital, Centre of Excellence for Auto Immune diseases, Salem, Tamil Nadu State, India are have been included for this systematic and prospective on going study on osteoarthritis with basic diagnostic work up, and wherever necessary, appropriate non-pharmacologic and pharmacologic treatments have been suggested. By and large, the osteoarthritis, quite often rheumatologist are being seen OA cases with lot of wrong or misdiagnosis and with erroneous treatment and exposed strong dose of steroid and with various DMARDs as rheumatoid arthritis. Thus, in this article, I have taken meticulous attempts to conveys to our colleagues to the ways to do basic diagnostic workup and disclose what are the common pitfalls could come across by treating doctors either in investigation or in diagnosis of OA before initiations of proper treatment. Conclusion: Proper clinical diagnosis and relevant basic investigations are enough for diagnosing osteoarthritis. At an early stages itself, when the modifiable and non-modifiable causes for the OA are identified and when it is removed or effectively modified with meticulous non-pharmacologic or by pharmacologic management, then there won’t be any necessity for pain killers are required and in near future, as there are more promising treatments like cartilage repair, stem cell therapy and gene therapy are in the reach of everyone and surely, there is a visible hope for OA populations that, they can lead not just pain free life and they can aim for disease free life. Keywords: Osteoarthritis, NSAIDs 1. Introduction pain killers. There is no unique treatment protocol is available to manage all OA patients, everyone is different There are no specific investigations for diagnosing in their mode of presentations and affliction of joints, the osteoarthritis. OA diagnosis is purely can be made from severity of OA, pain tolerance, type of occupation, detailed history, complete physical examination and purpose of joint mobility and their existing or associated radiological investigations. But it is wise to investigate the illnesses are the determining factors for selecting the given patient before initiation of your own treatment, appropriate treatment. The pharmacologic therapy an because, certainly they might have taken many forms of integral and paramount part of management of OA, vary treatments including steroids (oral, parenteral or intra- from external applicant, oral and parenteral NSAIDs, articular), all types of NSAIDs (sometimes double or disease modifiers, intra-articular steroid, visco- triple analgesics), and all modes of treatment options supplement, stem cell therapy, cartilage transplantation available under the sun, and further, as we are going to and etc. Each one has its own merits and demerits; thus, it treat a disease of above middle age, it is always better to is the duty of the physicians to select the suitable and rule out co-morbid conditions. The non-pharmacologic appropriate one for their individual patients. treatment is an adjunctive therapy for the management of OA. Our goal is to control pain, disability and to improve Diagnosis of Osteoarthritis quality of life. Unless the patient is subjected to non- pharmacologic therapy, our goal is not reachable just by Laboratory Investigations Volume 8 Issue 4, April 2019 www.ijsr.net Licensed Under Creative Commons Attribution CC BY Paper ID: ART20198569 10.21275/ART20198569 1958 International Journal of Science and Research (IJSR) ISSN: 2319-7064 ResearchGate Impact Factor (2018): 0.28 | SJIF (2018): 7.426 Complete Haemogram NSAID received patients is the important clue for its toxicity. Look for albuminuria, if present, order for 24 Cell counts are usually normal, normocytic hypochromic hours UAE (urinary albumin excretion) and presence of anaemia; occasionally neutrophilia can be present, due to new onset haematuria and RBC cast which can be caused an acute episode of arthritis and synovial effusions, by tubulointerstitial injuries by NSAIDs. Never forget infection (iatrogenic) or by osteonecrosis. Acute phase crystals, demonstration of various crystals in urine are reactants like ESR and CRP are normal or can be raised helpful for labelling diagnosis and management. Likewise, due to above said reasons and in erosive hand OA. just by urine tests, we can identify the site of pathologic lesions of the joints by estimating COMP (cartilage Biochemical Investigations (RFT, Uric Acid, Calcium, oligomeric matrix protein), keratan sulphate, hyaluronan, Blood Sugar, LFT, Newer Serum and Urine Markers of type III collagen N terminal –propeptide and glucosyl Bone and Cartilages) galactosyl pyridinoline but yet no standardized ways of estimating these molecules and it need further study. Doing RFT is mandatory in all cases of OA. Always, it is best to do before and after initiation of NSAIDs, and Serum Iron and Thyroid Function Tests DMOADs. In the presence of elevated or upper limit of normal RFT, beware about initiating or continuing Ask for serum iron, TIBC and TSH, free T3 and free T4 NSAIDs, colchicine and diacerein. Mere presence of hormones. Haemochromatosis is one of the known causes hyperuricemia is not going to label the diagnosis of gout for secondary OA, but iron overload per se is not causing or for even for initiating treatment for crystal arthritis. Do OA, rather these patients are likely prone for CPPD not reflexively write allopurinol, febuxostat just after arthritis. Likewise, hypothyroid patients usually are not seeing the value of elevated uric acid. Even a single dose developing OA as againstthe expectation, but once on of allopurinol is enough to cause or precipitate renal thyroxine replacement, they are rapidly showing evidence failure. Rather, the presence of hyperuricemia may give of HA or CPPD arthritis. clue for diagnosing plaque or non plaque psoriasis due to rapid cellular turnover. Serum calcium estimation is not Serum Vit D3 only useful for supplementing or treating for bone mineral loss or replacement, but it is occasionally useful to Vitamin D3 found to be useful either to prevent or slow identify, the suspected cases of Paget's disease (with back the progression of OA. As per Indian study, 70% of pain, knee pain and deformity), hyperparathyroidism. population are having Vitamin D3 deficiency due to lack of facility for Vit. D3 fortified food, poverty for balanced Blood Sugar diet and lack of exposure to sun, even in sun plenty country of ours. Serum Vit. D3 less than 20 ng/ml, Diabetes per se is a worsening factor for OA, and if it is denotes deficient person, 21-29 ng/ml indicates, they are uncontrolled for prolonged periods, results in cardio insufficient. Anything more than 30 ng/ml is enough. nephropathy, and neuropathic joints. Therefore, the uses of NSAIDs are directly prohibited. Rheumatoid Factor and Anti- CCP Liver Function Test and Pancreatic Enzymes Sometime, these laboratory tests are done, only to rule out inflammatory arthritis in the given situation of erosive Sometimes, doing AST, ALT, alkaline phosphatase and s. hand OA, and generalized OA or occasionally rheumatoid