Derived from the Greek word “osteo”, which means bone; “arthro” means joint and “itis” means inflammation. It is the most common of the various kinds of arthritis. A chronic, slowly progressing disorder that causes deterioration of articular cartilage. It affects weight-bearing joints (hip and knees) as well as joints of the distal interphalangeal and proximal interphalangeal joints of the fingers. It is also known as Degenerative Joints Disease, characterized by the inflammation of the joints between the bones.
Incidences By the numbers, 1 in 4 U.S adults has been diagnosed with some form of arthritis, while an additional 17% may have the disease without even knowing it. According to the Arthritis Foundation, Osteoarthritis affects an estimated 20.7 million Americans, 80 % of these are women.
Risk / Predisposing Factors 1. Aging 2. Long term mechanical stress-athletics, ballet, dancing or repetitive physical tasks
3. Congenital or acquired skeletal deformities
4. Anatomic abnormality 5. Inflammation in joint structures
6. Joint Instability from damage to supporting structures
7. Neurologic disorders (diabetic neuropathy, Charcot neuropathic joint) 8. Hematologic or endocrine disorders ( hemophilia, hyperthyroidism) 9. Obesity
10. Systemic Diseases 11. Genetic Factors 12. Drugs
13. Other form of arthritis
Manifestations 1. Pain and Swelling 2. Stiffness 3. Enlargement of Joint 4. Crepitus
5. Discomfort in the joint before or during a change in the weather
6. Limited range of motion 7. Hypermobility and subluxation of joints 8. Knee Alignment ( vagus or varus )
Classification of Osteoarthritis • Classification by the joint involved o Monoarticular, oligoarticular, or polyarticular (generalized) o Chief joint site 9index joint site) and localization within the joint
Hip ( superior pole, medial pole and concentric) Knee ( medial, lateral, patellofemoral compartments) Hand ( interphalangeal joint and or thumb base) Spine (apophyseal joints or intervertebral disk disease)
Classification into Primary and Secondary forms of OA o Primary (idiopathic)
o Secondary Indicates that a likely cause can be identified Metabolic causes • • • • • Ochronosis Acromegaly Hemochromatosis Calcium crystal deposition
Anatomic causes • • • • • • • Slipped femoral epiphysis Epiphyseal dysplasia Blount disease Perthes disease Congenital dislocation of the hip Leg length inequality Hypermobility syndromes
Traumatic Causes • • • • Major joint trauma Fracture through a joint or osteonecrosis Joint surgery (meniscectomy) Chronic injury (occupational arthropathies)
Inflammatory causes • • Any inflammatory arthropathy Septic arthritis
Classification by the presence of specific features o Inflammatory OA o Erosive OA o Atrophic or destructive OA o OA with chondrocalcinosis
Pathophysiology 1. Changes in articular cartilage occur first; later, secondary soft tissue changes may occur. 2. Progressive wear and tear on cartilage leads to thinning of point surface and ulceration into bone. 3. Leads to inflammation of the joint and increased flow and hypertrophy of subchondral bone. 4. New cartilage and bone formation at joint margins results in osteophytosis (bone spurs), altering the size and shape of bone. Diagnostic study 1. No specific laboratory examination. 2. CT Scan 3. Arthroscopy 4. X-rays of affected joints show joint space narrowing, osteophytes, and sclerosis. 5. Radionuclide imaging (bone scan)-shows increased uptake in affected bones. 6. Analysis of synovial fluid differentiates OA from RA 7. Aspiration of synovial fluid to rule out infection or crystal deposition 8. Erythrocyte Sedimentation Rate is useful if systemic manifestations are present. 9. Magnetic Resonance Imaging may be ordered to rule out meniscal injury. Management • Medical Management
B. Include PT and OT to maintain function while preserving the joints C. SAM-e (S-adenosylmethionine), occurs naturally in all living cells contributes to the production of proteoglycans for cartilage repair. D. Pain management using non-narcotic analgesics, such as acetaminophen;COX-2 inhibitors and NSAIDs, mostly for analgesic affects; and possibly, such oploids as oxycodone, codeine, or hydrocordone (these may be used in combination with non-narcotic analgesics).
Celecoxib (Celebrex) and meloxicam (Mobic) are COX-2 inhibitors. They mainly block the prostaglandins involved in inflammation. ( In 2003 the New England Journal of Medicine published the result of clinical trial showing that Celebrex, a long used drug for treating the pain of degrading cartilage, doees not protect the patients against bleeing ulcers ( a common side effects of arthritis medications) as well as previously believed. On he other hand, a different study found Celebrex may help combat heart disease by improving bloodvessel flexibility and lessening inflammation.) They can be used in patients taking anticoagulants because bleeding time and platelet aggregation are not affected by these agents. They can cause renal impairment; monitor renal function with longterm use. Celocoxib is contraindicated in people with known allergies to sulfonamides and history of asthma, atucaria, or allergic reaction to aspirin and other NSAIDs.
E. Hyaluronate (Hyalgan) and hylan G-F 20 ( synvisc), agents known as viscosupplements, have been approved by the food and drug administration. These drugs are administered overtime through intraarticular injections into the knee. •
They relieve pain and are most effective for people with mild to moderate knee Osteoathritis. After the injection, patient is instructed to avoid prolonged weightbearing activities for 48 hours.
Contraindicated for patients with joint infections and for those with allergies to hyaluronate preparations, avian proteins, and bird feathers or eggs.
F. Weight loss, if necessary, to relieve stress on joints. Losing weight may
reduce pressure on those painful joints.
G. Proper nutrition and adequate sleep.
H. For older patients, a new study has shown that receiving care for depression can significantly lessen the impact of pain associated with osteoarthritis of the knee. I. Hydrotherapy (exercising in swimming pool) improves mobility about as much as exercising in a gym, but with much greater reduction in joint pain, according to the study of both hip and knee patients. J. Movement therapies such as Tai Chi may be suggested as a low-impact alternative to increase fitness and flexibility within the client’s own limit. K. Use of cane in the contralateral hand can decrease joint stress during episodes of of severe hip or knee pain. L. Elastic brace or neoprene, may reduce pain and stabilize the joint in a functional position. M. Heat applications help with stiffness by increasing collagen elasticity and flexibility. N. Cold applications are used less frequently than heat but may be beneficial during episodes of acute inflammation immediately after exercise or for relief of muscle exercise. O. Ionized wrist bracelet are commonly advertised for pain relief, however research suggest that this form of therapy provides no better relief pain than in placebo. P. Capsaicin cream application to affected joints, it is effective for OA of the knees and hand. Q. Over-the-counter (OTC) supplements glucosamine and chondroitin sulfate are common alternative remedies that have potential cartilage-rebuilding effects, but clinical trials in humans have been scant up to this point. Surgical Intervention
Surgical intervention is considered when the pain becomes intolerable to patient and mobility is severely compromised. Options include osteotomy, debridement, joint fusion, arthroscopy, and arthroplasty • • Osteotomy is the cut across bone with resection of a bone fragment either to correct deformity or to alter stresses on joint. Arthrodesis or joint fusion procedure, the articular joint surfaces, which hold the bone ends together, are removed so that the bone edges unite like a fracture. Arthroplasty is performed to restore joint motion by replacing arthritic bone with metal and plastic components.
Nursing Diagnosis 1. Deficient Knowledge regarding procedures, outcomes and self-care needs 2. Acute or Chronic Pain Related to joint degeneration and muscle spasm 3. Impaired physical mobility related to pain and limited joint motion 4. Bathing, hygiene, feeding and toileting self-care deficits related to pain and limited joint movement. 5. Disturbed body Image / Ineffective role performance may be related to change in body structure
Nursing Responsibilities Education is the key to successful treatment of the disease. Important areas in the client education include: • • • • Pain management Rest-activity balance Nutrition and weight loss Self-care strategies
• Relieving pain
1. Advice patient to take prescribed NSAIDs or OTC analgesics as directed to
relieve inflammation and pain. May alternate with oploid analgesic, if prescribed. 2. Provide rest for involved joints- excessive use aggravates the symptoms and accelerates degeneration.
a. Use splints, braces, cervical collars traction, lumbosacral corsets as
necessary. b. Have prescribed rest periods in recumbent position. 3. Advise patient to avoid activities that precipitate pain. 4. Apply heat as prescribed- relieves muscle spasm and stiffness; avoid prolonged application of heat-may cause increased swelling and flare symptoms.
5. Teach correct posture and body mechanics- postural alterations leads to chronic
muscle tension and pain 6. Advise sleeping with a rolled terry cloth towel under the neck- for relief of cervical OA. 7. Provide crutches, braces, or cane when indicated- to reduce weight-bearing stress on hips and knees. 8. Teach use of cane in hand on side opposite involved hip/knee. 9. Advise wearing corrective shoes and metatarsal supports for foot disorder- also helps in the treatment of arthritis of the knee. 10. Encourage the weight loss to decrease stress on weight-bearing joints. 11. Support patient undergoing orthopedic surgery for unremitting pain and disabling arthritis of joints.
Increasing Physical Mobility
1. Encourage activity as much as possible without causing pain.
2. Teach ROM exercise to maintain joint mobility and muscle tone for joint support,
to prevent capsular and tendon tightening, and to prevent deformities. Avoid flexion and adduction deformities. 3. Teach isometric exercises and graded exercises to improve muscle strength around the involved joint. 4. Advise putting joints through ROM after periods of inactivity (eg, automobile ride)
1. Suggest performing important activities in morning, after stiffness has been abated and before fatigue and pain become a problem. 2. Advise on modification, such as wearing looser clothing without buttons, placing bench in tub or shower for bathing, sitting a table or counter in kitchen to prepare meals. 3. Help with obtaining assistive devices, such as padded handles for utensils and grooming aids, to promote independence. 4. Refer to OT for additional assistance.
Lippincott Manual of Nursing Practice Eight Edition A to Z Health Guide, by the Editors of TIME pp.15-17
Understanding Pathophysiology by Huether; 3rd ed., p.1091-1095 Medical Surgical Nursing by Black, 8th ed., p. 471-473 Nurse’s Pocket Guide by Doenges, 11th ed., p.798
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