Osteoarthritis

Submitted by: Javier, Jomar Junio, Gianne Avril GROUP 83/ BSN121

Osteoarthritis
Osteoarthritis, sometimes called degenerative joint disease or osteoarthrosis, is the most common form of arthritis. Osteoarthritis occurs when cartilage in your joints wears down over time. While osteoarthritis can affect any joint in your body, the disorder most commonly affects joints in your: 

Hands 

Hips 

Knees 

Neck 

Lower back

Osteoarthritis gradually worsens with time, and no cure exists. But osteoarthritis treatments can relieve pain and help you remain active. Taking steps to actively manage your osteoarthritis may help you gain control over your symptoms.

Causes

Primary osteoarthritis is mostly related to aging. With aging, the water content of the cartilage increases, and the protein makeup of cartilage degenerates. Eventually, cartilage begins to degenerate by flaking or forming tiny crevasses. In advanced cases, there is a total loss of cartilage cushion between the bones of the joints. Repetitive

use of the worn joints over the years can irritate and inflame the cartilage, causing joint painand swelling. Loss of the cartilage cushion causes friction between the bones, leading to pain and limitation of joint mobility. Inflammation of the cartilage can also stimulate new bone outgrowths (spurs, also referred to as osteophytes) to form around the joints. Osteoarthritis occasionally can develop in multiple members of the same family, implying a hereditary (genetic) basis for this condition.

Factors that increase your risk of osteoarthritis include: 

Older age. Osteoarthritis typically occurs in older adults. People under 40 rarely experience osteoarthritis. 

Sex. Women are more likely to develop osteoarthritis, though it isn't clear why. 

Bone deformities. Some people are born with malformed joints or defective cartilage, which can increase the risk of osteoarthritis. 

Joint injuries. Injuries, such as those that occur when playing sports or from an accident, may increase the risk of osteoarthritis. 

Obesity. Carrying more body weight places more stress on your weight-bearing joints, such as your knees. 

Certain occupations. If your job includes tasks that place repetitive stress on a particular joint, that may predispose that joint toward eventually developing osteoarthritis. 

Other diseases. Having gout, rheumatoid arthritis, Paget's disease of bone or septic arthritis can increase your risk of developing osteoarthritis.

Osteoarthritis symptoms often develop slowly and worsen over time. Signs and symptoms of osteoarthritis include: 

Pain. Your joint may hurt during or after movement. 

Tenderness. Your joint may feel tender when you apply light pressure to it. 

Stiffness. Joint stiffness may be most noticeable when you wake up in the morning or after a period of inactivity. 

Grating sensation (crepitus). You may hear or feel a grating sensation when you use the joint. 

Bone spurs. These extra bits of bone, which feel like hard lumps, may form around the affected joint.
o

Heberden¶s nodes

o

Bouchard¶s nodes

Diagnosis:

XRAY

Osteoarthritis is often visible in x-rays. Cartilage loss is suggested by certain characteristics of the images:
y y y

The normal space between the bones in a joint is narrowed. There is an abnormal increase in bone density. Bony projections, cysts, or erosions are visible.

If the doctor suspects other conditions, or if the diagnosis is uncertain, additional tests are necessary. It is important to note that a negative x-ray does not rule out osteoarthritis. Likewise, some people may have minimal symptoms even though an x-ray clearly shows they have arthritis. An MRI exam of an arthritic joint is generally not needed, unless the doctor suspects other causes of pain. X-rays are a form of ionizing radiation that can penetrate the body to form an image on film. Structures that are dense (such as bone) will appear white, air will be black, and other structures will be shades of gray depending on density. X-rays can provide information about obstructions, tumors, and other diseases, especially when coupled with the use of barium and air contrast within the bowel.

Physical Exam The affected joint in patients with osteoarthritis will generally be tender to pressure right along the joint line. Joint movement may cause a crackling sound. The bones around the joints may feel larger than normal. The joint's range of motion is often reduced, and normal movement is often painful.

Blood Tests Blood test results may help identify other causes of arthritis (if present) besides osteoarthritis. Some examples include:
y

Elevated levels of rheumatoid factor (specific antibodies in the synovium) are usually found in patients with rheumatoid arthritis

y

y

The erythrocyte sedimentation rates (ESR, or "sed rate") indicates inflammatory arthritis or related conditions, such as rheumatoid arthritis or systemic lupus erythematosus. Elevated uric acid levels in the blood may indicate gout.

A number of other blood tests may help identify other rheumatological illnesses.

Tests of the Synovial Fluid (arthrocentesis)

If the diagnosis is uncertain or infection is suspected, a doctor may attempt to withdraw synovial fluid from the joint using a needle. There will not be enough fluid to withdraw if the joint is normal. If the doctor can withdraw fluid, problems are likely, and the fluid will be tested for factors that might confirm or rule out osteoarthritis:
y y

y

Cartilage cells in the fluid are signs of osteoarthritis. A high white blood cell count is a sign of infection, gout, pseudogout, or rheumatoid arthritis. Uric acid crystals in the fluid are an indication of gout.

y

y

Other factors may be present that suggest different arthritic conditions, including Lyme disease and rheumatoid arthritis. In people with known osteoarthritis, researchers may look for certain factors in synovial fluid (sulfated glycosaminoglycan, keratin sulfate, and link protein) that can suggest a more or less severe condition.

Arthroscopy

INTERVENTIONS

Pain management The choice and frequency of pain medication depends on the severity of your symptoms and the risk of side effects and may range from acetaminophen and non-steroidal antiinflammatory drugs (NSAIDs) to narcotic drugs and steroids. You need to be aware of possible side effects, such as gastrointestinal upset and bleeding. Other pain management treatments include acupuncture and topical creams (such as capsaicin and methylsalicylate).

Nutritional counseling

Lack of mobility and sedentary lifestyle often lead to increased weight, putting strain on your already damaged joints. A nutritional assessment helps to develop a healthy weight-maintenance or health-reduction plan. Because osteoporosis is common with osteoarthritis, your diet should contain adequate vitamin D and calcium. Glucosamine supplements are widely used for osteoarthritis, particularly knee osteoarthritis. In osteoarthritis, cartilage -- the rubbery material that cushions joints -becomes stiff and loses its elasticity. This makes the joint prone to damage and may lead to pain, swelling, loss of movement, and further deterioration.

y

Chondroitin is the most abundant glycosaminoglycan in cartilage and is responsible for the resiliency of cartilage.Treatment with these joint supplements is based on the theory that oral consumption of glucosamine and chondroitin may increase the rate of formation of new cartilage by providing more of the necessary building blocks.

Joint protection You must balance rest and activity to prevent further injury. An acutely inflamed joint should rest until the inflammation subsides. Wearing a splint or brace that keeps the joint in functional position or using assistive devices (cane, walker) can relieve joint strain. You must learn to protect the affected joint; if your knee is affected, for instance, you should avoid kneeling or long periods of standing. Immobilization of a joint should not exceed one week because prolonged immobilization can increase stiffness.

Exercise program Bone health and mobility are dependent on exercise, so you need to develop a plan of exercise that includes some aerobic conditioning, such as walking. Exercise programs must begin slowly, allowing you to increase your endurance over time to avoid increasing joint inflammation. You should plan regular exercise at the time of day when your pain is least intense and after pain medication.

Heat/cold therapy Heat therapy (warm bath, compresses, shower) is especially effective to relieve stiffness and may be used 2 to 3 times a day for a half hour each time. Using heat

therapy before activities can increase endurance. Cold therapy (compresses, ice packs) is often effective to relieve swelling and discomfort when a joint is inflamed. Assistive devices/equipment

Brian Donnelly, LifeSpan Furnishings, CDC, US Public Health Information Library Assistive devices can make it much easier for you to function. Walkers and canes can help with mobility. Other devices include easy grip handles on equipment and seat belts, elevated toilet seats, handrails, safety bars, shower stools, grab tools, door knob grips, and chair with elevated and extended arms. Hyaluronic injection Injecting hyaluronic acid into an osteoarthritic joint has been shown to improve joint health by:y y y y

Increasing synovial fluid levels of hyaluronic acid improving its viscosity, and freedom of joint movement. Decreasing levels of prostaglandins improving pain, Increasing the cartilage depth on load bearing surfaces, Having effects on these parameters for more than 6 months.

SURGICAL MANAGEMENT 

Excision arthroplasty. In this method one or both of the articular ends of the bones are simply excised, so that a gap is created between them (Fig. 13). The gap fills with fibrous tissue, or a pad of muscle or other soft tissue may be sewn in between the bones. By virtue of its flexibility the interposed tissue allows a reasonable range of movement, but the joint often lacks stability. The method is applicable to all the joints for which arthroplasty is practicable except the knee and ankle. It is used most commonly at the metatarso-phalangeal joint of the great toe, in the treatment of hallux valgus and hallux rigidus. At the hip it may be used as a salvage operation after failed replacement arthroplasty. 

Osteotomy is an elective surgical procedure, performed under general anesthesia, in which a bone is cut or a portion is taken out in order to fix a bad bone alignment, to shorten or lengthen the bone, or to correct damage due to osteoarthritis. An osteotomy is needed when a bone has healed badly or crooked, or when adeformity is caused by disease or disorder. 

Joint fusion surgery (also known as arthrodesis surgery) literally involves the ³fusion´ of bones in the joint (ankles, spine, hip, etc). It is recommended to relieve persistent pain in these areas which may also be compounded by other symptoms like swelling, catching, clicking, instability or ³giving way´ of the joint. Arthrodesis surgery often results in the elimination of the actual joint itself. As a result, the joint might lose flexibility, but in most cases, it can bear weight better. In addition, pain and swelling tend to subside. 

Arthroscopic debridement (AD) involves using instruments to remove damaged cartilage or bone. Often the doctor will start the procedure by using a tool to spray jets of fluid to wash and suck out all debris around the joint. This is called lavage or washout. Then, the parts of the joint bone that are loose or misshapen are removed.

y

Total joint arthroplasty- Arthroplasty in which both joint surfaces are replaced with artificial materials, usually metal and high-density plastic.

CASTS

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