OSTEOA RT H R I T I S

(DEGENERA TI V E J OI NT
DISEASE)
Y JAIME S B UST AMANT E
PREPARED BY: GAR
LEARNING OBJECTIVES
GENERAL:
TO UNDERSTAND WHAT IS OSTEOARTHRITIS AND ITS DISEASE PROCESS
SPECIFIC:

• TO DEFINE OSTEOARTHRITIS
• TO IDENTIFY THE TYPES OF OSTEOARTHRITIS
• TO UNDERSTAND THE PATHOPHYSIOLOGY
• TO IDENTIFY THE RISK FACTORS AND CLINICAL MANIFESTATIONS
• TO IDENTIFY THE MANAGEMENT OF OSTEOARTHRITIS
DEFINITION

•OSTEOARTHRITIS IS A NON INFLAMMATORY DEGENERATIVE

DISORDER OF THE JOINTS. IT IS THE MOST COMMON FORM OF JOINT
DISEASE AND IS ROUTINELY REFERRED TO AS DEGENERATIVE JOINT
DISEASE. OA IS CLASSIFIED AS EITHER PRIMARY (IDIOPATHIC),
SECONDARY
PRIMARY VS SECONDARY
PRIMARY SECONDARY

•“WEAR AND TEAR” •RESULTING FROM A PREVIOUS JOINT

INJURY OR INFLAMMATORY DISEASE
•MORE COMMON (OBESITY, INACTIVITY, GENETICS)
•NO PRIOR EVENT OR DISEASE •STARTS AT EARLIER AGE (45-50)
RELATED TO OA
OSTEOARTHRITIS

•ANOTHER DISTINGUISHING CHARACTERISTIC OF OA IS THAT IT IS

LIMITED TO THE AFFECTED JOINT ONLY; THERE ARE NO SYSTEMIC
SYMPTOMS ASSOCIATED WITH IT.
WHEN DOES OA BEGINS?

•OA OFTEN BEGINS IN THE THIRD DECADE OF LIFE AND PEAKS BETWEEN
5TH AND 6TH DECADES. BY 40 YEARS OF AGE 90% OF THE POPULATION
HAS DEGENERATIVE JOINT CHANGES IN THEIR WEIGHT BEARING
JOINTS, EVEN THOUGH CLINICAL SYMPTOMS ARE USUALLY ABSENT.
WHEN DOES OA BEGINS?
•WOMEN, ESPECIALLY HISPANIC OR AFRICAN AMERICAN ARE MORE COMMONLY
AFFECTED. THE INCIDENCE OF OA INCREASES WITH AGE. IT IS ESTIMATED THAT
OVER 85% OF THE GENERAL POPULATION OVER 65 YEARS OF AGE HAS
RADIOGRAPHIC CHANGES INDICATING OA. ALTHOUGH OA USUALLY THOUGHT OF
AS A DISEASE OF AGING, IT ALSO AFFECTS YOUNGER AGE AND RESULTS IN
SIGNIFICANT LOSSES IN WORK RELATED PRODUCTIVITY AND HIGHER COST.
PATHOPHYSIOLOGY
MECHANICAL INJURY
CHONDROCYTE RESPONSES PREVIOUS JOINT DAMAGE
RELEASE OF CYTOKINES
STIMULATION, PRODUCTION, RELEASE OF PROTEOLYTIC ENZYMES,
METALLOPROTEASES, COLLAGENASE
RESULTING DAMAGE PREDISPOSES TO FURTHER DAMAGE
PATHOPHYSIOLOGY
•ALL JOINTS CONSIST OF BONE, PARTICULARLY SUBCHONDRAL BONE OR THE BONY
PLATE TO WHICH THE ARTICULAR CARTILAGE IS ATTACHED. THE ARTICULAR
CARTILAGE IS LUBRICATED, SMOOTH TISSUE THAT PROTECTS THE BONE FROM
DAMAGE WITH PHYSICAL ACTIVITY, BETWEEN THE ARTICULAR CARTILAGE OF THE
BONES FORMING THE JOINT IS A SPACE THAT ALLOWS FOR MOVEMENT. TO AID IN
FLUIDITY EACH JOINT CONTAINS SYNOVIAL FLUIDS TO HELP LUBRICATE AND
PROTECT JOINT’S MOVEMENT.
PATHOPHYSIOLOGY
•SUBCHONDRAL BONE IS THE LAYER OF BONE JUST BELOW THE
CARTILAGE IN A JOINT. THE -CHONDRAL REFERS TO CARTILAGE, WHILE
THE PREFIX SUB MEANS BELOW. SUBCHONDRAL BONE IS A SHOCK
ABSORBER IN WEIGHT-BEARING JOINTS
RISK FACTORS
•ADVANCED AGE
•FEMALE
•OBESITY
•LABORIOUS TASKS (JOBS)
•SPORT ACTIVITIES
•HISTORY OF PREVIOUS INJURIES
•MUSCLE WEAKNESS
•GENETIC
RISK FACTORS
•THE MOST PROMINENT MODIFIABLE RISK FACTOR IS OBESITY.
•IN FACT QUALITY AND QUANTITY OF LIFE ARE REDUCED WITH OA
ESPECIALLY WHEN OA AND OBESITY ARE COMBINED
•PROGRAM OF DIET AND EXERCISE MAY HELP MINIMIZE SYMPTOMS OF
OA IN PATIENTS WHO ARE OBESE.
CLINICAL MANIFESTATIONS
•PAIN •THE PAIN IS USUALLY AGGRAVATED
•STIFFNESS MOVEMENT OR EXERCISE AND
•FUNCTIONAL IMPAIRMENT RELIEVED BY REST
•CREPITUS
•MILD JOINT EFFUSION •IF MORNING STIFFNESS IS
PRESENT, IT USUALLY BRIEF
•ENLARGED JOINT WITH LESS RANGE OF
MOTION LASTING LESS THAN 30MINS
ASSESSMENT AND DIAGNOSTIC FINDINGS
•X-RAY- SHOWS NARROWING OF JOINT SPACE, OSTEOPHYTE FORMATION, DENSE, THICKENED SUBCHONDRAL
BONE.
•MRI- ISN’T COMMONLY NEEDED IN DIAGNOSING OA BUT HELP PROVIDE MORE INFORMATION IN COMPLEX
CASES.
•JOINT FLUID ANALYSIS- NEEDLE IS USED TO DRAW FLUID OUT OF THE AFFECTED JOINT EXAMINING AND TESTING
THE FLUID DETERMINES INFLAMMATION AND IF YOUR PAIN IS CAUSED BY GOUT OR BY AN INFECTION.
•BLOOD TESTS AND EXAMINATION OF JOINT FLUID ARE NOT USEFUL IN THE DIAGNOSIS OF OA BUT ARE
OCCASIONALLY INDICATED TO RULE OUT AUTOIMMUNE CAUSE OF JOINT PAIN.
MEDICAL MANAGEMENT
GOALS OF CARE:
1. DECREASE PAIN AND STIFFNESS
2. IMPROVE JOINT MOBILITY
MEDICAL MANAGEMENT
•EXERCISE IN THE FORM OF CARDIOVASCULAR AEROBIC EXERCISE.
•LOWER EXTREMETY STRENGTH TRAINING HAS BEEN FOUND TO PREVENT OA
PROGRESSION AND DECREASES SYMPTOMS
•WEIGHT LOSS TO DECREASE EXCESS LOAD ON THE JOINT
•OCCUPATIONAL AND PHYSICAL THERAPY HELPS THE PATIENT ADOPT SELF
MANAGEMENT STRATEGIES.
MEDICAL MANAGEMENT
•USE OF WEDGED INSOLES, KNEE BRACES AND OTHER MODALITIES ARE
BEING EVALUATED
•USE OF ORTHOTIC DEVICES (SPLINTS, BRACES) AND WALKING AIDS
CAN IMPROVE PAIN AND FUNCTION BY DECREASING FORCE ON THE
AFFECTED JOINT
MEDICAL MANAGEMENT
•PATIENTS OFTEN USE COMPLEMENTARY, ALTERNATIVE AND INTEGRATIVE HEALTH
THERAPIES. SUCH AS MASSAGE, YOGA, PULSED ELECTROMAGNETIC FIELDS, TENS, AND
MUSIC THERAPY
•OTHER SPECIAL DIETS, ACUPUNCTURE AND ACUPRESSURE, WEARING COPPER BRACELETS
OR MAGNETS OR TAI CHI.
•RESEARCH IS UNDERWAY TO DETERMINE THE EFFECTIVENESS OF MANY OF THESE
TREATMENTS.
PHARMACOLOGIC THERAPY
PHARMACOLOGIC MANAGEMENT OF OA IS DIRECTED TOWARD
SYMPTOM MANAGEMENT AND PAIN CONTROL. SELECTION OF
MEDICATION IS BASED ON THE CLIENT’S NEEDS, STAGE OF THE DISEASE
AND THE RISK OF THE SIDE EFFECTS.
PHARMACOLOGIC THERAPY
•ACETAMINOPHEN- IS THE INITIAL ANALGESIC THERAPY
•SOME RESPONDS TO NON SELECTIVE NSAID’S
•PATIENTS WHO ARE AT INCREASED RISK FOR GI COMPLICATIONS
ESPECIALLY GI BLEEDING IS MANAGED EFFECTIVELY WITH COX-2
ENZYME BLOCKERS
PHARMACOLOGIC THERAPY
NOTE!!!!
COX-2 ENZYME BLOCKERS MUST BE USED WITH CAUTION BECAUSE OF
THE ASSOCIATED RISK OF CARDIOVASCULAR DISEASE
PHARMACOLOGIC THERAPY
OTHER MEDICATIONS THAT CAN BE CONSIDERED:
•OPIOIDS AND INTRA-ARTICULAR CORTICOSTEROID
•TOPICAL ANALGESICS
-CAPSAICIN (CAPSIN,ZOSTRIX)
-METHYLSALICYLATE
-DICLOFENAC SODIUM GEL (VOLTAREN GEL)
PHARMACOLOGIC THERAPY
OTHER THERAPEUTIC APPROACHES:

• GLUCOSAMINE
• CHONDROITIN (SHARK AND COWS)
-ALTHOUGH IT HAS BEEN SUGGESTED THAT THESE SUBSTANCES MODIFY CARTILAGE STRUCTURE, STUDIES
HAVE NOT YET SHOWN THEM TO BE EFFECTIVE
PHARMACOLOGIC THERAPY
VISCOSUPPLEMENTATION:
- THE INJECTION OF GEL-LIKE SUBSTANCES (HYSLURONATES) INTO A JOINT (INTRA ARTICULAR)
TO SUPPLEMENT THE VISCOUS PROPERTIES OF SYNOVIAL FLUID.

- IT AIMS TO PREVENT THE LOSS OF CARTILAGE AND REPAIR

CHONDRAL DEFECTS.
SURGICAL MANAGEMENT
IN MODERATE TO SEVERE OA WHEN PAIN IS SEVERE OR BECAUSE OF LOSS OF FUNCTION THE PROCEDURES
MOST COMMONLY USED ARE:

• OSTEOTOMY
• ARTHROPLASTY (REPLACEMENT OF JOINT COMPONENTS)
NURSING MANAGEMENT
GOALS OF THE INTERVENTIONS:

• PAIN MANAGEMENT
• RESTORATION OF OPTIMAL FUNCTIONAL ABILITY
• EDUCATION
NURSING MANAGEMENT
• CLIENT EDUCATION REGARDING THE DISEASE PROCESS AND SYMPTOM PATTERN IS CRITICAL TO PLAN OF
CARE BECAUSE OA PATIENTS ARE USUALLY OLDER

• ENCOURAGE WEIGHT REDUCTION (FOR OBESE CLIENTS)

• PROMOTE ACTIVITY AND EXERCISE
• GIVING ASSISTIVE DEVICES
• GIVE ANALGESICS AS PRESCRIBED
• REFER TO PT
THANK YOUUUUUU!!!!