OSTEOARTHRITIS

OSTEOARTHRITIS
• Also known as degenerative joint (rheumatic) disease DJD
• A commonly occurring arthritis which may affect any weight bearing joint
• It is not inflammatory disease, but inflammation may occur as a result of the disease
• Commonly called arthritis – Inflammation of joint
• Approximately 200 different disease entities
• Affects skeletal muscles, bones, ligaments, tendons, and joints
• Affects males and females of all ages
• Impact can be life threatening or just an inconvenience
• Acute or insidious onset with periods of exacerbations and remission
• There is no cure but treatments are advanced

PROBLEMS WITH OSTEOARTHRITIS

GERONTOLOGICAL CONSIDERATIONS
• Age related changes
• Decrease in muscle tone (strength movement)
• Wear and tear of joints (stiffen with decreased ROM)
• Decrease in bone mass (brittle, vertebral disk are thin)
• Fibrous tissues replace muscle tissue
• Posture decreases
• Erosion of cartilage
• Arthritis is usually 2nd diagnosis; with other medical conditions precedence
• Arthritis account more total disability
• Osteoarthritis (DJD) most prevalent activity limitating activity
• Increases with age
• Most people over age 60 have dome degree of DJD

RISK FACTORS
• Heredity
o 30% TBP (collagen) – aids is the elasticity and movability of a joint; Once the cartilage is
affected you have a decrease in the ROM because the cartilage is a shock absorber in
the joint
• Injuries
o Sports injuries; Once you have had an injury it is at a greater risk of developing OA
• 70% H2O with free movement
• Obesity
o Most people maintain idea that weight decreases progression; Usually the knees
• Wear and Tear of joints
• Overuse of knee and hips are the most involved with these processes.
o Repeated bending wears and tears
PATHOPHYSIOLOGY
• With “wear and tear” the articular cartilage becomes rough, frayed, and cracked; is
eventually destroyed. Bone begins to rub against bone and changes in bone structure
occur.
• Joint cartilage and underlying deteriorates resulting in micorfractures of subchondral
bone
• Thickened subcondral bone absorbs weight poorly, damaging articular cartilage
o Synovial cells release enzymes further degrading cartilage
• Articular cartilage becomes rough and cracked
o Bone rubs against bone
• DJD cause stiffness, losing elasticity increase -- suspected damage
• Cartilage wears away over time decreasing ability to act as shock absorbers
• Cartilage wears away, tendons and ligaments stretch causing pain

CLINICAL MANIFESTATIONS
• Pain, stiffness, and functional impairment
o The pain is due to an inflamed synovium, stretching of the joint capsule or
ligaments, irritation of nerve endings in the periosteum over osteophytes.
• Deep aching pain in joint with soreness accentuated by use and weight bearing
o They will not have a lot of pain sitting and resting; it is when they try to get up is
when they have a lot of pain. (getting up from a chair causes pain)
• Chair: Firm chair with arm support to use to get down and get back up. Hard back
o No sofa or recliner because they will have trouble
• Enlarged Joints - Swollen
• Mild tenderness
• Change alignment of joints, decreasing mobility and ROM ----- Contractures
• You want to keep them moving
• Heberden’s Nodes: bony proliferations over distal interphalangeal joints
• Bouchard’s Nodes: bony knobs over proximal interphalangeal joints (PIP)
• Metacarpalphalangeal Joint

DIAGNOSIS
• Physical assessment of MS System
o Do not force ROM
• Location and pattern of pain
o Ask what they do to relieve pain
• X-Rays
o See bone hypertrophy, bony spur formation, cartilage destruction with resulting
narrowing of joint spaces, and gross irregularities of joint structures
o Looking for narrowing of joint spaces
o Osteophytes (spurs) narrowing of joint spaces
o Presents Asymmetrically
• Athrocentesis
o Looking at the fluid in the joint capsules. May have enzymes in the fluid that are the
cause of the breakdown.
 • No specific useful serum study. Serum studies are not useful in the diagnosis of this disorder
• ESR  sed. Rate with most inflammatory conditions but not specific.
THERAPEUTIC MANAGEMENT
• Although no treatment halts the degenerative process, certain preventive measures can slow
the progress if undertaken early enough.
• Goals of treatment
o Decrease joint pain and stiffness
o Improve joint mobility and stiffness
o Increase ability to perform ADL’s
• Pain management
• Maintenance of joint function

CONSERVATIVE MEASURES
• Heat or whichever relieves heat
o Hot paraffin wax
o Provides comfort
• Weight Control
o Decreases stress joints and decreases pain
• Rest joint, no overuse
o When it is flared (acutely inflamed) they need to rest it until they get past the acute stage
o Promote rest
• Supportive devices
o Canes, crutches, walkers, splints, braces, stabilize ligaments, tendons –  stress on
joint
• Exercise
o Moderate exercise but rest with acute flare ups
• OT / PT
o PT - Assist with activity; OT – Helps with ADL’s
• Pain management / maintenance of joint function : essential in order to accomplish goals of
treatment
• May have drug therapy

MEDICAL TREATMENT
• Salicylates
o Aspirin “Grandfather” (GI irritations) – Anti inflammatory – Take with food
• Ibuprofen
o Advil, Motrin, Nuprin – OTC – Can cause GI distress – Take with food or milk
• NSAIDs
o Anti Inflammatory - Vioxx, Celebrex, “Super ASA” Decrease GI irritants with pain relief
o Older: Endocin, Naprocin. Very GI Disturbing NO ALCOHOL
• Glucosamine and Chondroitin
o Nutritional supplements – OTC – Vitamins
o Helps build cartilage – encourage growth
o Physician needs to know
• Tramadol (Ultram)
o Narcotic related pain reliever – decreased rate of addiction
• Interarticular Corticosteriods
 o Administer MD office to relieve pain for 3-6 months some of the time
o Cannot do repeatedly
• RESEARCH
o Minecycline: Breaks down enzyme responsible for catabolism breakdown

NURSING DIAGNOSIS
• Chronic Pain R/T Osteoarthritis
• Impaired Physical Mobility R/T Restricted joint mobility
o Get the pain relieved
o Good exercise program
o Ideal weight
o Good posture
o Good shoes
o Alternate activity with rest periods
• Body image disturbance
o Talk to them about the disease process and what is going on and why.
o Keep them going and moving and doing things – may be depressed
 Make them feel involved
• Self care deficit R/T immobility
o OT
o Help with things they cannot do but let them do the things they can do
• Knowledge Deficit
o Explain meds and why they are doing what they are doing
• Ineffective individual / family coping or compromise
o Caregiver role strain
o Caregivers are put under a lot of pressure to care for them

PREVENTATIVE MEASURES
• Correct body mechanics
• Avoid grasping action that strain finger joint
• Spread weight of an object over several joints
• Maintain good posture
• Use strongest muscle and favor large joints
• Don’t carry big heavy things with fingers
• Ex. Backpack; weigh over several joints – Both shoulders
• Overuse of joints can increase the risk of osteoarthritis

• Surgery cannot return joints to precondition state