What is osteoarthritis?
most common form of joint disease in north america
slow and progressive noninflammatory disorder of the diarthrodial (synovial) joints
is OA considered a normal form of aging
no
when can cartilage destruction begin:
affected by age:
few experience symptoms after:
between 20-30 and affected by 40 few experience symptoms after 50 and 60
after 55 whos more affected men or women
women
OA is usually cause by
a known event or condition that directly damages cartilage or causes joint inability
in aging women is believed to be due to
estrogen reduction at menopause
OA modifiable risk factors:
obesity - contributes to knee and hip
anterior cruciate ligament injury - associate with quick tops and pivoting
jobs that require frequent kneeling and stooping - high knee risk
Ways to prevent OA
regular moderate exercise which also helps with weight control has been shown to decrease likelihood of disease development and progression
OA pathogenesis
complex with genetic, metabolic and local factors that interact and cause a process
OA results from***
cartilage damage at the level of chondrocytes
OA causes smooth white translucent articular cartilage to become
dull yellow and granular and it graducally becomes softer, less elastic and less able to resist wear with heavy use
Early changes in OA
synovium inflamed
joint capsule inflamed and edematous
cartilage splits an dis eroded
joint space narrowed by loss of cartilage
With time how does OA change joints
Outgrowth of bone
Development of sub-articular bone cysts
Hyperplasia of synovium with inflammation
thickening of subchondral bone plate
is inflammation characteristic of OA
no
Clinical manifestations: Systemic**
None
Clinical manifestations: Joints**
mild discomfort to significant disability
localized pain and stiffness after rest and static position resolves within 30 min**
trouble getting out of a chair where knees are higher than hips
affects joints asymetrically
Crepetation (cracking sound) and its asymmetrical (one side but on the other limb)
Clinical manifestations: pain may be reffered to
the groin, butt, medial side of the thigh or knee
Clinical manifestations: crepitation
grating sensation caused by loose particles of cartilage in the joint / bone on bone rubbing
can cause stiffness
common sing in knee oa pt
Predominant clinical manifestation of the joints
PREDOMINANT SYMPTOM: joint pain (usually why pt comes to doctor)
Clinical Manifestations: early oa v.s advance o.a
Early stages: joint pain is relieved by rest
Advance stage: hurts at rest and may disturb sleep. sometimes worsens when atmospheric pressure falls
Most common OA sites
distal interphalangeal / DIP and proximal interphalangeal / PIP joints of the fingers
metacarpol phalangeal / MCP joints of the thumb
weight bearing joints
cervical and lower lumbar vertebrae
Clinical Manifestations: Deformity
specific to involved joints and can appear as early as age 40
beouchards nodes on the PIP joints indicate similar disease involvement - red swollen and tender
no function loss just visible disfigurement but can impair adl and other functions
knee oa = bowlegged and altered gait
hip oa = one hip shorter than the other
OA diagnostic test (not important except one)
Bone scan, CT scan or MRI diagnoses oa because they detect early joint changes
also xrays help by tracking progression but do not correlate with amount of pain or symptoms
synovial fluid analysis differentiates oa and other inflammatory arthritis - fluid = clear and yellow with little to no inflammation
erythrocyte sedimentation rate is only elevated in acute synovitis because it measures inflammation *****
other blood test only screen for related conditions
True/False: there is no cure for oa
true
oa care is focused on
managing pain and inflammation and preventing disability and maintaining and improving joint function. non drug interventions are key.
Collaborative Care: Rest and Joint protection
rest during inflammation and maintained in a functional position with splints or braces if necessary
immobilization should exceed one week because joint stiffens with inactivity
modify activities to decrease stress on affected joints
use assitive devices to help decrease stress on arthritic joints
knee oa= avoid standing, kneeling or squatting for a long time
Collaborative Care: Heat and Cold Applications**
heat and cold application
Heat = helps with pain and stiffness
ice = acute inflammation
Collaborative Care: Nutritional Therapy and Exercise**
Put overweight patients in a weight reduction program - critical to rx plan**
help patient i.d diet changes
Exercise is fundamental: aerobic, ROM, and quadricep strengthening ***
Collaborative care: Complementary and Alternative Therapies**
acupuncture - decreases chronic arthritic pain
yoga, massage, guided imagery and therapeutic touch
nutritional supplements: glucosamine and chondrotin helps relieve arthritic pain and improve joint mobility in some
Balance rest and activity***
Collaborative Care: Drug Therapy
based on pt symptoms
mild - moderate = acetaminophen (no more than 4g daily) and topical cream (zostrix).
temporary pain relief can by met by using products with camphor, eucalyptus oil and menthol
topical salicylates for patients who cant take asprin
moderate-sever/ when acetaminophen doesnt work:
- NSAID
- supplemental treatment with protective agents (misoprostol)
what are disease-modifying osteoarthritis drugs
medications thought to slow the progression of oa or support joint healing
Collaborative care: surgical therapy
for severe patients only
- knee replacements
- debris removal
- reconstructive surgery
Goals for a patient with OA:
- maintain or improve joint function through a balance of rest and activity
- use joint protection measures
- achieve independence in self care and maintain optimal role function
- use drug and non drug strategies
Implementation: Health promotion
prevention is possible with community education focused on altering modifiable risk factors. Athletic instruction and physical fitness programs. That reduce trauma to joints.
Implementation: Acute intervention
questionaires pin point areas of decreased function and should be completed at regular intervals to track progression and create treatment goals
drugs to treat pain an dinflamation
non drugs to decrease pain and disability
assure pt that deformities are not the usual course
provide info about treatment pain and body mechanics plus use of assistive devices and energy conservation. Encourage weight loss and nutritional changes.
ESR (inflammation test)**
It will be elevated