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Flashcards in Ostoarthritis Deck (36)
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1
Q

What is osteoarthritis?

A

most common form of joint disease in north america

slow and progressive noninflammatory disorder of the diarthrodial (synovial) joints

2
Q

is OA considered a normal form of aging

A

no

3
Q

when can cartilage destruction begin:
affected by age:
few experience symptoms after:

A

between 20-30 and affected by 40 few experience symptoms after 50 and 60

4
Q

after 55 whos more affected men or women

A

women

5
Q

OA is usually cause by

A

a known event or condition that directly damages cartilage or causes joint inability

6
Q

in aging women is believed to be due to

A

estrogen reduction at menopause

7
Q

OA modifiable risk factors:

A

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

8
Q

Ways to prevent OA

A

regular moderate exercise which also helps with weight control has been shown to decrease likelihood of disease development and progression

9
Q

OA pathogenesis

A

complex with genetic, metabolic and local factors that interact and cause a process

10
Q

OA results from***

A

cartilage damage at the level of chondrocytes

11
Q

OA causes smooth white translucent articular cartilage to become

A

dull yellow and granular and it graducally becomes softer, less elastic and less able to resist wear with heavy use

12
Q

Early changes in OA

A

synovium inflamed

joint capsule inflamed and edematous

cartilage splits an dis eroded

joint space narrowed by loss of cartilage

13
Q

With time how does OA change joints

A

Outgrowth of bone

Development of sub-articular bone cysts

Hyperplasia of synovium with inflammation

thickening of subchondral bone plate

14
Q

is inflammation characteristic of OA

A

no

15
Q

Clinical manifestations: Systemic**

A

None

16
Q

Clinical manifestations: Joints**

A

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)

17
Q

Clinical manifestations: pain may be reffered to

A

the groin, butt, medial side of the thigh or knee

18
Q

Clinical manifestations: crepitation

A

grating sensation caused by loose particles of cartilage in the joint / bone on bone rubbing

can cause stiffness

common sing in knee oa pt

19
Q

Predominant clinical manifestation of the joints

A

PREDOMINANT SYMPTOM: joint pain (usually why pt comes to doctor)

20
Q

Clinical Manifestations: early oa v.s advance o.a

A

Early stages: joint pain is relieved by rest

Advance stage: hurts at rest and may disturb sleep. sometimes worsens when atmospheric pressure falls

21
Q

Most common OA sites

A

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

22
Q

Clinical Manifestations: Deformity

A

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

23
Q

OA diagnostic test (not important except one)

A

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

24
Q

True/False: there is no cure for oa

A

true

25
Q

oa care is focused on

A

managing pain and inflammation and preventing disability and maintaining and improving joint function. non drug interventions are key.

26
Q

Collaborative Care: Rest and Joint protection

A

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

27
Q

Collaborative Care: Heat and Cold Applications**

A

heat and cold application

Heat = helps with pain and stiffness

ice = acute inflammation

28
Q

Collaborative Care: Nutritional Therapy and Exercise**

A

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 ***

29
Q

Collaborative care: Complementary and Alternative Therapies**

A

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***

30
Q

Collaborative Care: Drug Therapy

A

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)
31
Q

what are disease-modifying osteoarthritis drugs

A

medications thought to slow the progression of oa or support joint healing

32
Q

Collaborative care: surgical therapy

A

for severe patients only

  • knee replacements
  • debris removal
  • reconstructive surgery
33
Q

Goals for a patient with OA:

A
  1. maintain or improve joint function through a balance of rest and activity
  2. use joint protection measures
  3. achieve independence in self care and maintain optimal role function
  4. use drug and non drug strategies
34
Q

Implementation: Health promotion

A

prevention is possible with community education focused on altering modifiable risk factors. Athletic instruction and physical fitness programs. That reduce trauma to joints.

35
Q

Implementation: Acute intervention

A

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.

36
Q

ESR (inflammation test)**

A

It will be elevated