Osteoarthritis

DEFINITION OSTEOARTHRITIS

➢ is the most common form of arthritis ➢ Is considered a “wear and tear” disease and is characterized by a

slow and steady progressive breakdown of cartilage. ➢ It is a non inflammatory disorder causing bones and joints to

degenerate. ➢ It most commonly affects the joints of the knees, hips, and distal

interphalangeal finger joints, thumb base joints of the hands and facet joints of the spine. ➢ it usually occurs after age of 40 and symptoms most commonly present between the ages 50 to 60 ➢ Also called as progressive degenerative joint disease.

ETIOLOGY Exact cause or etiology is unknown but there are several factors that increase a person’s risk of developing Osteoarthritis. It includes:  Age Age is the strongest risk factor for developing Osteoarthritis. The chance of developing the disease increases with age. Most people over age 60 have osteoarthritis to some degree.  Injury Traumatic injury to a joint increases your risk of developing Osteoarthritis in that joint.  Joint Overuse Joints that are used repeatedly in certain jobs or sports may be more likely to develop Osteoarthritis. Occupations that involve frequent knee

bending increase the risk of knee OA, and those that require frequent lifting appear linked to hip OA.  Obesity Obesity increases the risk for osteoarthritis of the knee and hip. Excess weight causes stress on joints that weren't made to support that weight.  Gender

Before age 45, osteoarthritis occurs more frequently in men. After age 45, osteoarthritis is more common in women.  Heredity

A person could have a defect in one of the genes responsible for making cartilage. This can cause cartilage to deteriorate more rapidly.

SIGNS AND SYMPTOMS •

Deep aching joint pain that gets worse after exercise, or putting weight on it, and is relieved by rest

•

Grating of the joint with motion

•

Joint swelling

•

Limited movement

•

Morning stiffness / Stiffness after periods of inactivity, such as sleeping or sitting.

•

Upon assessment may include edema and tenderness around the joints and bony enlargements of distal interphalangeal joints ( HERBERDEN’S NODES)

TREATMENT The goals of treatment are to: •

Increase the strength of the joints

•

Maintain or improve joint movement

•

Reduce the disabling affects of the disease

•

Relieve pain

MEDICATIONS The most common medications used to treat osteoarthritis are non-steroidal anti-inflammatory drugs (NSAIDs). They are pain relievers that reduce pain and swelling. Types include aspirin, ibuprofen, and naproxen. Although NSAIDs work well, long-term use of these drugs can cause stomach problems, such as ulcers and bleeding. Manufacturers of NSAIDs include a warning label on their products that alerts users to an increased risk for cardiovascular events (heart attacks and strokes) and gastrointestinal bleeding. Other medications used to treat OA include: •

Steroids. These medications are injected right into the joint. They can also be used to reduce inflammation and pain.

•

Supplements. Many people are helped by over-the-counter remedies such as glucosamine and chondroitin sulfate. There is some evidence that these supplements can help control pain, although they do not seem to grow new cartilage.

•

Artificial joint fluid (Synvisc, Hyalgan). These medications can be injected into the knee. They may relieve pain for up to 6 months.

COMPLEMENTARY AND ALTERNATIVE THERAPIES •

ACUPUNCTURE can reduce pain and improve function in patients with knee and hip osteoarthritis.

•

Ginger and turmeric, herbs that are used as spices, have antiinflammatory, antioxidant antitumor properties. They are available for relief of arthritis pain in a supplement called Zyflamend.

PHYSICAL THERAPY Physical therapy can help improve muscle strength and the motion at stiff joints. Therapists have many techniques for treating osteoarthritis. If therapy does not make you feel better after 3 - 6 weeks, then it likely will not work at all. BRACES Splints and braces can sometimes support weakened joints. Some prevent the joint from moving; others allow some movement. Using a brace the wrong way can cause joint damage, stiffness, and pain. SURGERY Severe cases of osteoarthritis might need surgery to replace or repair damaged joints. Surgical options include: •

Arthroscopic surgery to trim torn and damaged cartilage and wash out the joint

•

Cartilage restoration to replace the damaged or missing cartilage in some younger patients with arthritis

•

Change the alignment of a bone to relieve stress on the bone or joint (osteotomy)

•

Surgical fusion of bones, usually in the spine (arthrodesis)

•

Total or partial replacement of the damaged joint with an artificial joint (knee arthroplasty, hip arthroplasty)

NURSING MANAGEMENT  Teaching the patient to balance exercises and rest. - Exercise helps maintain joint and overall movement. Water exercises, such as swimming, are especially helpful. - Do a variety of physical activity. Alternate periods of heavy activity with periods of rest. For example, if you do weight training one day, do aerobic exercise the next day. Repetitive stress on joints for long

periods of time can cause the excessive wear and tear that can lead to osteoarthritis.  Instruction to moist heat application  Encourage client to maintain weight - Eating a healthy balanced diet -Losing weight if you are overweight - Excess weight puts stress on your joints, especially your hips, knees, back, and feet.  Encourage client to practice good posture. - Good posture protects your joints from excessive pressure, especially your neck, back, hips, and knees.  Imagery, relaxation, and diversion are helpful to reduce pain.  Quadriceps strengthening exercises may relieve pain and disability of the knees. -Instruct the patient to straighten the leg out while lying down and tense the leg muscles, straightening the knee, while raising the heel slightly. The contraction is held for a count of 5 and released for a count of 5. The exercise is done on each leg 10 to 15 times hourly while the patient is awake. Commercial breaks on television are a good reminder to do this.

NURSING DIAGNOSES  Chronic pain related to joint tenderness and edema  Impaired Physical Mobility related to joint deterioration