NOTES ON Osteoarthritis

Osteoarthritis


By: Sue Renfrow, RN, BSN



Osteoarthritis

* A form of Degenerative Joint Disease (DJD) * A common disabling joint disorder (problems with hips, knees, ankles) *Osteoarthritis is the most prevalent activity limitation among the elderly leading to disability *Affects 16- 20 million people in U.S.



Causes

*Idiopathic- Primary *No prior event or disease * Aging *Secondary *Resulting from previous joint or inflammatory disease *Congenital diseases ( Legg-Cave’-Perthes) *Gout *Obesity the more you weigh the harder it is on your joints



Clinical Manifestations

*Pain *Stiffness/ swelling *Functional Impairment/ asymetric *Heberden’s Nodes



Assessment/Diagnostic

*Physical assessment of musculoskeletal system *Location and pattern of pain *X-Rays- Show loss of joint cartilage, narrowing of joint space, osteophytes (bone Spurs) *Labs-ESR, RH-rule out RA (RH 40 or less)



Medical Management

*Decrease weight *Injury prevention *Ergonomic modifications



Conservative:

-heat/cold -avoid overuse -supports for joints -isometric, postural and aerobic exercise -Physical/Occupational therapy



Pharmacological

*Tylenol, Acetaminophen (drug of choice) worry about liver damage





*Salicylates, Aspirin - the “grandfather” *NSAIDS: Ibuprofen, Advil, Motrin & Nuprin (eventually will wind up on NSAIDs) *Cox-2 (Celebrex) worry about GI bleed *Opiates *Corticosteroids *Glucosamine/Chondroiton *Hyaluronic acid (Synivisc) *Topical- Capsain, methylsalicylate



Surgical Management

*Osteotomy-moderate to severe loss of function, may have this (realign joint) *Arthroplasty-surgical repair of the joint p. 1628



Treatment

*GOALS of treatment include: GOALS *decreasing joint pain and stiffness *improving joint mobility and stability *increasing ability to perform ADL’s *optimizing functional ability



Nursing Management:

*Chronic pain related to joint degeneration *Impaired physical mobility related to restricted joint mobility *Body image disturbance related to visible body changes *Self-care deficit related to immobility *Knowledge deficit *Ineffective individual/family coping or compromise



Preventative Measures:

*Joint Protection Joint *Correct body mechanics *Avoid grasping actions that strain finger joints *Spread weight of an object over several joints *Maintain good posture *Use strongest muscles and favor large joints