CATANDUANES STATE UNIVERSITY COLLEGE OF HEALTH SCIENCES DEPARTMENT OF NURSING

WRITTEN REPORT OSTEOARTHRITIS

OSTEOARTHRITIS Definition: Osteoarthritis (OA), also known as degenerative joint disease or osteoarthrosis, is the most common joint disorder. It is a chronic, non-inflammatory and slowly progressing disorder that causes the deterioration of articular cartilage. It affects weight bearing joints(hips and knees), as well as the distal interphalangeal and proximal interphalangeal joints of the fingers. Besides age, risk factors for OA include female gender, generic predisposition, obesity, mechanical joint stress, joint trauma, congenital and developmental disorders of the hips, previous bone and joint disorders, inflammatory joint diseases, and endocrine and metabolic diseases.

Pathophysiology: 1. Changes in articular cartilage occur first; secondary soft tissue changes may occur later. 2. Progressive wear and tear on cartilage leads to the thinning of joint surfaces and ulceration into the bone. 3. Inflammation of the joint and increased blood flow and hypertrophy of subchondral bone. 4. New cartilage and bone formation of at joint margins results in osteophytosis (bone spurs), altering the size and shape of bone. 5. Generally affects ages 50-90. 6. Cause is unknown, but aging and obesity are contributory factors. Previous trauma may cause secondary osteoarthritis. Clinical Manifestation: Pain Stiffness Functional impairment due to pain on movement and limited joint motion when structural changes develop. Bony nodes may be present (painless unless inflamed)

Diagnostic Examination: No specific laboratory examination. X-rays of affected joint show joint space narrowing, osteophytes and sclerosis. Radionuclide imaging (bone scan) shows increased uptake in affected bones. Analysis of synovial fluid differentiates OA from RA.

Management:

Management focuses on slowing and treating symptoms because there is no treatment available that stops the degenerative joint disease process.

Prevention: Weight reduction Prevention of injuries Perinatal screening for congenital hip disease Ergonomic modifications

Pharmacologic Theraphy: Acetaminophen; non-steroidal anti-inflammatory drugs (NSAIDs) if joint symptoms persist. The newer Cox-2 inhibitors(for patient with increased risk for GIbleeding). This blocks prostaglandins involved in inflammation. Topical analgesic such as capsaicin and methylsalicylates. The newer therapeutic approaches: glucosamine and chondroitin are common alternative remedies that that have potential cartilage-rebuilding effects. Viscosupplementation- intra-articular of hyaluronic acid Intra- articular injections of corticosteroids for acute joint inflammation (short term only)

Conservative Measures: Heat,weight reduction, joint rest and avoidance of joint overuse Orthostatic devices to support inflamed joints (splints, braces) Isometric and postural exercise, and aerobic exercise Occupational and physical therapy

Surgical Management: Osteotomy

Debridement Joint Fusion Arthroscopy Arthroplasty (joint replacement) is used with patient with end-stage disease.

Nursing Diagnosis: Pain related to joint degeneration and muscle spasm Impaired physical mobility related to pain and limited joint movement Self-care deficits related to pain and limited joint movement