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IRENE JOY GOMEZ

4NU01 | GROUP 6

OSTEOARTHRITIS



I. DEFINITION

Osteoarthritis is the most common form of arthritis, affecting millions of people around the
world. Often called wear-and-tear arthritis, osteoarthritis occurs when the protective cartilage
on the ends of your bones wears down over time.
While osteoarthritis can damage any joint in your body, the disorder most commonly affects
joints in your hands, neck, lower back, knees and hips.
Osteoarthritis gradually worsens with time, and no cure exists. But osteoarthritis treatments
can slow the progression of the disease, relieve pain and improve joint function.















II. SIGNS & SYMPTOMS


Osteoarthritis symptoms often develop slowly and worsen over time. Signs and symptoms
of osteoarthritis include:
Pain. Your joint may hurt during or after movement.
Tenderness. Your joint may feel tender when you apply light pressure to it.
Stiffness. Joint stiffness may be most noticeable when you wake up in the morning or after a
period of inactivity.
Loss of flexibility. You may not be able to move your joint through its full range of motion.
Grating sensation. You may hear or feel a grating sensation when you use the joint.
Bone spurs. These extra bits of bone, which feel like hard lumps, may form around the
affected joint.


III. PATHOPHYSIOLOGY

Osteoarthritis may be thought as an end result of many factors that, when combined,
predispose the patient to the disease. OA affects the articular cartilage, subchondral bone (the
bony plate that supports the articular cartilage) and synovium. A combination of cartilage
degradation, bone stiffening and reactive inflammation of the synovium occurs. Understand of
OA has been greatly expanded beyond what previously was thought of as simple wear and
tear related to aging. The basic degenerative process in the joint exemplified in OA is presented
in the figure below.

































IV. TREATMENT AND MANAGEMENT

There's no known cure for osteoarthritis, but treatments can help to reduce pain and maintain
joint movement.
Medications
Osteoarthritis symptoms can be relieved by a variety of medications, including:
Acetaminophen.Acetaminophen (Tylenol, others) can relieve pain, but it doesn't reduce
inflammation. It has been shown to be effective for people with osteoarthritis who have
mild to moderate pain. Taking more than the recommended dosage of acetaminophen can
cause liver damage.
Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs may reduce inflammation and
relieve pain. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin, others) and
naproxen (Aleve, others). Stronger NSAIDs are available by prescription. NSAIDs can cause
stomach upset, ringing in your ears, cardiovascular problems, bleeding problems, and liver
and kidney damage. Older people have the highest risk of complications.
Mechanical injury

Release of Cytokines

Resulting damage
predispose to further
damage

Stimulation, production,
and release of proteolytic
enzymes,
metalloproteases,
collagenase


Other

Chondrocyte
response

Previous joint damage

Genetic and hormonal
factors

Narcotics. These types of prescription medication typically contain ingredients similar to
codeine and may provide relief from more severe osteoarthritis pain. These stronger
medications carry a risk of dependence, though that risk is thought to be small in people
who have severe pain. Side effects may include nausea, constipation and sleepiness.
Therapy
A combination approach to treatment often works best. Your doctor may suggest:
Physical therapy. A physical therapist can work with you to create an individualized exercise
regimen that will strengthen the muscles around your joint, increase the range of motion in
your joint and reduce your pain.
Occupational therapy. An occupational therapist can help you discover ways to do everyday
tasks or do your job without putting extra stress on your already painful joint. For instance,
a toothbrush with a large grip could make brushing your teeth easier if you have finger
osteoarthritis. A bench in your shower could help relieve the pain of standing if you have
knee osteoarthritis.
Braces or shoe inserts. Consider trying splints, braces, shoe inserts or other medical devices
that can help reduce your pain. These devices can immobilize or support your joint to help
you keep pressure off it.
A chronic pain class. The Arthritis Foundation and some medical centers have classes for
people with osteoarthritis and chronic pain. Ask your doctor about classes in your area or
check with the Arthritis Foundation. These classes teach skills that help you manage your
osteoarthritis pain. And you'll meet other people with osteoarthritis and learn their tips and
tricks for reducing and coping with joint pain.
Surgical and other procedures
If conservative treatments don't help, you may want to consider procedures such as:
Cortisone shots. Injections of corticosteroid medications may relieve pain in your joint.
During this procedure your doctor numbs the area around your joint, then places a needle
into the space within your joint and injects medication. The number of cortisone shots you
can receive each year is limited, because the medication can worsen joint damage over
time.
Lubrication injections. Injections of hyaluronic acid derivatives (Hyalgan, Synvisc) may offer
pain relief by providing some cushioning in your knee. These agents are similar to a
component normally found in your joint fluid.
Realigning bones. During a surgical procedure called an osteotomy, the surgeon cuts across
the bone either above or below the knee to realign the leg. Osteotomy can reduce knee pain
by shifting your body weight away from the worn-out part of your knee.
Joint replacement. In joint replacement surgery (arthroplasty), your surgeon removes your
damaged joint surfaces and replaces them with plastic and metal devices called prostheses.
The hip and knee joints are the most commonly replaced joints. Surgical risks include
infections and blood clots. Artificial joints can wear out or come loose and may need to
eventually be replaced.


V. DIAGNOSTIC EXAM

During the physical exam, your doctor will closely examine your affected joint, checking for
tenderness, swelling or redness. He or she will also check the joint's range of motion. Your
doctor may also recommend imaging and lab tests.
Imaging tests
Pictures of the affected joint can be obtained during imaging tests. Examples include:
X-rays. Cartilage doesn't show up on X-ray images, but the loss of cartilage is revealed by a
narrowing of the space between the bones in your joint. An X-ray may also show bone spurs
around a joint. Many people have X-ray evidence of osteoarthritis before they experience
any symptoms.
Magnetic resonance imaging (MRI). MRI uses radio waves and a strong magnetic field to
produce detailed images of bone and soft tissues, including cartilage. This can be helpful in
determining what exactly is causing your pain.
Lab tests
Analyzing your blood or joint fluid can help pinpoint the diagnosis.
Blood tests. Blood tests may help rule out other causes of joint pain, such as rheumatoid
arthritis.
Joint fluid analysis. Your doctor may use a needle to draw fluid out of the affected joint.
Examining and testing the fluid from your joint can determine if there's inflammation and if
your pain is caused by gout or an infection.


VI. NURSING CARE

1. Administer anti-inflammatory medication and other drugs as ordered.
2. Provide emotional support and reassurance to help the patient cope with limited
mobility.
3. Encourage the patient to perform as much self-care as his immobility and pain allow.
4. To help promote sleep, adjust pain medications to allow for maximum rest.
5. Help the patient identify techniques and activities that promote rest and relaxation.
6. For joints in hand, provide hot soaks and paraffin dips to relieve pain as ordered.
7. Check crutches, cane, braces, or walker for proper fit.
8. Assess the patients pain patterns.
9. Watch for skin irritation caused by prolonged use of assistive devices.
10. Instruct the patient to plan for adequate rest during the day.
11. Instruct the patient to take medications exactly as prescribed.