OSTEOARTHRITIS I.

Definition It is also known as degenerative arthritis It is a type of arthritis that is caused by the breakdown and eventual loss of the cartilage of one or more joints. It commonly affects the hands, feet, spine, and large weight-bearing joints, such as the hips and knees. It breaks down the cartilage in your joints. Cartilage is the slippery tissue that covers the ends of bones in a joint. Healthy cartilage absorbs the shock of movement. When you lose cartilage, your bones rub together. Over time, this rubbing can permanently damage the joint. II. Types Primary osteoarthritis. Considered wear and tear osteoarthritis, this type of osteoarthritis is more commonly diagnosed. People tend to develop this type of osteoarthritis around age 55 or 60 Secondary osteoarthritis. This type of osteoarthritis has a specific cause, such as an injury, an effect of obesity, genetics, inactivity, or other diseases. It tends to strike at an earlier age, around 45 or 50 III. Causes Primary osteoarthritis is mostly related to aging. With aging, the water content of the cartilage increases, and the protein makeup of cartilage degenerates. Eventually, cartilage begins to degenerate by flaking or forming tiny crevasses. In advanced cases, there is a total loss of cartilage cushion between the bones of the joints. Repetitive use of the worn joints over the years can irritate and inflame the cartilage, causing joint pain and swelling. Loss of the cartilage cushion causes friction between the bones, leading to pain and limitation of joint mobility. Inflammation of the cartilage can also stimulate new bone outgrowths (spurs, also referred to as osteophytes) to form around the joints. Osteoarthritis occasionally can develop in multiple members of the same family, implying a hereditary (genetic) basis for this condition. Secondary osteoarthritis is caused by another disease or condition. Conditions that can lead to secondary osteoarthritis include:

Congenital disorders of joints

Diabetes. Inflammatory diseases (such as Perthes' disease), (Lyme disease), and all chronic forms of arthritis (e.g. costochondritis, gout, andrheumatoid arthritis). In gout, uric acid crystals cause the cartilage to degenerate at a faster pace. Injury to joints, as a result of an accident or orthodontic operations. Septic arthritis (infection of a joint ) Ligamentous deterioration or instability may be a factor. Marfan syndrome Obesity Alkaptonuria Hemochromatosis and Wilson's disease

IV. Signs and Symptoms Pain relieved by resting joints Joint stiffness Heberdens nodes and Bouchards nodes Limited ROM Crepitation Increased pain in damp, cold weather Enlarged, edematous joints Smooth, taut, shiny skin

V. Diagnostic test findings X-rays: joint deformity, narrowing of joint space, bone spurs Arthroscopy: bone spurs, narrowing of joint space Hematology: Increased ESR

VI. Medical Management a. b. c. d. e. f. Acetaminophen-initial analgesic therapy Topical Analgesics ( Capsaicin and Methylsalicylate) NSAIDs- second line of drug therapy Steroid Injections- used in a single joint COX-2 Inhibitors- GI bleeding Opioid Analgesics- Not Appropriate due to the chronic nature of pain in DJD g. Newer Drugs undergoing investigation:

Glucosamine and Chondroitin= improve tissue function and retard breakdown of cartilage Viscosupplementation and Intra-articular Injection of Hyaluronic Acid= improve cartilage function and retard degradation; may also have some anti-inflammatory effects

VII. Nursing Management a. Instruct the client to lose weight if overweight. b. Instruct the client on exercise to strengthen muscle, muscle tone, and joint range of motion. c. Instruct on assistive devices such as a cane, a walker, or crutches. d. Encourage to get adequate rest. e. Maintain proper positioning of the affected joint. f. Implement heat and cold therapy as appropriate. g. Complementary and Alternative therapies: TENS Hypnosis Acupuncture Imagery Music Therapy Tai Chi Therapeutic Touch VIII. Complications Contractures GI bleeding Injury