Osteoarthritis, also known as degenerative joint disease or osteoarthrosis (even though inflammation may be present), is the most common

and frequently disabling of the joint disorders. OA is both overdiagnosed and trivialized; it is frequently overtreated or under-treated. The functional impact of OA on quality of life, especially for elderly patients, is often ignored. OA has been classified as primary (idiopathic), with no prior event or disease related to the OA, and secondary, resulting from previous joint injury or inflammatory disease. The distinction between primary and secondary OA is not always clear. OA often begins in the third decade of life and peaks between the fifth and sixth decades. Clinical Manifestations y y y Pain The pain is due to an inflamed synovium, stretching of the joint capsule or ligaments, irritation of nerve endings in the periosteum over osteophytes, trabecular micro-fracture, intraosseous hypertension, bursitis, tendinitis, and muscle spasm. Stiffness Stiffness, which is most commonly experienced in the morning or after awakening, usually lasts less than 30 minutes and decreases with movement. Functional Impairment Functional impairment is due to pain on movement and limited motion caused by structural changes in the joints. Although OA occurs most often in weight-bearing joints (hips, knees, cervical and lumbar spine), the proximal and distal finger joints are also often involved. Risk Factors for Osteoarthritis y y y y y y Increased age Obesity Previous joint damage Repetitive use (occupational or recreational) Anatomic deformity Genetic susceptibility Pain Stiffness Functional impairment

Assessment and Diagnostic Findings Diagnosis of OA is complicated because only 30% to 50% of patients with changes seen on Xrays report symptoms. Physical assessment of the musculoskeletal system reveals tender and enlarged joints. Inflammation, when present, is not the destructive type seen in the connective tissue diseases such as RA. OA is characterized by a progressive loss of the joint cartilage, which appears on x-ray as a narrowing of joint space. Medical Management y y No treatment halts the degenerative process Certain preventive measures can slow the progress if undertaken early enough. These include: o weight reduction, prevention of injuries, o perinatal screening for congenital hip disease, and ergonomic o modifications Conservative treatment measures include: o the use of heat, o weight reduction o joint rest and avoidance of joint overuse o orthotic devices to support inflamed joints (splints, braces) o isometric

Pharmacologic Therapy y Directed toward symptom management and pain control The initial analgesic therapy is acetaminophen Selection of medication is based on the patient s needs, the stage of disease, and the risk for side effects. Topical analgesics such as capsaicin and methylsalicylate are also recommended Newer therapeutic approaches include glucosamine and chondroitin, which are thought to improve tissue function and retard breakdown of cartilage Viscosupplementation, the intra-articular injection of hyaluronic acid, is thought to improve cartilage function and retard degradation; it may also have some anti-inflammatory effects

Surgical Management Only when pain is severe or there is loss of function. Nursing Management y y y y y y y y Pain management and optimizing functional ability are major goals of nursing intervention. Patients understanding of their disease process and symptom pattern is critical to a plan of care. Most patients with OA are older and may have other health problems. Commonly they are overweight, and they may have a sedentary lifestyle. Weight loss and an increase in aerobic activity such as walking, with special attention to quadriceps strengthening, are important approaches to pain management A referral for physical therapy or to an exercise program for individuals with similar problems may be very helpful. Canes or other assistive devices for ambulation should be considered. Exercises such as walking should be begun in moderation and increased gradually. Patients should plan their daily exercise for a time when the pain is least severe or should plan to use an analgesic, if appropriate, before exercising.