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OSTEOARTHRIT IS (HYPERTROPHIC
ARTHRITIS)
OSTEOARTHRITIS
Aka degenerative joint disease (although inflammation may be present) Chronic, nonsystemic disorder of joints characterized by
OSTEOARTHRITIS
Causes:
1.Primary osteoarthritis
( a normal part of aging) Genetic factors ( decreased collagen synthesis) Chemical factors (drugs such as steroids that stimulate the collagen-digesting enzymes in synovial membrane Mechanical factors (repeated stress on
Causes:
2. Secondary osteoarthritis
(follows an identifiable predisposing event that leads to degenerative changes) Trauma (most common cause) Congenital deformity Obesity
Pathophysiolo gy
Clinical manifestations:
Pain aggravated by use and relieved by rest Stiffness of joints HEBERDENS NODES- bony overgrowth at distal interphalangeal joints : due to repeated inflammation
Clinical manifestations:
BOUCHARDS NODES- bony overgrowth at the proximal interphalangeal joints Decreased ROM : due to pain and stiffness crepitus: due to cartilage damage
Diagnostic findings
1. X-ray: narrowing of joint space and margins 2. Presence of osteophytes and joint space narrowing: sensitive and specific findings 3. Radionuclide bone scan: rule out inflammatory
Diagnostic findings
4. MRI: shows affected joint, adjacent bones and disease progression
Collaborative management:
Weight loss to reduce extra stress on weightbearing joints Exercise to keep joints flexible and improve muscle strength Heat and cold therapy for temporary pain relief.
Collaborative management:
Viscosupplementation the
intra-articular injection of hyaluronic acid. Thought to improve cartilage function and retard degradation and have anti-inflammatory effects.
Hyaluronic acid a glycosaminoglycan that acts as a lubricant and shock-absorbing fluid in the joint. It stimulates the production of synoviocytes, possibly providing better and more prolonged pain control
GOUT ARTHRITIS
Michael Roland E. Sumbe
GOUT ARTHRITIS
Heterogenous group of conditions related to genetic defect of purine metabolism resulting in hyperuricemia ( serum concentration greater than 7 mg/dL) Oversecretion of uric acid or renal defect resulting in decreased excretion of uric acid or a combination of both occurs Characterized by high levels of uric acid in the blood and in the urine There is precipitation of urate crystals ( tophi) in the joints. This causes inflammation and pain Occurs most often in males; and it is familial
Causes:
metabolism causing
hyperuricemia
Risk factors:
Severe dieting or starvation Excessive intake of foods high in purines ( shellfish, organ meats) Hereditary : commonly in males Medications such as diuretics and salicylates Increasing age Hypertension
Pathophysiology:
Attacks of gout appear to be related to sudden decrease or increase of serum uric acid level Uric acid becomes supersaturated in the blood and body fluids Uric acid then crystallizes and forms a precipitate of urate salts that accumulates in connective tissue throughout the body
Pathophysiology:
With repeated attacks, accumulations of sodium urate crystal called TOPHI are deposited in the peripheral areas of the body such as great toe, hands and
the ear.
Crystal deposits trigger inflammatory response when neutrophils begin to ingest them Neutrophils release lysosomes that damage tissues and perpetuate the inflammation
Clinical manifestations:
Joint pain : due to acid deposits and inflammation redness, heat, swelling, great/big toe and ankle are most commonly affected : duet to uric acid deposits and irritation tophi in the great toe, outer ear, hands and feet : due to urate deposits
Clinical manifestations:
elevated skin temperature: due to inflammation Renal urate lithiasis (kidney stones) with chronic renal disease secondary to urate deposition may develop
is a sudden onset of severe pain in the great toe or occasionally the heel, ankle, wrist, fingers and elbows. When the urate crystals are deposited in the synovial fluids they can rapidly lyse neutrophils which release lysosomal enzymes --INFLAMMATION
THE
joints become red, hot and tender. The pain become intense! Fever and elevated WBC. If untreated, lasts for 3-14 days.
3. Intercritical Gout
The
MANAGEMENT:
ACUTE ATTACK: COLCHICINE [oral or IV] every 8 hours ( discontinue if diarrhea or nausea and vomiting occur ,or NSAIDs ( Indocin, Butazolidin)
Inhibits
Phagocytosis of uric acid crystals by neutrophils Given until the pain subsides or nausea and vomiting, cramping or diarrhea develops
Immobilization and protection of the inflamed , painful joints Local application of heat to stimulate circulation in the area and clear cellular debris from the inflammation Local application of cold to decrease pain Increase fluid intake ( 3L/day) if not contraindicated to prevent renal calculi NSAIDS to reduce pain and inflammation
b. CHRONIC GOUT
Maintenance dosages of ALLOPURINOL to suppress uric acid formation or control of uric acid levels, preventing further attacks ( used cautiously with renal failure) Cholchicine to prevent recurrent acute attack
b. CHRONIC GOUT
Uricosuric Agents- these are agents that increases excretion of uric acid in the urine
Benemid
Avoid purine-rich foods ( Organ meats, shellfish, legumes, sardines, salted anchovies, mushrooms, herring, sweetbreads, beer and wine )
Should be used cautiously in clients with GI, renal, cardiac and hepatic diseases Maintain a fluid intake of at least 2-3L a day to avoid kidney stones Instruct client to avoid alcohol and caffeine. These products can increase uric acid level Avoid purine-rich foods ( caffeine, alcohol, organ meats, sardines, salmon, scallops and gravy)
Instruct client to take medications with food. To prevent GI irritation Instruct client to avoid large doses of vitamin C while taking allopurinol to prevent kidney stones Advise client to have yearly eye examination. Visual changes can occur from prolonged used of allopurinol Do not take ASA with antigout medications. To prevent gout hypoglycaemic agents.
Observe for the ff. side-effects of antigout medications; Headache Nausea and vomiting, diarrhea Bone marrow depression Flushed skin and skin rash Uric acid kidney stone Sore gums Metallic taste
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