Osteoarthritis

Submitted by:
Javier, Jomar
Junio, Gianne Avril
GROUP 83/ BSN121
Osteoarthritis

Osteoarthritis, sometimes called

degenerative joint disease or
osteoarthrosis, is the most common form
of arthritis. Osteoarthritis occurs when
cartilage in your joints wears down over
time.
While osteoarthritis can affect any joint in
your body, the disorder most commonly
affects joints in your:
Hands
Hips
Knees
Neck
Lower back
Osteoarthritisgradually worsens with
time, and no cure exists. But osteoarthritis
treatments can relieve pain and help you
remain active. Taking steps to actively
manage your osteoarthritis may help you
gain control over your symptoms.
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 painand 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.
Factors that increase
your risk of
osteoarthritis
Older age. Osteoarthritis typically occurs in older adults.
People under 40 rarely experience osteoarthritis.
Sex. Women are more likely to develop
osteoarthritis, though it isn't clear why.
Bone deformities. Some people are born with
malformed joints or defective cartilage, which can
increase the risk of osteoarthritis.
Joint injuries. Injuries, such as those that occur when playing sports or
from an accident, may increase the risk of osteoarthritis.
Obesity. Carrying more body weight places more
stress on your weight-bearing joints, such as your
knees.
Certain occupations. If your job includes tasks
that place repetitive stress on a particular joint, that
may predispose that joint toward eventually
developing osteoarthritis.
Other diseases. Having gout, rheumatoid
arthritis, Paget's disease of bone or septic
arthritis can increase your risk of developing
osteoarthritis.
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.
Grating sensation (crepitus). 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.

Heberden’s nodes
Bouchard’s nodes
Diagnostic Studies
XRAY
Osteoarthritis is often visible in x-rays.
Cartilage loss is suggested by certain
characteristics of the images:
The normal space between the bones in a
joint is narrowed.
There is an abnormal increase in bone
density.
Bony projections, cysts, or erosions are
visible.
 If the doctor suspects other conditions, or if the diagnosis is
uncertain, additional tests are necessary.
 It is important to note that a negative x-ray does not rule out
osteoarthritis. Likewise, some people may have minimal
symptoms even though an x-ray clearly shows they have
arthritis.
 An MRI exam of an arthritic joint is generally not needed,
unless the doctor suspects other causes of pain.
 X-rays are a form of ionizing radiation that can penetrate the
body to form an image on film. Structures that are dense
(such as bone) will appear white, air will be black, and other
structures will be shades of gray depending on density. X-
rays can provide information about obstructions, tumors, and
other diseases, especially when coupled with the use of
barium and air contrast within the bowel.
 Blood Tests
 Blood test results may help identify other causes of arthritis
(if present) besides osteoarthritis. Some examples include:
 Elevated levels of rheumatoid factor (specific antibodies in
the synovium) are usually found in patients with rheumatoid
arthritis
 The erythrocyte sedimentation rates (ESR, or "sed rate")
indicates inflammatory arthritis or related conditions, such as
rheumatoid arthritis or systemic lupus erythematosus.
 Elevated uric acid levels in the blood may indicate gout.
 A number of other blood tests may help identify other
rheumatological illnesses
Tests of the Synovial Fluid
(arthrocentesis)
 If the diagnosis is uncertain or infection is suspected, a doctor may
attempt to withdraw synovial fluid from the joint using a needle.
There will not be enough fluid to withdraw if the joint is normal. If
the doctor can withdraw fluid, problems are likely, and the fluid
will be tested for factors that might confirm or rule out
osteoarthritis:
 Cartilage cells in the fluid are signs of osteoarthritis.
 A high white blood cell count is a sign of infection, gout,
pseudogout, or rheumatoid arthritis.
 Uric acid crystals in the fluid are an indication of gout.
  
 Other factors may be present that suggest different arthritic
conditions, including Lyme disease and rheumatoid arthritis.
 In people with known osteoarthritis, researchers may look for
certain factors in synovial fluid (sulfated glycosaminoglycan,
keratin sulfate, and link protein) that can suggest a more or less
severe condition.
Arthroscopy
INTERVENTIONS
Pain management

The choice and frequency of pain medication

depends on the severity of your symptoms
and the risk of side effects and may range
from acetaminophen and non-steroidal anti-
inflammatory drugs (NSAIDs) to narcotic
drugs and steroids. You need to be aware of
possible side effects, such as gastrointestinal
upset and bleeding. Other pain management
treatments include acupuncture and topical
creams (such as capsaicin and
methylsalicylate).
Nutritional counseling
Lack of mobility and sedentary lifestyle
often lead to increased weight, putting strain
on your already damaged joints. A nutritional
assessment helps to develop a healthy
weight-maintenance or health-reduction plan.
Because osteoporosis is common with
osteoarthritis, your diet should contain
adequate vitamin D and calcium.
 
 
Glucosamine supplements are widely used for
osteoarthritis, particularly knee osteoarthritis. In
osteoarthritis, cartilage -- the rubbery material that cushions
joints -- becomes stiff and loses its elasticity. This makes
the joint prone to damage and may lead to pain, swelling,
loss of movement, and further deterioration.
 
Chondroitin is the most abundant glycosaminoglycan in cartilage and
is responsible for the resiliency of cartilage.Treatment with these joint
supplements is based on the theory that oral consumption of
glucosamine and chondroitin may increase the rate of formation of new
cartilage by providing more of the necessary building blocks.
Joint protection
You must balance rest and activity to prevent further injury. An acutely
inflamed joint should rest until the inflammation subsides. Wearing a
splint or brace that keeps the joint in functional position or using
assistive devices (cane, walker) can relieve joint strain. You must learn
to protect the affected joint; if your knee is affected, for instance, you
should avoid kneeling or long periods of standing. Immobilization of a
joint should not exceed one week because prolonged immobilization
can increase stiffness.
Exercise program
Bone health and mobility are dependent on exercise, so you
need to develop a plan of exercise that includes some
aerobic conditioning, such as walking. Exercise programs
must begin slowly, allowing you to increase your
endurance over time to avoid increasing joint
inflammation. You should plan regular exercise at the time
of day when your pain is least intense and after pain
medication
Heat/cold therapy
Heat therapy (warm bath, compresses, shower) is
especially effective to relieve stiffness and may be
used 2 to 3 times a day for a half hour each time.
Using heat therapy before activities can increase
endurance. Cold therapy (compresses, ice packs) is
often effective to relieve swelling and discomfort
when a joint is inflamed.
Assistive devices/equipment
Brian Donnelly, LifeSpan Furnishings, CDC, US Public
Health Information Library
Assistive devices can make it much easier for you to
function. Walkers and canes can help with mobility. Other
devices include easy grip handles on equipment and seat
belts, elevated toilet seats, handrails, safety bars, shower
stools, grab tools, door knob grips, and chair with elevated
and extended arms.
Hyaluronic injection
Injecting hyaluronic acid into an osteoarthritic joint has
been shown to improve joint health by:
Increasing synovial fluid levels of hyaluronic acid
improving its viscosity, and freedom of joint movement.
Decreasing levels of prostaglandins improving pain,
Increasing the cartilage depth on load bearing surfaces,
Having effects on these parameters for more than 6 months.
SURGICAL MANAGEMENT
Excision arthroplasty. In this method one or both of the articular ends
of the bones are simply excised, so that a gap is created between them
 The gap fills with fibrous tissue, or a pad of muscle or other soft tissue
may be sewn in between the bones. By virtue of its flexibility the
interposed tissue allows a reasonable range of movement, but the joint
often lacks stability. The method is applicable to all the joints for
which arthroplasty is practicable except the knee and ankle. It is used
most commonly at the metatarso-phalangeal joint of the great toe, in
the treatment of hallux valgus and hallux rigidus. At the hip it may be
used as a salvage operation after failed replacement arthroplasty.
Osteotomy is an elective surgical procedure, performed under general 
anesthesia, in which a bone is cut or a portion is taken out in order to
fix a bad bone alignment, to shorten or lengthen the bone, or to correct
damage due to osteoarthritis. An osteotomy is needed when a bone has
healed badly or crooked, or when adeformity is caused by disease or
disorder.
Joint fusion surgery (also known as arthrodesis surgery) literally involves
the “fusion” of bones in the joint (ankles, spine, hip, etc).  It is recommended to
relieve persistent pain in these areas which may also be compounded by other
symptoms like swelling, catching, clicking, instability or “giving way” of the
joint.  Arthrodesis surgery often results in the elimination of the actual joint
itself.  As a result, the joint might lose flexibility, but in most cases, it can bear
weight better.  In addition, pain and swelling tend to subside.    
Arthroscopic debridement (AD) involves using
instruments to remove damaged cartilage or bone. Often
the doctor will start the procedure by using a tool to spray
jets of fluid to wash and suck out all debris around the
joint. This is called lavage or washout. Then, the parts of
the joint bone that are loose or misshapen are removed.
Total joint arthroplasty- Arthroplasty in which
both joint surfaces are replaced with artificial
materials, usually metal and high-density plastic.
CASTS
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