Osteoarthritis: Causes, Prevention, and Risk Factors

• Osteoarthritis (OA), also known as degenerative joint disease (DJD), involves the progressive deterioration of articular cartilage.
• OA is a noninflammatory and nonsystemic condition, contrary to previous beliefs that it was solely due to wear and tear from aging.
• In OA, cartilage destruction exceeds new tissue production, leading to erosion of cartilage and bone, osteophyte formation, and narrowed joint spaces.
• These changes cause pain, immobility, muscle spasms, and potential inflammation.
• Early-stage OA can be difficult to differentiate from rheumatoid arthritis (RA).

Health Promotion and Disease Prevention

• Employ joint-saving measures like good body mechanics and labor-saving devices.
• Maintain a healthy weight to reduce joint degeneration in hips and knees.
• Avoid or limit repetitive strain on joints by avoiding activities like jogging, contact sports, and other risk-taking activities.
• Wear well-fitted shoes with supports to prevent falls.

Risk Factors

• Aging is a major risk factor, with most adults over 60 showing joint changes on X-rays.
• Genetic factors can predispose individuals to OA.
• Joint injury due to acute or repetitive stress increases the risk of later OA.
• Obesity affects weight-bearing joints, such as knees and hips.
• Metabolic disorders like diabetes and blood disorders, such as sickle cell disease, increase risk.
• Females are more prone to OA.

Expected Findings

• Experience joint pain and stiffness.
• Feel pain upon joint palpation or during range of motion, with potential muscle atrophy, loss of function, limping, and restricted activity.
• Exhibit crepitus in affected joints.
• Notice enlarged joints from bone hypertrophy.
• Develop Heberden’s nodes on distal interphalangeal joints.
• Develop Bouchard’s nodes on proximal interphalangeal joints, which can be inflamed and painful.
• Inflammation can result from secondary synovitis, indicating advanced disease.
• Joint effusion (excess joint fluid) is easily moved within the joint.
• Experience vertebral radiating pain affected by cervical or lumbar nerve root compression.
• Develop a limping gait due to hip or knee pain.
• Experience back pain due to OA of the spine.

Laboratory Tests

• Lab tests are typically normal.
• Erythrocyte sedimentation rate and high-sensitivity C-reactive protein may be slightly elevated due to secondary synovitis.

Diagnostic Procedures

• Radiographs (X-rays) identify joint changes.
• CT scans and MRIs examine knee joints and vertebrae.

Nursing Care

• Assist with both pharmacological and nonpharmacological pain relief.
• Establish an acceptable pain level goal (e.g., 3 or less on a 0-10 scale).
• Determine the psychosocial impact of OA, such as body image changes or impaired self-care or employment abilities.
• Educate on joint protection: using large joints, using two hands for objects, and bending knees instead of the waist.
• Assess the need for assistive devices, such as mobility aids or Velcro closures.
• Caution against unproven cures and advise consulting with a healthcare provider before starting new therapies.

Intra-articular Injections

• Glucocorticoids treat localized inflammation, limited to 4 injections per joint per year.
• Hyaluronic acid may replace natural hyaluronic acid, which is lost due to joint inflammation; however, benefits are unclear.

Total Joint Arthroplasty or Replacement

• It can relieve pain, improve mobility, and enhance quality of life when other measures fail.
• Joint replacement is contraindicated with infection, advanced osteoporosis, or rapidly progressive inflammation.
• Uncontrolled diabetes or hypertension can cause postoperative complications.

Acetaminophen

• This is the medication of choice for managing pain.
• Monitor liver function tests.

Topical Medications

• Lidocaine patches (5%) can relieve joint pain but are contraindicated with class I antidysrhythmic medications.
• Salicylates (gels, patches, or creams) and buspirone cream can be used topically.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

• Analgesics and anti-inflammatories like celecoxib, naproxen, and ibuprofen are used for pain unrelieved by acetaminophen.
• Baseline liver and kidney function tests and CBC are needed before NSAID use.
• Topical NSAIDs like diclofenac epolamine patches are non-systemic.
• Monitor kidney function (BUN, creatinine).

Complementary and Alternative Therapies

• Topical capsaicin provides temporary pain relief by blocking pain impulses.
• Apply capsaicin cream topically 3-4 times daily, which may cause a brief burning sensation; avoid touching the face and eyes.
• Wear gloves during application and wash your hands immediately.
• Glucosamine and chondroitin are natural substances that aid in cartilage repair and maintenance.
• Glucosamine reduces inflammation, and chondroitin strengthens cartilage.
• Adverse effects include GI upset, rash, headache, and drowsiness.
• There is increased bleeding risk with anticoagulants and chondroitin.

Activity and Rest

• Balance activity with rest.
• Heat helps with joint tenderness and muscle stiffness through hot baths, showers, or packs; avoid high temperatures.
• Cold therapy reduces inflammation and numbs nerve endings; limit applications to 20 minutes and wrap packs in cloth.
• Maintain joints in functional positions and use good posture.
• Achieve and maintain a healthy weight to reduce joint stress.
• Follow the prescribed exercise regime consistently and prioritize active exercises.
• On painful days, attempt exercise with reduced repetitions, avoiding resistance exercises.