Understanding Osteoarthritis: Causes, Prevention

• Osteoarthritis (OA), also known as degenerative joint disease (DJD), is marked by the gradual breakdown of articular cartilage and is considered a noninflammatory and nonsystemic condition.
• OA involves both cartilage destruction and tissue production within the joint, with destruction exceeding production, which contrasts with the older view of it being solely a wear-and-tear condition related to aging.
• Cartilage and underlying bone erode, leading to osteophyte formation and narrowed joint spaces, which in turn cause pain, immobility, muscle spasms, and inflammation.

Health Promotion and Disease Prevention

• Use proper body mechanics and labor-saving devices.
• Maintain a healthy weight to reduce joint degeneration, especially in hips and knees.
• Avoid repetitive strain on joints by limiting activities like jogging and contact sports.
• Wear supportive, well-fitted shoes to prevent falls.

Risk Factors

• Adults over 60 commonly show joint changes on X-rays.
• Genetic predisposition is a factor.
• Joint injury from acute or repetitive stress leads to later OA.
• Obesity increases risk in weight-bearing joints.
• Metabolic disorders such as diabetes and sickle cell disease increase joint degeneration.
• Females are more prone.

Expected Findings

• Experience joint pain and stiffness.
• Pain upon joint palpation or during range of motion.
• Crepitus may be present in affected joints.
• Joint enlargement occurs due to bone hypertrophy.
• Heberden’s nodes appear on distal interphalangeal joints.
• Bouchard’s nodes are located at proximal interphalangeal joints, typically occurring bilaterally and can be inflamed and painful.
• Inflammation can result from secondary synovitis in advanced stages.
• Joint effusion is present characterized by excess joint fluid.
• Vertebral radiating pain may occur due to nerve root compression.
• Limping gait can result from hip or knee pain.
• Back pain results from OA of the spine.

Laboratory Tests

• Lab results are typically normal, though ESR and high-sensitivity C-reactive protein may be slightly elevated due to secondary synovitis.

Diagnostic Procedures

• Radiographs (X-rays) show joint changes.
• CT scans and MRIs are used for detailed examination of the knee joint and vertebrae.

Nursing Care

• Aid clients with both pharmacological and nonpharmacological pain relief methods.
• Help clients set an acceptable pain level goal (e.g., 3 or less on a 0-10 scale).
• Evaluate the psychosocial effects of OA, such as body image issues or impaired self-care and employment abilities.
• Educate clients on joint protection techniques, such as using larger joints, using two hands for objects, and bending knees instead of the waist.
• Assess the need for assistive devices like mobility aids or clothing with Velcro closures.
• Caution clients against unverified OA treatments and emphasize consulting with a healthcare provider before trying new therapies.

Intra-articular Injections

• Glucocorticoids treat localized inflammation, limited to four injections per joint annually.
• Hyaluronic acid replaces natural hyaluronic acid, which can be destroyed by joint inflammation.

Total Joint Arthroplasty or Replacement

• Joint replacement is considered for pain relief, mobility improvement, and enhanced quality of life when other treatments fail.
• Contraindications include infection, advanced osteoporosis, or rapidly progressive inflammation.
• Uncontrolled diabetes or hypertension leads to major postoperative complications.
• Monitor liver function tests.

Topical Medications

• Lidocaine patches (5%) relieve joint pain, but are contraindicated with class I antidysrhythmic medications.
• Topical salicylates and buspirone cream are other options.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

• Analgesics and anti-inflammatories like celecoxib, naproxen, and ibuprofen relieve pain and synovitis when acetaminophen and topical agents are insufficient.
• Kidney function (BUN, creatinine) should be monitored.
• Baseline liver and kidney function tests and CBC is required if NSAIDs are administered.
• Topical NSAIDs like diclofenac epolamine patches offer non-systemic relief.

Complementary and Alternative Therapies

Topical Capsaicin

• Provides temporary relief by blocking pain impulses.
• Apply cream topically 3-4 times daily, avoiding contact with face and eyes.
• Gloves should be worn during application and hands should be washed immediately afterwards.

Glucosamine and Chondroitin Supplements

• Glucosamine and chondroitin aid in the repair and maintenance of cartilage.
• Glucosamine reduces inflammation, and chondroitin strengthens cartilage.
• GI upset, rash, headache, and drowsiness may occur.
• Increased risk of bleeding exists when taken with anticoagulants.

Lifestyle Adjustments

• Balance activity with rest.
• Heat helps ease joint tenderness and muscle stiffness through hot baths, showers, or packs, avoiding high temperatures.
• Cold therapy reduces inflammation and numbs nerve endings, using cold or ice packs for up to 20 minutes wrapped in cloth.
• Maintain joints in a functional position, using good posture to maintain spinal curvature and weight distribution.
• When lying down, use a small pillow under the head and neck, avoiding joint flexion.
• Maintain a healthy weight to lessen joint stress.
• Adhere to the prescribed exercise regime consistently, favoring active over passive exercises.
• On high-pain days, attempt exercise with reduced repetitions and avoid resistance exercises.