Osteoarthritis

WHAT WENT WRONG?
A degenerative joint disease caused by the wear and tear of the articular cartilage.
As the protective joint cartilage is worn away, the underlying bone becomes ex-
posed, causing the exposed bones to rub. Degenerative changes within the bone
tissue produce small areas of re-growth, causing jagged joint spaces and bone spurs.
These rough areas project out into soft tissue or joint spaces, causing pain.


PROGNOSIS
Pain associated with osteoarthritis typically is related to activity and is relieved
with rest. The major weight-bearing joints are more affected in overweight patients
due to the excess wear and tear on the joints, especially affecting hips and knees.
Initially patients respond well to rest periods and over-the-counter medications for
pain control. As joints become more damaged over time, a joint replacement may
be necessary to correct pain and to improve quality of life and mobility.

SIGNS AND SYMPTOMS

• Stiff joints for short time in morning, usually 15 minutes or less due to changes
within joints
• Joint pain with movement or weight bearing due to joint remodeling
• Crepitus (grating feeling on palpation over joint during range of motion) due
to loss of articular cartilage and bony overgrowth in joint
• Pain relief when joints are rested because lack of movements will relieve irri-
tation in joint space
• Enlargement of joint due to bony overgrowth or remodeling
• Heberden’s nodes—swelling of the distal interphalangeal joints

TEST RESULTS

• X-ray shows narrowed joint spaces, bone spurs, or osteophytes around joints.
• Tests for inflammation will be normal—erythrocyte sedimentation rate, C-
reactive protein.

TREATMENT
Initial treatment is usually with over-the-counter medications. The patients re-
spond well to these medications. There is no underlying inflammatory disorder, so
the medications can be used on an as-needed basis. Many of the patients are older
and will be on other medications, so it is important that you check for medication
interactions.
• Administer NSAID (nonsteroidal anti-inflammatory drug)—for any local
inflammation from irritation at the joint area due to osteophytes or bone spur
formation:
• ibuprofen, naproxen
• diclofenac, diflunisal, etodolac, fenoprofen, flurbiprofen, indomethacin,
ketoprofen, ketorolac, meloxicam, nabumetone, oxaprozin, piroxicam, sal-
salate, sulindac, tolmetin
• Administer acetaminophen for pain relief.
• Glucosamine and chondroitin sulfate for relief of pain and stiffness.
• Capsaicin cream topically.
• Intra-articular injections of corticosteroid up to 3 or 4 times in a year.
• Intra-articular injections of:
• hyaluronate sodium; series of 3 to 5 injections
• hyaluron; series of 3 injections
• hylan GF 20; series of 3 injections
• Exercise to maintain joint mobility and muscle tone.
• Walking aid for stability.

NURSING DIAGNOSES
• Pain
• Activity intolerance
• Impaired mobility
NURSING INTERVENTION
• Monitor pain to adequately treat pain, as needs may change.
• Diet modification for weight loss for overweight patients to decrease excess
stress on weight-bearing joints.
• Explain to the patient:
• When and how to take medications.
• Importance of maintaining activity.
• Disease process.