OA

Question 1

Is OA a inflammatory disease

Answer 1

No, it is a chronic, non inflammatory disease due to gradual wear and tear of joint cartilage and underlying bone + inadequate repair (degenerative joint disease but multifactorial)

Question 2

what are the risk factors of OA

Answer 2

1. Increased age (>50yr old)
2. Obesity
3. Joint overuse/injury/trauma
4. Altered walking pattern - increase joint stress
5. Fam hx (genetic)
6. Female (decreased oestrogen on menopause - biochemical/wider hip = more pressure)
7. Medical conditions
   
   • metabolic conditions: DM
   • neurological conditions: multiple sclerosis
   • Haematological conditions: sickle cell disease
8. Long term mechanical stress - wear & tear

Question 3

What happens during OA

Answer 3

Articular cartilage wears away from repetitive stress > Become weak & lose elasticity > Areas of maximal stress develop fibrillation (cracks & clefts as cartilage have limited repair capacity) > Overtime, cartilage erode away until underlying bones are exposed > Bone react by growing outward @ margin of joint ends (osteophyte/bone spur formation)

Question 4

What are the pathological changes in OA

Answer 4

1. Local areas of damage & loss of articular cartilage (proteases)/meniscal degration (knee)
2. New bone formation of joint margins (osteophytes)
3. Thickening of subchondral bone (bone below cartilage)
4. Formation of bone marrow lesion & cyst
5. Variable degree of synovitis with synovial hypertrophy
6. Thickening of joint capsule - joint appear swollen
7. Sclerotic bone

Question 5

What are the SS of OA

Answer 5

1. Joint pain for 30min (morning/when inactive for a while)
   
   • early stage: worsens with activity & more pronounced in evening
   • overtime: experience pain with slightest motion/at rest
   • sometimes gets worse with weather changes
2. Joint stiffness (30min in morning)
   
   • limited ROM & difficulty initiating movement after inactivity
   • more pronounced in morning
   • improves as joint warms up/with activity
3. Joint swelling/enlargement/instability - harder to perform ADL
4. Tenderness
5. Limited motion
6. Deformity - osteophytes in distal interphalangeal joints (Heberden nodes) & proximal interphalangeal joints (Bouchard node) [*late stage OA]

Question 6

What are the conservative tx in OA

Answer 6

1. Moderate exercise
2. Weight loss
3. PT
4. Orthostatic device (brace)
5. Acupuncture
6. Meditation
7. Yoga
8. Massage
9. Heat
10. Meds (Diclofenac, Celecoxib, Intra-articular hyaluronic acid, Tramadol, Corticosteroid/glucocorticoids)

Question 7

What are the surgical tx in OA used for

Answer 7

1. Improve joint movement
2. Correct deformity/malalignment
3. Create new joint with artificial implants

Question 8

What are the goals for OA

Answer 8

1. Reduce symptoms
2. Promote joint health & function
3. Improve QOL

Question 9

What are the nursing management for OA

Answer 9

1. Evaluate (joint enlargement/swelling, stiffness, crepitus & ROM)
2. Ask how symptoms affect ADL
3. Assist with ROM exercise
4. Assess joint pain (OLDCART + quality)
5. Apply heat pack & immobilise with brace/splint
6. Pain mgt (PO & topical)
7. Shower 30min after wake up to prevent pain
8. Confirm PT referral for simple, gentle & light exercise
9. Emotional support

Question 10

What are the discharge plans of OA

Answer 10

1. Educate on maintaining healthy weight, engaging in regular physical activity, minimise stress on joints by cycling, swimming & walking/rowing (slow progression of disease)
2. Wound care
3. Diet (increase protein, vitamin & fibre)
4. Fall precaution
5. Inform if there is redness & swelling of joint, increased joint pain or decreased ability to move joint/bear weight