Osteoarthritis Flashcards
Osteoarthritis is characterized under rheumatic disorders as a what?
Local joint disorder with localized inflammation
T/F Osteoarthritis is progressive and patients will become more symptomatic over time
True
T/F Osteoarthritis shows systemic manifestations
False, OA involves a low level of inflammation at the local joint, and involves formation of new joint tissue in response to cartilage destruction
Is OA a normal part of the aging process
NO
What is one of the first medications given with OA
Tylenol
Osteophytes are also known as
Bone spurs due to excess bone growth
Age when symptoms start with OA
usually after 40
commonly affected body parts in OA
Lumbar and cervical spine
joint at base of thmb
knuckles and tips of fingers
hip
knee
joint in foot above the heel
knuckle at the base of big toe
LESS commonly affected body parts in OA
shoulder
wrist
elbow
knuckles at base of fingers
symptoms of OA
pain
stiffness
crackling or clicking in joints
extra bone growth
decreased Range of motion
problems in joint alignment
tenderness
OA Clinical manifestations
No systemic Cues
Joint pain (Most common reason for medical attention)
- Worsens with use
- Relieved by rest
- Change in temperature or barometric pressure
Pain - worse with activity Stiffness - worse with inactivity - More common in the AM; resolves within 30 min
Crepitus
- typically asymmetrical
Finer deformities in OA
Heberden’s nodes - most distal joint on fingers
Bouchard’s nodes - more proximal on fingers
knee deformities in OA
Bowlegged appearance
3 tests that show early joint changes and can diagnose OA
Bone scan
CT
MRI
Test helpful in staging progression
X-Ray
What can an X-Ray help show in OA
Joint narrowing
bony sclerosis (bone thickening)
osteophyte formation (bone spurs)
T/F Xray does not correlate to degree of pain
True
Are there biomarkers for OA?
No
What will the ESR value be if there is no synovitis present
ESR will be normal
What color would the synovial fluid be in someone with OA
Clear yellow with no signs of inflammation
What are 5 nursing problems we see in OA
Acute and/or chronic pain
Impaired physical mobility
self-care deficit
Imbalance in nutrition : More intake than required
Depression r/t chronic pain
What do we want to do to understand a patient’s baseline for pain in OA
multidimensional pain assessment to get a baseline
Non drug intervetions for OA relating to joint protection
Rest/Joint protection
- maintain functional position with orthotics
- avoid prolonged immobilization
- use assistive devices ( canes, walkers, chair lift)
Weight reduction prn and aerobic exercise
OA drug therapy mild-mod
acetaminophen - if lacking s/s of inflammation
- 3 gm daily
- 4 gm if limited duration or medically supervised
- MONITOR LFT’s
OA drug therapy if unrelieved w tylenol or s/s of inflammation
NSAIDs
- monitor bleeding
- ulcer
- GI upset
- Renal issues
OA drug therapy if GI side effects a problem
Cox-2 inhibitor (celecoxib)
What topical creams can be use in treatment of OA
NSAIDs or capsaicin (active ingredient - chili peppers)
2 types of joint injections in OA
Glucocorticoid (steroid) injections
Hyaluronate injections
What do we use steroid injections for
suppress inflammation and if unrelieved by other measures and Arthritis confined to a few joints
Are steroid injections permenant or temporary relief
temporary; may experience brief flare up after injection
What are patients at risk for with injections
risk for injection
if injected frequently can cause joint damage
- no more than 3-4 a year
what do Hyaluronate injections do
substance in joints that allows joint fluid to be slippery
What is hyaluronate injections typically reserved for
those awaiting joint replacement (knee, in particular)
What are 4 of the interdisciplinary teams that can help with OA
Rheumatologist
PT
OT
nutritionist
What is important with home management of OA
Family/support system
Non drug complementary interventions for OA
- yoga
- acupuncture, biofeedback
- Glucosamine/chondroitin (OTC, no evidence to support, can give 6-month trial)
Non drug interventions for OA r/t heat and cold therapy
Heat/cold application
- heat can decrease stiffness (20min on/20 min off)
- hot packs
- paraffin wax bath
- whirlpool