Osteoarthritis (Exam 3) Flashcards
Osteoarthritis: Characteristics
Involved the formation of new joint tissue in response to cartilage destruction
Local manifestations only
Low-level inflammation in joint area
Is Osteoarthritis a normal part of agining?
No
What are bone spurs in osteoarthritis are called?
Osteophytes
When do symptoms of osteoarthritis usually occur?
After 40
Osteoarthritis: Commonly affected body parts
Neck / Lower back
Joint at base of thumb
Knuckles in the middle / top of finger
Knee
Hip
Joint in foot (above heel)
Knuckle at base of big toe
Osteoarthritis: Symptoms
Pain
Stiffness
Crackling and clicking (crepitus)
Extra bone growth
Tenderness to touch
OA: Clinical Manifestations
Local Joint pain (reason for seeking medial attention)
Pain worsens with use: initially relieved by rest
Stiffness in a.m; resolves within 30 minutes (quickly)
Crepitus
Asymmetrical (unlike RA)
Are the clinical manifestations of OA symmetrical or asymmetrical?
ASYMMETRICAL
only involves one part or side of the body at a time
OA: What can trigger joint pain in
Change in temperature or barometric pressure can trigger pain
Pain gets worse with activity
Stiffness worse with inactivity
OA: Morning pain n
Stiffness in the AM resolves within 30 minutes of walking around
Deformities Associated with OA: Fingers
Herberden’s
Bouchards
Deformities Associated with OA: Knees
Bowlegged appearance
How do we diagnose OA
Bone scan (early joint change)
CT scan (early joint change)
MRI (early joint change)
X-ray:
-Helpful in staging progression / join narrowing - Osteophyte formation
-Does not correlate to degree of pain
ESR = Normal
No biomarkers for OA
Clear yellow synovial fluid (unlike RA)
OA: Possible Nursing Problems
Acute or chronic pain
Impaired physical mobility
Self care deficit
Imbalanced nutrition: More than body requirements
Depression r/t chronic pain
What is a good way to start reducing pain with OA
Losing weight if overweight
OA: Collaborative Care
Thorough baseline pain assessment
Non-drug interventions are foundation
Non-drug intervenations for OA
Foundation of treatment
-Rest/joint protection (maintain functional position)
-Avoid prolonged immobilization
-Use assistive device PRN (canes/ lift / shower bars)
-Heat/cold application
-Weight reduction PRN and aerobic exercise
-Yoga
-Acupuncture / biofeedback
Drug for OA
Glucosamine/chondroitin
UpToDate: Glucosamine/chondroitin
does not recommend; no evidence to support; if patient chooses to try, give it a 6 month trial and weigh outcomes
OA Mild to Moderate Pain Drug Therapy
Acetaminophen - if lacking s/s inflammation (synovitis)
3 grams daily limit; 4 gram ok if limited duration and medically supervised
Monitor LFTs
When giving patient with OA Acetaminophen, what do we want to monitor?
LFT
If pain is unrelieved with acetaminophen or if s/s of inflammation are present, what do we try next?
NSAIDS
-Monitor for GI adverse effects
-Renal Problems (nephrotoxicity)
What NSAID do we give if GI side effects are present?
celecoxib (ony works on COX 2)
OA Pharm: Joint Injection
Glucocorticoid in
Used if all other treatments do not work and it is confined to a few specific joints
Temporary relief; may experience brief flare after injection
If injected frequently, can cause joint damage; recommend no more than 3/4 per year
