Ostoarthritis

Question 1

What is osteoarthritis?

Answer 1

most common form of joint disease in north america

slow and progressive noninflammatory disorder of the diarthrodial (synovial) joints

Question 2

is OA considered a normal form of aging

Answer 2

no

Question 3

when can cartilage destruction begin:
affected by age:
few experience symptoms after:

Answer 3

between 20-30 and affected by 40 few experience symptoms after 50 and 60

Question 4

after 55 whos more affected men or women

Answer 4

women

Question 5

OA is usually cause by

Answer 5

a known event or condition that directly damages cartilage or causes joint inability

Question 6

in aging women is believed to be due to

Answer 6

estrogen reduction at menopause

Question 7

OA modifiable risk factors:

Answer 7

obesity - contributes to knee and hip

anterior cruciate ligament injury - associate with quick tops and pivoting

jobs that require frequent kneeling and stooping - high knee risk

Question 8

Ways to prevent OA

Answer 8

regular moderate exercise which also helps with weight control has been shown to decrease likelihood of disease development and progression

Question 9

OA pathogenesis

Answer 9

complex with genetic, metabolic and local factors that interact and cause a process

Question 10

OA results from***

Answer 10

cartilage damage at the level of chondrocytes

Question 11

OA causes smooth white translucent articular cartilage to become

Answer 11

dull yellow and granular and it graducally becomes softer, less elastic and less able to resist wear with heavy use

Question 12

Early changes in OA

Answer 12

synovium inflamed

joint capsule inflamed and edematous

cartilage splits an dis eroded

joint space narrowed by loss of cartilage

Question 13

With time how does OA change joints

Answer 13

Outgrowth of bone

Development of sub-articular bone cysts

Hyperplasia of synovium with inflammation

thickening of subchondral bone plate

Question 14

is inflammation characteristic of OA

Answer 14

no

Question 15

Clinical manifestations: Systemic**

Answer 15

None

Question 16

Clinical manifestations: Joints**

Answer 16

mild discomfort to significant disability

localized pain and stiffness after rest and static position resolves within 30 min**

trouble getting out of a chair where knees are higher than hips

affects joints asymetrically

Crepetation (cracking sound) and its asymmetrical (one side but on the other limb)

Question 17

Clinical manifestations: pain may be reffered to

Answer 17

the groin, butt, medial side of the thigh or knee

Question 18

Clinical manifestations: crepitation

Answer 18

grating sensation caused by loose particles of cartilage in the joint / bone on bone rubbing

can cause stiffness

common sing in knee oa pt

Question 19

Predominant clinical manifestation of the joints

Answer 19

PREDOMINANT SYMPTOM: joint pain (usually why pt comes to doctor)

Question 20

Clinical Manifestations: early oa v.s advance o.a

Answer 20

Early stages: joint pain is relieved by rest

Advance stage: hurts at rest and may disturb sleep. sometimes worsens when atmospheric pressure falls

Question 21

Most common OA sites

Answer 21

distal interphalangeal / DIP and proximal interphalangeal / PIP joints of the fingers

metacarpol phalangeal / MCP joints of the thumb

weight bearing joints

cervical and lower lumbar vertebrae

Question 22

Clinical Manifestations: Deformity

Answer 22

specific to involved joints and can appear as early as age 40

beouchards nodes on the PIP joints indicate similar disease involvement - red swollen and tender

no function loss just visible disfigurement but can impair adl and other functions

knee oa = bowlegged and altered gait

hip oa = one hip shorter than the other

Question 23

OA diagnostic test (not important except one)

Answer 23

Bone scan, CT scan or MRI diagnoses oa because they detect early joint changes

also xrays help by tracking progression but do not correlate with amount of pain or symptoms

synovial fluid analysis differentiates oa and other inflammatory arthritis - fluid = clear and yellow with little to no inflammation

erythrocyte sedimentation rate is only elevated in acute synovitis because it measures inflammation *****

other blood test only screen for related conditions

Question 24

True/False: there is no cure for oa

Answer 24

true

Question 25

oa care is focused on

Answer 25

managing pain and inflammation and preventing disability and maintaining and improving joint function. non drug interventions are key.

Question 26

Collaborative Care: Rest and Joint protection

Answer 26

rest during inflammation and maintained in a functional position with splints or braces if necessary

immobilization should exceed one week because joint stiffens with inactivity

modify activities to decrease stress on affected joints

use assitive devices to help decrease stress on arthritic joints

knee oa= avoid standing, kneeling or squatting for a long time

Question 27

Collaborative Care: Heat and Cold Applications**

Answer 27

heat and cold application

Heat = helps with pain and stiffness

ice = acute inflammation

Question 28

Collaborative Care: Nutritional Therapy and Exercise**

Answer 28

Put overweight patients in a weight reduction program - critical to rx plan**

help patient i.d diet changes

Exercise is fundamental: aerobic, ROM, and quadricep strengthening ***

Question 29

Collaborative care: Complementary and Alternative Therapies**

Answer 29

acupuncture - decreases chronic arthritic pain

yoga, massage, guided imagery and therapeutic touch

nutritional supplements: glucosamine and chondrotin helps relieve arthritic pain and improve joint mobility in some

Balance rest and activity***

Question 30

Collaborative Care: Drug Therapy

Answer 30

based on pt symptoms

mild - moderate = acetaminophen (no more than 4g daily) and topical cream (zostrix).

temporary pain relief can by met by using products with camphor, eucalyptus oil and menthol

topical salicylates for patients who cant take asprin

moderate-sever/ when acetaminophen doesnt work:

• NSAID
• supplemental treatment with protective agents (misoprostol)

Question 31

what are disease-modifying osteoarthritis drugs

Answer 31

medications thought to slow the progression of oa or support joint healing

Question 32

Collaborative care: surgical therapy

Answer 32

for severe patients only

• knee replacements
• debris removal
• reconstructive surgery

Question 33

Goals for a patient with OA:

Answer 33

1. maintain or improve joint function through a balance of rest and activity
2. use joint protection measures
3. achieve independence in self care and maintain optimal role function
4. use drug and non drug strategies

Question 34

Implementation: Health promotion

Answer 34

prevention is possible with community education focused on altering modifiable risk factors. Athletic instruction and physical fitness programs. That reduce trauma to joints.

Question 35

Implementation: Acute intervention

Answer 35

questionaires pin point areas of decreased function and should be completed at regular intervals to track progression and create treatment goals

drugs to treat pain an dinflamation

non drugs to decrease pain and disability

assure pt that deformities are not the usual course

provide info about treatment pain and body mechanics plus use of assistive devices and energy conservation. Encourage weight loss and nutritional changes.

Question 36

ESR (inflammation test)**

Answer 36

It will be elevated