Overview
This lecture covers the causes, symptoms, treatment, and distinguishing features of osteoarthritis and rheumatoid arthritis, including key differences for exam preparation.
Osteoarthritis (OA)
- OA is a progressive degeneration of articular cartilage in joints, primarily due to mechanical wear and tear.
- Risk factors: older age, female gender, obesity, smoking, and repetitive joint stress.
- Symptoms: joint pain and stiffness, enlarged joints, crepitus (crunching sound), Heberden's nodes (distal fingers), Bouchard's nodes (proximal fingers).
- Treatments: oral NSAIDs, topical agents (Voltaren gel, capsaicin), glucosamine supplement, joint injections (corticosteroids, hyaluronic acid).
- Patient teaching: balance rest and activity, weight loss if needed, strength training, PT, yoga, tai chi, ice for acute pain, heat for stiffness, use assistive devices as needed.
Rheumatoid Arthritis (RA)
- RA is an autoimmune disease where antibodies attack the synovium, causing joint inflammation and destruction.
- Risk factors: female gender, age 20-50, family history.
- Symptoms: bilateral/symmetrical joint pain and swelling, morning stiffness, ankylosis (joint fixation), swan neck and boutonniere finger deformities, ulnar drift, subcutaneous nodules, fever, red sclera, lymphadenopathy.
- Labs: positive rheumatoid factor, positive ANA titer, elevated WBC, CRP, ESR.
- Diagnostics: X-ray, MRI, arthrocentesis (synovial fluid analysis).
- Treatments: immunosuppressants (prednisone, methotrexate), NSAIDs, hydroxychloroquine, plasmapheresis, PT and OT.
- Nursing care: monitor for complications (e.g., Sjogren's syndrome), encourage warm showers for stiffness, promote activity, and advise use of assistive devices.
Key Differences: OA vs. RA
- OA is degenerative and often unilateral; RA is autoimmune, inflammatory, and bilateral/symmetrical.
- OA pain worsens with activity and improves with rest; RA pain/stiffness improves with activity.
- OA features Heberden's and Bouchard's nodes; RA features swan neck, boutonniere deformities, and ulnar drift.
- OA has negative rheumatoid factor; RA has positive rheumatoid factor and ANA.
Key Terms & Definitions
- Articular cartilage — Smooth tissue at joint ends that cushions bones.
- Crepitus — Crunching/grating joint sound.
- Heberden’s nodes — Bony swellings of distal finger joints (OA).
- Bouchard’s nodes — Bony swellings of proximal finger joints (OA).
- Ankylosis — Joint fixation/deformity.
- Swan neck deformity — Finger joint hyperextension (PIP), flexion (DIP), seen in RA.
- Boutonniere deformity — Finger joint flexion (PIP), hyperextension (DIP), seen in RA.
- Ulnar drift — Fingers deviate toward ulna (pinky side), seen in RA.
- Sjogren’s syndrome — Dry eyes and mouth, RA complication.
- ANA (Antinuclear antibody) — Autoantibody seen in autoimmune disorders.
- Rheumatoid factor — Antibody found in RA.
Action Items / Next Steps
- Review table comparing OA and RA features.
- Study key labs: rheumatoid factor and ANA.
- Practice distinguishing symptoms and joint deformities for each condition.