Osteoarthritis (OA) Overview

Introduction

• OA is the most common type of arthritis, distinguished from rheumatoid arthritis (RA) and gout.
• Develops from deterioration of articular cartilage (hyaline cartilage).
• Key difference from RA: OA involves cartilage deterioration, not synovial inflammation.

Role of Hyaline Cartilage

• Function: Allows joint movement without stiffness or pain; absorbs shock.
• Structure: Smooth, rubbery tissue at the end of bones within joints.
• Healthy Joint: Clear joint space, thick hyaline cartilage, no bone contact.
• OA Affected Joint: Reduced joint space, thin or absent hyaline cartilage, bones rub together causing problems.

Pathophysiology

• Consequences of Cartilage Loss:
  • Crepitus: Grating sound due to bones rubbing together.
  • Osteophytes (bone spurs): Bony growths, visible on X-ray.
  • Sclerosis: Hardening of bone.
  • Joint debris: Loose bone/cartilage fragments can increase pain.

Signs and Symptoms

• Hard, bony joints (not soft or inflamed as in RA).
• Pain due to bone-on-bone contact.
• Severe stiffness (morning stiffness <30 mins).
• Crepitus (grating sensation).
• OA is not systemic (no fever, heart, lung involvement, or anemia).

Key Characteristics of OA

• Also known as Degenerative Joint Disease.
• Affects older adults (>40 years), weight-bearing joints (knees, hips, spine, hands).
• Asymmetrical and not systemic.

Risk Factors

• Age (40+ years)
• Repeated joint injuries (e.g., from sports)
• Strenuous jobs (e.g., nursing)
• Obesity (increased stress on joints)
• Genetics

Management

• No cure; damage can't be reversed.
• Improvement through lifestyle changes and medical interventions.
• Exercise: Enhances muscle strength, aids weight loss, improves mental health.
• Medications:
  • Corticosteroid injections in joints for temporary relief.
  • NSAIDs and topical creams for pain management.
• Surgery: Joint replacement or arthroscopy for severe cases.

Diagnosis

• No single test; combination of symptoms, physical exams, and imaging.
• X-rays: Reveal reduced joint space, osteophytes, sclerosis.

Nursing Interventions

• Assess joint mobility and signs of OA.
• Encourage exercise and physical therapy.
• Educate about low-impact exercises (walking, water aerobics).
• Recommend heat/cold therapy for pain relief.
• Monitor use of assistive devices (e.g., raised toilet seats).
• Stress weight management for overweight patients.

Mnemonic: OSTEO

• O: Outgrowths (bony nodes like Heberden's and Bouchard's)
• S: Sunrise stiffness (<30 mins, worse at day's end)
• T: Tenderness at joint site
• E: Experiencing crepitus
• O: Only the joints are affected

Conclusion

• OA requires a multifaceted approach involving lifestyle changes, medical management, and sometimes surgical interventions.
• Support and education on managing symptoms and improving quality of life are crucial.