Osteoarthritis vs. Rheumatoid Arthritis

Overview

In this lecture, Cathy from Level Up RN details the key points and differences between osteoarthritis (OA) and rheumatoid arthritis (RA). Key highlights include the pathophysiology, risk factors, symptoms, treatments, and patient education for both conditions.

Osteoarthritis (OA)

• Definition: Progressive degeneration of the articular cartilage in a joint due to mechanical stress.
• Causes: Excessive mechanical stress leads to wear and tear, enzyme release, inflammation, bone spurs, and decreased mobility.
• Risk Factors:
  • Older age
  • Female gender
  • Smoking
  • Obesity
  • Repetitive stress on joints
• Signs & Symptoms:
  • Joint pain and stiffness
  • Enlarged joints
  • Crepitus (crunching sound)
  • Heberdine's nodes (distal interphalangeal joints)
  • Bouchard's nodes (proximal interphalangeal joints)
• Management:
  • Medications: NSAIDs, topical Voltaren gel, capsaicin, glucosamine supplements
  • Injections: Corticosteroids and hyaluronic acid
  • Patient Education:
    • Balance rest with activity
    • Weight loss if applicable
    • Strength training and physical therapy
    • Use of ice for acute pain and heat for stiffness
    • Splinting and assistive devices

Rheumatoid Arthritis (RA)

• Definition: Autoimmune disorder where antibodies attack the synovium, causing inflammation and cartilage destruction.
• Characteristics: Periods of exacerbation and remission.
• Risk Factors:
  • Female gender
  • Age 20-50
  • Family history
• Signs & Symptoms:
  • Bilateral, symmetrical joint pain and swelling
  • Morning stiffness
  • Ankylosis (joint fixation and deformity)
  • Swan neck and boutonniere deformities
  • Ulnar drift
  • Subcutaneous nodules
  • Systemic symptoms: fever, red sclera, lymphadenopathy
• Abnormal Labs:
  • Positive rheumatoid factor
  • Positive ANA titer
  • Elevated WBC, CRP, ESR
• Management:
  • Medications: Immunosuppressants (prednisone, methotrexate), NSAIDs, hydroxychloroquine
  • Procedures: Plasmapheresis
  • Physical and occupational therapy
  • Patient Education:
    • Warm showers for morning stiffness
    • Encourage physical activity
    • Use of assistive devices for safety

Key Differences

• OA: Degenerative, end-of-day pain relieved with rest, affects specific joints (often unilateral), nodes formation.
• RA: Autoimmune, morning stiffness relieved with activity, affects all joints (bilateral and symmetrical), swan neck and boutonniere deformities.
• Lab Tests: Negative rheumatoid factor in OA, positive in RA.

Summary Quiz

1. Heberdeen's and Bouchard's nodes: Indicative of OA
2. Positive ANA titer: Indicative of RA
3. Bilateral joint pain and swelling: Indicative of RA
4. Swan neck and boutonniere deformities: Indicative of RA
5. Pain with activity that improves with rest: Indicative of OA

Conclusion

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