hey everyone in cereth register nurse re and calm and in this video i want to be doing it in clicks review where i'm going to be comparing osteoarthritis vs rheumatoid arthritis and this video is part of an ink lex review series over the musculoskeletal system and as always at the end of this video you can access the free quiz that will test you on these conditions so let's get started first let's start out talking about osteoarthritis Oh a ok what is this this is a form of arthritis caused by the deterioration of that articular cartilage which is Highland cartilage and what is this this is rubbery smooth tissue found at the end of the bone where a joint is so it joins where two bones meet together and what happens is that over time this cartilage wears away and as it wears away it causes the joint space to decrease and eventually what happens is that we have bone rubbing against bone the bones will grate together and this will cause the patient a lot of pain what can happen is that parts of that cartilage can break off and hang out in the joint space the bone inside the bone it can become abnormally hardened sclerosis and the patient can have formation of bone spurs osteophytes so this patient can exhibit extreme stiffness and pain and limited mobility now on the flip side we have rheumatoid arthritis RA and this is a form of arthritis that is due to the immune system attacking the synovium and the synovium is found within the joint you have your joint capsule which is this here maroon and then in the red and the purple ish you have the synovium which is like a connective tissue area that lines within that joint and what happens is that those white blood cells attacking and inflame it and causes the patient a lot of problems and what can happen is that over time which we'll talk about a little bit later these bones can fuse to get together in a condition called ankylosis so we can have bone fusion so remember cartilage is being affected in a way and so no in our a so what joints are affected so in a way all the joints can be affected but it most commonly affects those weight-bearing joints and the reason is is because they have a lot of stress on them and it only affects the joints the system other systems in the body are not affected so just to the joints what typically is affected are the hands the hips the knees and the spine and another key thing to remember is that this is unsymmetrical so necessarily just because the patient has it in the right knee oh and the right knee they don't have to have it in the left knee as compared with ra-ra is symmetrical so patient with a a can have it in both knees both hips or just one hit or something like that so on the flip we have our a and it's most commonly in our joints but it also affects other systems of the bodies like the heart the eyes the lungs patients will have a low-grade fever they're just going to feel horrible all over along with anemia most commonly infects the fingers and the wrist but it can also extend to the neck the shoulders the elbows the feet and the ankles now like I said RA is symmetrical if the patient has it in the right wrist they have to have it in the left wrist that's how the disease process goes it's not like that in a way so remember that because that's one of those key points oay happens due to just that wear and tear on the body so it's gonna happen over time gradually which is why these are risk factors older aids you're gonna see it in patients who are 40 plus repeated injuries so they played a lot of sports in college and they have a lot of repeated joint injuries they're at risk for this being overweight because it puts a lot of weight on those weight-bearing joints losing weight can help this condition genetics in manual student strenuous labor like those jobs that require you to work really hard like in nursing being on your feet for those 12-hour shifts nurses can suffer from osteoarthritis in the knees now with rheumatoid arthritis the cause is unknown but we know that the body is attacking the synovium we have inflammation throughout the body it tends to affect women more than men and hormonal issues may be a cause along with genetics and this disease can occur at any age it's not just limited to older age and typically it occurs between 20 to 60 years old now with osteoarthritis in the nation is not as common as with RA because again this is the wear and tear issue and the joint pain that they're experiencing along with the stiffness is from the grading of those bones on one another and those bone spur formations the hard bony areas which we're going to talk about a little bit later herb it in and bouchard's nodes on the hands and what can happen is that that cartilage again breaks off into that joint space along with bone breakdown so the joints are going to appear whenever you're assessing it as a nurse they're gonna be hard and bony but on the flip side with rheumatoid arthritis inflammation is going to be present that's a big key with this like synovitis which is inflammation of that synovium so when you look at those joints they're going to be red warm they're gonna be soft and boggy from all that swelling and inflammation so when you're looking at osteoarthritis versus rheumatoid arthritis side by side as you can see in this picture here this is a picture of our throttle some of the knee the picture on the left is representing osteoarthritis and the picture on the right is representing rheumatoid arthritis so let's look at the one with a way on the left notice that the joint space is practically gone and you have the two bones within that joint rubbing up against each other and what is happening is that it's affecting the inside of the bone and the outside of the bone and you get what's called bone spur formation and that's what you're seeing where that Highland cartilage should be at the end of those two bones those protrusions that is the formation of osteophytes also called bones and what's happening is these bones are rubbing together and it can cause the bone to abnormal we Harden with sclerosis going to cause the patient major stiffness and pain now on the right with rheumatoid arthritis you have a joint space but it's inflamed the synovium surrounding that joint space is inflamed which is represented in the red and the blue area and what can happen is that synovium is inflamed called synovitis and what's happened is that white blood cells have invaded the synovium and it causes it to become thick and a penis conformed and a penis is a layer of fibrous tissues and notice that we don't have bone spur formation that's only going to be found in osteoarthritis now this panis that we're talking about can grow so large that it will damage the bone and not Highland cartilage within that joint and this space image between the joints will start to disappear and you'll get bone fusion in those really severe cases called ankylosis and the patient will have major stiffness and in mobility so now let's compare the signs and symptoms of osteoarthritis versus rheumatoid arthritis side by side okay to help us remember the signs and symptoms of oay let's remember the mnemonic osteo because we're talking about osteoarthritis okay oh for outgrowths the Abney's outbreaks are going to be hard bony nodule areas and specifically we were talking about some unique nodes that you're gonna see on the hands on the fingers and these are known as both shards and her badeen nodes now for testing purposes you want to know where these are located at because they're on different areas of the finger okay the first one are both shards and they are found on the proximal interphalangeal joint so the middle joint of the fingers the next is her Bateen and these are found on the distal interphalangeal joint and that is the top joint closest to the fingertips and how I remember this that whenever I'm looking at the hand I'm thinking of the alphabet and B comes before H so both shards B is going to be the closest one to me and it's the proximal proximal closest proximity that's where these are located in the middle and then her badeen age it's next laughs and alphabets gonna be the top and this is the distal part and let's look at this on a person's hands here in this picture the black circles these are representing both shards nodes and they're at that proximal interphalangeal joint and then the ones in the red squares are herba Dean's found at the distal interphalangeal joint and just notice the protrusion coming off where the joint space is located in this again is due to the bone spur formation those osteophytes next s for sunrise stiffness they're gonna have morning stiffness but the key with this is that it's gonna be less than 30 minutes so they're gonna recover faster with this then compared to RA and the pain of the stiffness is actually going to get worse and it's going to be the worst at the end of the day because they've used those joints so joints have graded upon one another and it's causing them some pain T for tenderness on the joint site whenever you palpate the joint side it'll be tender to the patient but that's because of the bone spur formation you're not gonna have the red the warm the softball guiness of the joints like compared to over here in RA because they're they have the inflammation so it's gonna be hard and bony eat there in experience what's called crepitus whenever they they Bend those joints because those bones are rubbing up against each other it's gonna be like a grating clicking type sound that will have that in this knot over here in all right and o4 it's only the joints that are affected not the system so you're not gonna see a fever and anemia and the heart in the eyes and the lungs being affected in a way compared to RA so all right to remember the signs and symptoms let's remember the seven s's so as sunrise stiffness is going to be greater than 30 minutes it's gonna taking them a lot longer to recover from their stiffness next s soft tender warm joints that's from that inflammation remember it's hard and bony over here in a a yes swelling in those joints other s it's going to be symmetrical that's a requirement for this knot over here another s synovium is going to be in plain our synovium is not inflamed over here it's just the hyaline cartilage s for systemic and then the last s is the stages remember the synovitis inflammation of snow mia the penis formation and then the bone fusion with ankylosis now let's look at how these two diseases are diagnosed because it's the nurse you want to be familiar with what the physician may order okay with osteoarthritis it's important to be able to differentiate those signs and symptoms that we just went over between if this is our AOA or even gal those other forms of arthritis because when you see those you can report those to the physician who can order these further evaluations now with Oh a a one good test is an x-ray and an x-ray remembers only shows bone so it's not going to show us that cartilage that's deteriorating but we can see from where that cartilage has deteriorated the signs and symptoms it has caused so you will see a decrease joint space in the x-ray also you can see bone spur formation and sclerosis of the bones hardening of those bones and a loss of integrity of those bones and again remember that cartilage and parts of bones can break off and go into the joint space and the bone parts and it went into the joint space can be picked up compared to Rimet or arthritis they can do some blood tests and a positive rheumatoid factor will come back they can have an increase erythrocyte sedimentation a positive C reactive protein this just indicates that there's inflammation in the body doesn't necessarily mean it's RA but the patient has inflammation and the x-ray will show joint deterioration they won't see the bone spurs like how you can over here so you just want to be familiar with those different types of tests that can be ordered now for both conditions there is no cure for both can't be reversed however they can be managed now depending on our nursing interventions they tend to be a little bit similar along with exercise and other treatment plans like the patient goals because we want to preserve the joints we want to manage their pain and do heat and cold therapy other things are surgeries in severe cases that can be managed with RA a sin of ectomy is like where they go and remove that synovium that's inflamed or an arthrodesis which is a joint fusion however on the flip side with oay they can have what's called an osteotomy and this is where they go in so it was up the knees they can realign that knee and it can help shift weight from that bad knees so you can preserve the function because these procedures are due usually as alternatives to joint replacements to reflect to lengthen how long it's going to be before they need their knee replace now with oay it's really important that they lose weight if they're overweight because this can dramatically increase their mobility and decrease the pain and the stiffness that they're experiencing now with both conditions exercise is crucial in the treatment plan and you need to tell the patient I know you don't feel like exercising and the key is to start out slow but just keep doing it over time and you're gonna notice that your pain is decreasing you're feeling better mentally and physically you have more energy it's going to help the patient lose weight and things like that it really helps preserve that joint function as much as they can so types of exercises they want to do are like low-impact that's like walking water aerobics stationary bike riding strength training like lifting weights range of motion they want to avoid those high-impact it's like running jogging or anything that requires two feet be off the ground jump roping things like that and if their joints are painful they need to rest them until that has gone away and then resume exercising and for medication treatments NSAIDs as nonsteroidal antiinflammatory and tunnel are good for treating the pain however it differs a little bit with some medications with RA remember we have a lot of inflammation going on so DMARDs those disease-modifying antirheumatic drugs help with out what they do is they suppress the immune system which decreases that inflammation also oral corticosteroids play a role in helping with that as well and oral supplements cause remember these patients tend to struggle with anemia so administering supplements that increase red blood cell production like folic acid iron vitamin b12 over here with Oh a topical creams help that they can rub on the side that warmth or the cold like icy hot and joint injections of corticosteroids tend to help as well decrease the inflammation on those tendon and ligaments however that tends to just be temporary and they usually stop having relief within one to two months and have to get repeated injections and injections are better than oral corticosteroids in this condition because again we don't have system-wide inflammation compared to RA okay so that wraps up this in CLECs review on osteoarthritis versus rheumatoid arthritis thank you so much for watching don't forget to take the free quiz and to subscribe to our channel for more videos