Degenerative Joint Disease Osteoarthritis OA

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Degenerative Joint Disease Osteoarthritis (OA)
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Osteoarthritis (OA)

• Most common most frequent of the disabling
  joint disorders
• Classified as primary (idiopathic) or secondary,
  resulting from previous joint injury or
  inflammatory disease

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Osteoarthritis (OA)

• Begins in the 3rd decade of life and peaks
  between the 5th and 6th
• Direct correlation with age and the degenerative
  process

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Pathophysiology

• OA is a joint disease that mostly affects
  cartilage.
• Cartilage is tissue that covers the bones in a
  joint.
• Healthy cartilage allows bones to glide over each
  other. It also helps absorb shock of movement.
• In osteoarthritis, the top layer of cartilage
  breaks down and wears away.

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Pathophysiology

• This allows bones under the cartilage to rub
  together.
• The rubbing causes pain, swelling, and loss of
  motion of the joint. Over time, the joint lose
  its normal shape.
• Also, bone spurs may grow on the edges of the
  joint.

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Pathophysiology

• Bits of bone or cartilage can break off and float
  inside the joint space, which causes more pain
  and damage.
• People with osteoarthritis often have joint pain
  and reduced motion.

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Risk Factors of OA

• Obesity,
• ? Age,
• Joint injury,
• stress on the joints from certain jobs and
  playing sports
• Genetics (Legg-Calve-Perthes disease)

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Clinical Manifestations OA

• Stiffness in a joint after getting out of bed or
  sitting for a long time
• Last lt30 min. and ? with movement
• Swelling or tenderness in one or more joints
• A crunching feeling or the sound of bone rubbing
  on bone.

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Assessment and Diagnosis

• Difficult to diagnose
• Physical assessment
• Tender enlarged joints
• Inflammation
• Progressive loss of cartilage appears on xray
• Blood test are not useful

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Medical Management Goals

• Osteoarthritis treatment has four main goals
• Improve joint function
• Keep a healthy body weight
• Control pain
• Achieve a healthy lifestyle

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Medical Management of OA

• Conservative treatment
• Education
• Use of heat
• Weight reduction
• Joint rest and avoidance of joint overuse
• Orthotic devices
• Isometric and aerobic exercises
• Massage, yoga, TENS,
• Occupational and physical therapy

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Medical Management of OA

• Alternative therapy
• Herbal and dietary supplements
• Acupuncture, acupressure
• Copper bracelets or magnets

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Pharmacologic Therapy

• Symptom management and pain control
• Medication selection
• Patients needs
• Stage of disease
• Risk of side effects
• Medications and other treatments

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Pharmacologic Therapy Cont

• Initial therapy
• Acetaminophen
• Nonselective NSAIDs
• diclofenac (voltaren) ibuprofen (Advil, Motrin)
• COX-2 inhibitors
• celecoxib (Celebrex) valdecoxib (Bextra)
• Associated with risk CVD

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Pharmacologic Therapy Cont

• Opioids
• Codiene, oxycodone (Percocet)
• Intra-articular corticosteroids
• Topical analgesic
• capsaicin (Capsin, Zostrix)
• Methylsalicylate

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Surgical Management

• Osteotomy- alter the distribution of weight
  within the joint
• Arthroplasty- disease joint components are
  replaced with artificial products
• Tidal irrigation- lavage (provides pain relief
  for up to 6 months)

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Nursing Management

• Pain management
• Optimal function
• Patients understanding of disease
• Lifestyle changes
• Weight loss
• Referrals
• Assistive devices

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THE END!