V.

Lokeesan, BSN
T.Assistant lecturer
FHCS,EUSL.
 Osteoarthritis (OA)
• OA is the most common form of
arthritis and the most common
joint disease
• Known as degenerative joint
disease or osteoarthrosis
• Most of the people who have OA
are older than age 45, and
women are more commonly
affected than men.
• OA most often occurs at the
ends of the fingers, thumbs,
neck, lower back, knees, and
hips.
 OA has been classified as….
• Primary (idiopathic)
– No prior event or disease related to the OA
• Secondary
– Resulting from previous joint injury or
inflammatory disease

• Distinction between primary and secondary

OA is not always clear
OA
OA is a disease of
joints that affects all
of the weight-bearing
components of the
joint:
 Osteoarthritis (OA) - Definition
Osteoarthritis may result from wear and tear
on the joint
•The normal
cartilage lining
is gradually
worn away and
the underlying
bone is
exposed.
 OA – Risk Factors
Age

• Age is the strongest risk factor for OA. Although OA can start in young adulthood, if you are over 45 years old, you are
at higher risk.

Female gender

• In general, arthritis occurs more frequently in women than in men. Before age 45, OA occurs more frequently in men;
after age 45, OA is more common in women. OA of the hand is particularly common among women.

Joint alignment

• People with joints that move or fit together incorrectly, such as bow legs, a dislocated hip, or double-jointedness, are
more likely to develop OA in those joints.
 OA – Risk Factors
Hereditary gene defect

• A defect in one of the genes responsible for the cartilage component collagen can cause deterioration of cartilage.

Joint injury or overuse caused by physical labor or sports

• Traumatic injury (ex. Ligament tears) to the knee or hip increases your risk for developing OA in these joints. Joints

that are used repeatedly in certain jobs may be more likely to develop OA because of injury or overuse.

Obesity

• Being overweight during midlife or the later years is among the strongest risk factors for OA of the knee.
 Mechanical
Genetic and Previous joint
injury
hormonal damage
factors
Chondrocyte response
Other

Release of cytokines

Stimulation, production and release of proteolytic

enzymes, metalloproteases, collagenase

Resulting damage predisposes to

more....
 OA – Articular Cartilage
Articular cartilage is the main tissue affected
OA results in:
•Increased tissue swelling
•Change in color
•Cartilage fibrillation
•Cartilage erosion down to subchondral bone
 OA – Radiographic Diagnosis

Asymmetrical joint space narrowing from loss of

articular cartilage
The medial (inside) part of the knee is most commonly affected by osteoarthritis.
 OA – Symptoms
• OA usually occurs slowly - It may be many years
before the damage to the joint becomes
noticeable
• Only a third of people whose X-rays show OA
report pain or other symptoms:
– Steady or intermittent pain in a joint
– Stiffness that tends to follow periods of inactivity, such as sleep
or sitting
– Swelling or tenderness in one or more joints [not necessarily
occurring on both sides of the body at the same time]
– Crunching feeling or sound of bone rubbing on bone (called
crepitus) when the joint is used
Diagnostic Findings

• You'll need to describe your symptoms in

detail, including the location and frequency of
any pain
• Examination of the affected joints
• X-rays or other imaging studies
• blood tests are used to rule out other forms of
arthritis
 Medical Management
• No treatment halts the degenerative process
• preventive measures can slow the progress
– weight reduction
– prevention of injuries
– perinatal screening for congenital hip disease, and
occupational modifications.
• Conservative treatment measures
– use of heat
– weight reduction, joint rest and avoidance of joint
overuse
– orthotic devices to support inflamed joints
(splints, braces)
– postural exercises and aerobic exercise
 PHARMACOLOGIC THERAPY
• Pharmacologic management of OA is directed
toward symptom management and pain
control
• Initial analgesic therapy is acetaminophen
• Nonselective NSAIDs
• Opioids and intra-articular corticosteroids
• glucosamine and chondroitin - which are
thought to improve tissue function and retard
breakdown of cartilage
 Surgical management
• Osteotomy (to alter the force distribution in
the joint)
• Arthroplasty
• viscosupplementation (the reconstitution of
synovial fluid viscosity)- Hyaluronic acid
• Tidal irrigation (lavage)- of the knee involves
the introduction and then removal of a large
volume of saline into the joint through
cannulas.
Proximal Tibial Osteotomy
 Proximal Tibial Osteotomy

•A staple or plate and screws

are used to hold the bone in
place until it heals.
 Total Knee Replacement
•The ends of the femur, tibia, and patella are shaped to accept
the artificial surfaces.
•The end result is that all moving surfaces of the knee are
metal against plastic
Total Knee Replacement
 OA – Disease Management
•OA is a condition which progresses slowly over a
period of many years and cannot be cured
•Treatment is directed at decreasing the symptoms of
the condition, and slowing the progress of the
condition

•Functional treatment goals:

•Limit pain
•Increase range of motion
•Increase muscle strength
 OA – Non-operative Treatments

•Pain medications
•Physical therapy
•Walking aids
•Shock absorption
•Re-alignment through
orthotics
•Limit strain to affected
areas
 Nursing Management
Nursing Assessment for Osteoarthritis
• Activity / Rest
– Joint pain due to movement, tenderness
worsened by stress on the joints, stiffness in the
morning, usually occurs bilaterally and
symmetrically functional limitations that affect
lifestyle, leisure, work, fatigue, malaise.
– Limitation of movement, muscle atrophy, skin:
contractor / abnormalities in the joints and
muscles.
• Cardiovascular
– Raynaud's phenomenon of the hand (eg litermiten
pale, cyanosis and redness on the fingers before
the color returned to normal.
• Ego Integrity
– Stress factors of acute / chronic (eg, financial jobs,
disability, relationship factors.
– Hopelessness and helplessness (inability
situation).
– Threats to the self-concept, body image, personal
identity, for example dependence on others.
• Food / Fluids
– The inability to produce or consume food or
liquids adequately nausea, anorexia.
– Difficulty chewing, weight loss, dryness of mucous
membranes.
• Hygiene
– The difficulties to implement self-care activities,
dependence on others.
• Neurosensory
– Tingling in hands and feet, swollen joints
• Pain / comfort
– The acute phase of pain (probably not
accompanied by soft tissue
– swelling in the joints. chronic pain and stiffness
(especially in the morning).
• Social Interaction
– Damage interaction with family or others, the
changing role: isolation.
• Counseling / Learning
– Family history of rheumatic
– The use of health foods, vitamins, cure disease
without testing
– History pericarditis, valve lesion edge. Pulmonary
fibrosis, pleuritis.
 Nursing Diagnosis
• Acute / Chronic pain related to distention of
tissue by the accumulation of fluid /
inflammatory process, synovial joints.
• Assess pain; note the location and intensity of
pain (scale 0-10).
• Write down the factors that accelerate and
signs of non-verbal pain.
• Give the hard mattress, small pillow. Elevate
bed when a client needs to rest / sleep.
• Help the client take a comfortable position
when sleeping or sitting in a chair.
• Monitor the use of a pillow.
• Help clients to frequently change positions.
• Help the client to a warm bath at the time of
waking.
• Help the client to a warm compress on the
sore joints several times a day.
• Monitor temperature compress.
– Encourage the use of stress management
techniques such as progressive relaxation
therapeutic touch, visualization, self hypnosis
guidelines imagination, and breath control.
Engage in activities of entertainment that is
suitable for individual situations.
• Give the drug before activity / exercise that is
planned as directed.
• Assist clients with physical therapy.
• Impaired Physical Mobility related to skeletal
deformities, pain, discomfort, decreased
muscle strength.
• Monitor the level of inflammation / pain in
joints
• Maintain bed rest / sit if necessary
• Schedule of activities to provide a rest period
of continuous and uninterrupted night time
sleep.
• Assist clients with range of motion active /
passive and resistive exercise and isometric if
possible.
• Slide to maintain an upright position and
sitting height, standing, and walking.
• Provide a safe environment, for example,
raise the chair / toilet, use a high grip and tub
and toilet, the use of mobility aids /
wheelchairs rescue.
• Collaboration physical therapist / occupational
specialist.
• Anxiety related to operative procedures
• Risk for infection related to long term use of
corticosteroids
• Risk for injury related to mobility changes
secondary to osteoarthritis
• Knowledge deficit about condition, prognosis
and treatment needs related to lack of
information.
Thank you