- The most common form of arthritis.
- It causes the deterioration of the joint cartilage and formation of reactive new bone at the margins and subchondral areas of the joint.
- This chronic degeneration results from a breakdown of chondrocytes, most often in the hips and knees.
- Osteoarthritis occurs equally in both sexes after age 40.
- The earliest symptoms appear in middle age and progress with advancing age.
- Depending on the site and severity of joint involvement, disability can range from minor limitation of the fingers to near immobility in persons with hip or knee disease.
- Progression rates vary; joints may remain stable for years in the early stage of deterioration.
Etiology And Pathophysiology
- Changes in articular cartilage occur first; later, secondary soft tissue changes may occur.
- Progressive wear and tear on cartilage leads to thinning of joint surface and ulceration into bone.
- Leads to inflammation of the joint and increased blood flow and hypertrophy of subchondral bone.
- New cartilage and bone formation at joint margins results in osteophytosis, altering the size and shape of the bone.
- Generally affects adults ages 50 to 90; equal to males and females.
- Cause is unknown, but aging and obesity are contributing factors. Previous trauma cause secondary osteoarthritis.
- Deep, aching pain; pronounced after weight bearing or exercise, usually relieved by rest.
- Joint swelling or deformity.
- Joint stiffness on awakening, usually lasting less than 30 minutes.
- Hard nodes on distal or proximal interphalangeal joints on the fingers; known as Heberden’s nodes when present on distal interphalangeal joints and Bouchard’s nodes when present on proximal interphalangeal joints.
- Chronic pain related to joint deterioration.
- X-rays of affected joints show joint space narrowing and sclerosis.
- Radionuclide imaging (bone scan) may show increased uptake in affected bones.
- Synovial fluid analysis will differentiate osteoarthritis from rheumatoid arthritis by low cell count.
- Provide rest for involved joints. Excessive use aggravates the symptoms and accelerates degeneration.
- Advise the patient to avoid activities that precipitate pain.
- Apply heat as directed to relieve muscle pain and stiffness.
- Teach the patient correct posture and body mechanics.
- Advise the patient to sleep with rolled terry cloth towel under the neck to relieve cervical pain.
- Provide patient with crutches, braces, or cane when indicated to reduce-weight bearing stress on hips and knees.
- Encourage patient to wear corrective shoes and metatarsal support for foot disorders.
- Encourage patient to lose weight to decrease stress on weight-bearing joints.
- Teach the patient range-of-motion exercises to maintain join mobility.
- Refer patient to physical and occupational therapy.
- Osteoarthritis may cause flexion contractures, subluxation and deformity, ankylosis, bony cysts, gross bony overgrowth, central cord syndrome, nerve root compression, and cauda equine syndrome.