ELDER TIP Primary osteoarthritis is strongly associated with aging, and indeed aging may predispose to the cartilage degeneration common in persons with osteoarthritis.
Signs and symptoms
The most common symptom of osteoarthritis is a deep, aching joint pain, particularly after exercise or weight bearing, usually relieved by rest. Other symptoms include stiffness in the morning and after exercise (relieved by rest), aching during changes in weather, “grating’’ of the joint during motion, altered gait contractures, and limited movement. These symptoms increase with poor posture, obesity, and stress to the affected joint.
Osteoarthritis of the interphalangeal joints produces irreversible joint changes and node formation. The nodes eventually become red, swollen, and tender, causing numbness and loss of dexterity. (See What happens in osteoarthritis, page 590.)
Diagnosis
A thorough physical examination confirms typical symptoms, and absence of systemic symptoms rules out an inflammatory joint disorder. X-rays of the affected joint help confirm diagnosis of osteoarthritis but may be normal in the early stages. X-rays may require many views and typically show:
❑ narrowing of joint space or margin
❑ cystlike bony deposits in joint space and margins and sclerosis of the subchondral space
❑ joint deformity due to degeneration or articular damage
❑ bony growths at weight-bearing areas
❑ fusion of joints. (See Digital joint deformities, page 591.)
Treatment
Treatment is aimed at relieving pain, maintaining or improving mobility, and minimizing disability. Medications include nonsteroidal anti-inflammatory drugs, Cox-2 inhibitors and, in some cases, intra-articular injections of corticosteroids. Studies indicate that glucosamine and chondroitin may be useful in controlling symptoms and reducing functional impairment. Injecting artificial joint fluid into the knee can provide relief of pain for up to 6 months.
Effective treatment also reduces stress by weight loss and supporting or stabilizing the joint with crutches, braces, cane, walker, cervical collar, or traction. Exercise, such as through physical therapy, is integral to maintaining or improving joint mobility. Other supportive measures include massage, moist heat, paraffin dips for hands, protective techniques to prevent undue stress on the joints, and adequate rest (particularly after activity).
Surgical treatment, such as one of the following, is reserved for patients who have severe disability or uncontrollable pain:
❑ Arthroplasty (partial or total): replacement of deteriorated part of joint with prosthetic appliance
❑ Arthrodesis: surgical fusion of bones, used primarily in spine (laminectomy)
❑ Osteoplasty: scraping and lavage of deteriorated bone from joint
❑ Osteotomy: change in alignment of bone to relieve stress by excision of wedge of bone or cutting of bone.
Special considerations
Patient care for osteoarthritis includes the following:
❑ Promote adequate rest, particularly after activity. Plan rest periods during the day, and provide for adequate sleep at night. Moderation is the key — teach the patient to pace daily activities.
❑ Assist with physical therapy, and encourage the patient to perform gentle, isometric range-of-motion exercises.
❑ Provide emotional support and reassurance to help the patient cope with limited mobility. Explain that osteoarthritis isn’t a systemic disease.
Specific patient care depends on the affected joint:
❑ Hand: Apply hot soaks and paraffin dips to relieve pain, as ordered.
❑ Spine (lumbar and sacral): Recommend a firm mattress (or bed board) to decrease morning pain.
❑ Spine (cervical): Check cervical collar for constriction; watch for redness with prolonged use.
❑ Hip: Use moist heat pads to relieve pain and administer antispasmodic drugs, as ordered. Assist with range-of-motion and strengthening exercises, always making sure the patient gets the proper rest afterward. Check crutches, cane, braces, and walker for proper fit, and teach the patient to use them correctly. For example, the patient with unilateral joint involvement should use an orthopedic appliance such as a walker, or a cane. Recommend the use of cushions when sitting as well as the use of an elevated toilet seat.
❑ Knee: Twice daily, assist with prescribed range-of-motion exercises, exercises to maintain muscle tone, and progressive resistance exercises to increase muscle strength. Provide elastic supports or braces if needed.
To minimize the long-term effects of osteoarthritis:
❑ Teach the patient to take medication exactly as prescribed, and report adverse effects immediately.
❑ Advise the patient to avoid overexertion. He should take care to stand and walk correctly, to minimize weight-bearing activities, and to be especially careful when stooping or picking up objects.
❑ Instruct the patient to wear proper-fitting, supportive shoes and not to allow the heels to become worn down.
❑ Advise the patient to install safety devices at home such as guard rails in the bathroom.
❑ Instruct the patient to maintain proper body weight to lessen strain on joints.
Pictures
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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