Disease Process
What is osteoarthritis?
Inflammation of the bone and joint cartilage
Osteoarthritis is a disease that disrupts the function of bone and joint cartilage causing pain, swelling and stiffness ultimately affecting a person’s ability to move freely (Marshall).
The primary function of collagen fibers are
What is providing support for chondrocytes and formation for cartilage.
“The primary function of the collagen fibers is to provide a rigid scaffold to support the chondrocytes and ground substance of cartilage. The hydrated proteoglycan molecules, because of their size and charge, are trapped in the collagen meshwork of the extracellular matrix and prevented from expanding to their maximum size.” (Norris, Porth)
What major risk factor can impact osteoarthritis?
Obesity
“increased weight adds stress to weight-bearing joints, such as your hips and knees. Also, fat tissue produces proteins that can cause harmful inflammation in and around your joints”
What clinical manifestations may accompany physical activity with osteoarthritis?
Crepitus and grinding may be evident when the affected joint is moved for long periods of time without rest.
d/t the advancement is the disease limiting the range of motion from intra-articular and periarticular structural damage (Norris and Porth).
This phrase describes the normal thickening and hardening of the joint capsule that occurs in osteoarthritis.
What is fibrosis?
“Fibrosis is a condition that develops slowly but eventually leads to tissue degeneration, which has devastating consequences for heart, lung, liver, kidney, and skin disorders. It occurs when there is an excessive buildup of fibrous connective tissue in the extracellular matrix (ECM) area of tissues that have been injured,” (Antar et, al., 2023).
What is another popular term for osteoarthritis?
wear and tear arthritis
Osteoarthritis is also popularly known as wear and tear arthritis due to progressive deterioration of the cartilage within joints over time (Norris)
The difference between one with healthy cartilage versus diseased cartilage
What is increased water and less proteoglycans?
“Early during the disease, the cartilage contains increased water and decreased concentrations of proteoglycans compared with healthy cartilage” (North, Porth)
Osteoarthritis has to do with breakdown of cartilage only. True or False
False
osteoarthritis also affects the entire joint because it causes changes in the bone and deterioration of the connective tissues holding the joints together. (Sandhya)
What joints are commonly affected with osteoarthritis?
Weight bearing joints such as: hips, knees, lumbar and cervical vertebrae, proximal and distal joints of the hands, the first carpometacarpal joint and the first metatarsophalangeal joints in the feet.
Although single weight-bearing joints may be involved initially, other joints often become affected because of the additional stress placed on them while trying to protect the initial joint (Norris and Porth).
NSAIDs can be applied topically, directly to the afflicted joint. They come in a variety of forms, such as tablets and capsules.
What is topical gel or cream?
“Nonprescription (over-the-counter) diclofenac topical gel (Voltaren Arthritis Pain) is used to relieve pain from arthritis in certain joints such as those of the knees, ankles, feet, elbows, wrists, and hands,” (National Library of Medicine, 2021).
What type of cartilage does osteoarthritis affect and what joints are affected?
The type of cartilage affected is hyaline cartilage, found in synovial joints. Common joints affected are in the spine, knees, hips, and hands.
Joint changes from osteoarthritis include a slow progressive loss of articular cartilage which is found in synovial joints. Common joints affected are in the spine, knees, hips, and hands (Norris).
Protease enzymes break up these molecules which leads to decreased collage leavens
What are proteoglycans?
“Breakdown of proteoglycans leads to a reduction in the compressive stiffness of the tissue that accelerates the rate of collagen loss” (Akkiraju, Nohe)
Is there a specific cause of osteoarthritis? Yes or No
No, it can occur from a number of things but mostly having to do with age and as your get older, normal wear and tear on your joints can cause cartilage break down.
Pain is usually bilateral with Osteoarthritis. True or False
FALSE: pain is often unilateral BUT can affect one or more joints in the affected area. The pain can become worse with activity and with disease progression.
Unilateral pain is more common since the cartilage is the missing piece causing the bone-on-bone friction and pain (Herrero et, al., 2024).
This injectable drug relieves localized inflammation in osteoarthritis and is frequently used when NSAIDs are ineffective.
What is corticosteroid injection?
“Corticosteroids help fight inflammation-- the heat, redness, pain, and swelling in an injured or inflamed part of the body. Corticosteroid shots ease pain faster than anti-inflammatory pills. A single injection doesn’t cause stomach upset the way pills can. When corticosteroids are injected into a joint, their effects are mostly limited to that joint,” (Dunkin, 2023).
What is the difference between primary and secondary variants of osteoarthritis?
Primary osteoarthritis is linked to intrinsic defects where secondary osteoarthritis is linked to congenital defects.
The primary variant of osteoarthritis is caused by intrinsic defects of articular cartilage where the secondary variant of osteoarthritis is caused by congenital or acquired defects of joint structures (Norris).
This substance loses its protective functions and allows synovial fluid to enter the bone.
What is cartilage?
“As the crack deepens and clefts form, it eventually extends through the articular surface and into the subchondral aspect of the bone. Portions of the articular cartilage eventually become completely eroded and the exposed surface of the subchondral bone becomes thickened and polished to an ivory-like consistency.” (Norris, Porth)
SATA, Risk factors of osteoarthritis: Children, excessive use of joints, sports injury, steroids, High BMI
Children, incorrect because their joints should be growing and becoming strong not breaking down
Excessive use of joints, correct because the joint is having long-term mechanical stress or overuse
Sports injury, correct because a fracture or break of a bone can cause breakdown of cartilage leading to osteoarthritis
Steroids, correct because the cartilage isn’t healing or growing on its own, the use of these drugs can cause more harm than good
High BMI correct because obesity can cause high stress on joints
As a nurse what age group would you clinically expect to present with osteoarthritis?
Clinical manifestations appear around age 50-60 years. ALTHOUGH joint changes in general commonly begin after 40 years of age.
As weakening of the collagen network in the joints occur, caused by decrease in the local synthesis of new collagen and an increase in the breakdown of existing collagen as the body ages (Norris and Porth).
The assessment for osteoarthritis is palpating the joint to feel for soreness, swelling, or tenderness.
What is palpation?
Palpation is a procedure during a medical examination to feel with the hands or fingers. “Palpation of swollen joints can sometimes differentiate among joint effusion, synovial thickening, and capsular or bony enlargement. Small joints (eg, acromioclavicular, tibiofibular, radioulnar, sternoclavicular) can be the source of pain that was initially believed to arise from a nearby major joint. Bony enlargement (often due to osteophytes) is noted,” (Hsu & Siwiec, 2023).
What is the commonality of osteoarthritis?
Osteoarthritis is the most common type of arthritis in older adults leading to disability for over 32.5 million adults in the United States.
Osteoarthritis is the most common form of arthritis and is the leading cause for disability and pain among older adult populations (Norris). It affects more than 32.5 million adults in the United states (Arthritis Foundation).
What is the term for when bone or cartilage breaks off and enters the joint space?
What are joint mice?
“Fragments of cartilage and bone often become dislodged, creating free-floating osteocartilaginous bodies (“joint mice”) that enter the joint cavity” (Norris, Porth)
A postmenopausal woman at the age of 60 is at a lower risk to develop osteoarthritis than a male the age of 75. True or False
False
because women postmenopausal tend to be at a greater risk due to their body no longer having normal menstrual cycles which can lead to lower levels of estrogen which contribute to losing bone more rapidly. (Cleveland clinic)
When palpating a client’s osteoarthritic site what would the nurse want to take into consideration to ensure that there are abnormalities present?
Compare to the unaffected side to the affected side to confirm the patients normal before determining abnormalities.
A baseline normal is essential for staging and progression for certain diseases (Zhang, 2013).
This term refers to the typical or expected range of flexion for a specific joint in healthy individuals.
What is the normal range of motion?
“Active range of motion (the maximum range through which the patient can move the joint) is assessed first; limitation may reflect weakness, pain, or stiffness as well as mechanical abnormalities. Then passive range of motion (the maximum range through which the examiner can move the joint) is assessed; passive limitation typically reflects mechanical abnormalities (eg, scarring, swelling, deformities) rather than weakness or pain. Active and passive movement of an inflamed joint (eg, due to infection or gout) may be very painful,” (Villa-Forte, 2024).