Degenerative Joint Disease, commonly known as osteoarthritis is the most disabling amongst the other joint diseases. Osteoarthritis is usually over – diagnosed, subsequently, it can be over – treated or under – treated. Classifying osteoarthritis can be primary or secondary, though the contrast between the two categories is not clear.
Osteoarthritis is classified according to the underlying cause of the disease.
- Primary – this kind of osteoarthritis has no known cause or idiopathic
- Secondary – this kind has an underlying cause, disease or injury that precipitated the osteoarthritis
Congenital and developmental disorders of the hip
- Acetabular dysplasia
- Congenital sublaxation dislocation of the hip
- Legg – Calve – Perther disease
- Slipped capital femoralepiphysis
Degenerative process with increasing age (Osteoarthritis begins in the third decade of life and peaks on the fifth and sixth decades respectively.)
- Preceding joint damages
- Occupational factor (repetitive use of the use)
- Anatomical deformity
- Hormonal factors
- Mechanical injury
There are several predisposing factors for osteoarthritis. These factors would affect the articular cartilage, subchondral bone and the synovium, these would trigger chondrocyte response that would release cytokines. This stimulates, produces and releases proteolytic enzymes, metalloproteases and collgenase that would lead to damages like cartilage degradation, bone stiffening and reactive inflammation of the synovium. This event would also predispose to other diseases and disorders.
- Pain (from inflamed synovium, trabecular microfracture, intraosseous hypertension, stretching of the joint capsule or ligaments, bursitis, irritation of nerve endings in the periosteum, tendinitis and muscle spasms)
- Stiffness (felt during morning and would last for approximately 30 minutes)
- Functional impairment (rooted from the pain and stiffness experienced and from structural changes of the joints)
Assessment and Diagnosis
Verifying the presence of osteoarthritis is a little tricky because there is a little percentage of patients with altered x-rays report symptoms.
- Osteorthritis is characterized by a progressive loss of joint cartilage whcich is evident on x-rays as a narrowing space.
- Presence of osteophytes in the joint margins and subbchondral bone
Since this disease is degenerative, some definite preventive measures are available to slow the process, such as perinatal screening for congenital hip disease, ergonomic modification (a simple and cost effective way to avoid long term health problems), weight reduction, and prevention of injuries.
- Conservative treatment consists of heat therapy, weight reduction, joint rest, avoidance of joint use, exercises (isometric, postural, aerobic), use or orthotic devices.
- Occupational therapy
- Physical therapy
- Pharmacological therapy includes:
- COX-2 inhibitors
- Intra – articular corticosteroids
- Topical analgesics
- Glucosamine and chondroitin ( improves tissue function and delay cartilage breakdown)
- Viscosupplementation (an intra – articular injection of hyaluronic acid that is thought to improve cartilage function and delay degradation)
- Arthroplasty (artificial replacement of joints)
- Viscosupplementation (reconstitution of synovial fluid consistency)
- Tidal irrigation
Nursing management of patients with osteoarthritis covers both pharmacologic and independent nursing approaches.
- Pain management
- Optimizing functional ability
- Patient education
- Weight loss management and regimen
- Exercise therapy
- Referral to physical therapy sessions
- Introduction of walking and assistive devices