A significant percentage of the people who suffer from arthritis are often diagnosed with osteoarthritis (OA). This type of arthritis causes the wearing out of protective cartilages of the ends of the bones with time. It affects all bones but most commonly the joints of the hands, knees, hips, and the spine ( Glyn-Jones et al., 2015) . The deterioration of the joint cartilages exposes bones to each other and this in turn causes pain or stiffness because the bones rub against each other during movement. This pain and irritation impairs movement in the affected limbs.
OA can either be primary or secondary. Primary OA is chronic and is often attributed to old age. It is primarily caused by the reduction of water content of the muscle cartilages which in turn reduces the resilience of the cartilages ( Goldring & Otero, 2011) . Conversely, the secondary OA can start at any point of a person’s life and is often a result of an injury or other lifestyle conditions such as diabetes or obesity.
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The pathophysiology of both primary and secondary OA involves the breakdown of the articular cartilage. The articular cartilage is a tough rubbery substance that offers protection from friction between two bones at the point of contacts ( Goldring & Otero, 2011) . The breakdown of this cartilage is caused by the release of enzymes in the joints which in turn break down collagen and proteoglycans. This leads to the loss of joint space and ultimately the bones get in contact.
Risk factors
There are certain factors known to increase the chance of OA occurrence. Whether or not the factors are beyond the control of the patient, certain measures can be undertaken to mitigate them. These risk factors include age, family history, obesity, gender, previous injury, and certain posture and lifestyle occupations.
Age is the primary cause of chronic OA because the wear and tear of muscle cartilages increases with age. Close to 33% of OA patients are aged 65 and above ( Litwic et al., 2013). Another rampant cause of OA is inheritance where most families with OA have registered continued manifestation of the condition along the bloodline. The third factor is obesity where the joints of overweight individuals are subjected to excessive strain thereby increasing the chances of cartilage breakdown. Previous injuries on a joint are also likely to induce OA at the points of the injuries. Additionally, poor posture such as sitting and standing in absurd positions also strain the joints thereby increasing the risk of contracting OA. Lastly, occupations that put excessive pressure on the joints increase the chances of contracting OA. These include squatting, climbing stairs, and heavy lifting.
Clinical manifestations
OA manifests gradually and symptoms worsen with time. The most common symptoms include: pain in the affected joints which often hurt and sometimes impaired movements, stiffness of the joints mostly noticed in the morning and after long hours of low muscle inactivity, tenderness of the joint which is felt when one applies pressure on the joint using fingers, loss of flexibility or rather rigidity of the joints whereby the patient finds it hard to rotate or stretch the joints to their full range ( Loeser et al., 2012). Further, there are grating sensations of the joints especially in form of crackling and popping sounds during joint movements. There are also instances of bone spurs characterized by hard lumps of bones forming around the affected areas. Lastly, the joints swell and this is more or less a result of soft tissue inflammation in the joints.
Diagnostic Studies
To establish whether or not to visit a doctor, a patient should observe for pain and stiffness in the joints which worsen or improve by the day. The pain worsens with activity and eases of when the body is at rest while the stiffness increases with rest and eases off with increasing activity. On laboratory examination, the clinician inspects for deformity around specific areas such as Bouchard nodes or Heberden nodes of the hands. Other deformity is in the fixed flexion and the alignment of the knees ( Glyn-Jones et al., 2015) . The caregiver can also feel for crepitus all through the range of movements. The joint will have limited movement which is characterized with pain.
The condition is investigated primarily through clinical diagnosis. Fluid tests can be used to eliminate infective causes. This is done through arthrocentesis which involves the extraction of the joint fluid for analysis to exclude gout and other causes of inflammatory arthritis. Radiographs can be used to confirm the diagnosis ( Glyn-Jones et al., 2015) . Features to observe from radiograph include the osteophytes, subchondral cysts, subchondral sclerosis and loss of joint space ( Glyn-Jones et al., 2015) .
Managing Osteoarthritis
There is no established cure for OA, except for the treatments used to manage the symptoms. These are highlighted as follows:
Weight Management
This focuses on the reducing the intake of calories to ensure that an individual does not gain excessive weight. It is also achieved by increased physical activity.
Physical Activity
OA is best managed by getting the body in motion ( Fransen et al., 2015) . Simple movements such as walking around the neighborhood help in reducing the pain of arthritis and even maintaining a healthy weight. Slow and gentle stretching of the joints also enhances their flexibility and reduces stiffness.
Anti-inflammatory Medications
Pills, creams, syrups and lotions are available for use in reducing pain. These include analgesics, NSAIDs, corticosteroids, and hyaluronic acid.
Physical Therapy
Occupational therapists offer varied options for controlling the pain of OA. These include offering guide on the appropriate ways of using joints, using cold and heat therapies, offering motion and flexibility exercises and providing the patients with assistive devices. These assistive devices aid in mobility and other functions. They include scooters, walkers, canes and steering wheel grips. Some of these devices can be accessed from the local stores but others are strictly given under doctor’s prescriptions.
Surgery
The severely damaged joints can be repaired by replacing the joints through orthopedic surgery.
Nursing Considerations
Once successfully managed, nurses should ensure that: the OA patients are aware of the conditions and factors that increase activity intolerance and make effort to reduce them; the patient identifies and uses the best methods of enhancing activity intolerance; the patient gives a feedback or reports on any increase in activity intolerance; the patient reports or gives a feedback on the pain, whether it is relived or it worsens; the patient follows the treatment procedure as provided by the health expert. The patient must also take part in ADLs and other activities deemed suitable for taking care of the joints. After the discharge, the management of OA should continue at home through well planned daily exercises ( Fransen et al., 2015) ; the use of alternative therapies where the patient uses herbal and dietary supplements and special diets to manage their condition; and continued use of the medication.
References
Fransen, M., McConnell, S., Harmer, A. R., Van der Esch, M., Simic, M., & Bennell, K. L. (2015). Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews , (1).
Glyn-Jones, S., Palmer, A. J. R., Agricola, R., Price, A. J., Vincent, T. L., Weinans, H., & Carr, A. J. (2015). Osteoarthritis. The Lancet , 386 (9991), 376-387.
Goldring, M. B., & Otero, M. (2011). Inflammation in osteoarthritis. Current opinion in rheumatology , 23 (5), 471.
Litwic, A., Edwards, M. H., Dennison, E. M., & Cooper, C. (2013). Epidemiology and burden of osteoarthritis. British medical bulletin , 105 (1), 185-199.
Loeser, R. F., Goldring, S. R., Scanzello, C. R., & Goldring, M. B. (2012). Osteoarthritis: a disease of the joint as an organ. Arthritis & Rheumatism , 64 (6), 1697-1707.
