Osteoarthritis (OA) is the most common type of arthritis. It affects millions of people around the world. The disease process is such that the protective cartilage cushioning the ends of bones wears down with time. The disease affects any joints of the body; however, the most commonly affected joints include the spine, hands, knees, and hips. The CDC estimates that about 32.5 million adults in the U.S. have OA (CDC, 2020). The disease is more prevalent in women than men, with increased risk with the advancement in age. OA is, however, more prevalent in men for populations younger than 45. There are two categories of the disease: primary and secondary OA. Primary OA occurs in the absence of any predisposing trauma or disease. On the other hand, secondary OA occurs with preexisting joint abnormality including Paget disease, hemoglobinopathy, trauma or injury, and congenital joint disorders among others. Although the disease varies in its clinical presentation from asymptomatic incidental findings to permanent disabling; pharmacological interventions help in the management of OA while nursing interventions help reduce the risk of complications.
OA majorly affects joints. Sandiford, Kendoff, and Muirhead-Allwood (2020) inform that OA damages the articular cartilage and spares no tissues. The development of the disease is a combination of risk factors, abnormal joint mechanics, and mechanical stress. The risk factors include female gender, joint injury, age, obesity, race/ethnicity, genetics, and diet among others (Plotnikoff et al. 2015). The combination of the factors instigates pro-inflammatory markers and proteases, which facilitate joint destruction. Pro-inflammatory markers and proteases traditionally manifest in OA symptoms of pain/aching and swelling.
The earliest manifestations of OA are usually the changes in the articular cartilage. Sandiford, Kendoff, and Muirhead-Allwood (2020) argue that articular cartilage develops surface fibrillation, irregularity, and focal erosions. The erosions then move into the bone expanding to include adjacent joint surfaces. The assemblage of these changes then results in some of the most common symptoms of OA including pain, stiffness, and joint deformity (Sandiford, Kendoff & Muirhead-Allwood, 2020). Sandiford, Kendoff, and Muirhead-Allwood (2020) further explain that cartilage damage is a consequence of biomechanical and biochemical factors although the definitive cause of the disease is an imbalance between damage and repair of tissues. Thus, cartilage injury damages the collagen matrix leading to the multiplication of chondrocytes and the formation of clusters. Phenotypic changes to hypertrophic chondrocytes occur causing cartilage outgrowths that harden and form osteophytes. These internal changes manifest as symptoms including stiffness and loss of flexibility, grating sensation, and bone spurs.
One of the pharmacological interventions is the use of analgesic drugs. Sandiford, Kendoff, and Muirhead-Allwood (2020) aver that analgesics have been the mainstay of treatment for OA. The use of analgesics uses the approved World Health Organization ladder that stipulates the levels of pain control using the drugs. At the first level is paracetamol, which has been shown to not only reduce pain but also increase function for OA patients (Sandiford, Kendoff & Muirhead-Allwood, 2020). Paracetamol traditionally has little to no side effects for OA patients. The second level involves the combination of paracetamol and Non-Steroidal Anti-inflammatory Drugs (NSAID). These reduce inflammation in the joints while reducing pain. While effective and safe, NSAIDs have been known to have side effects including Gastritis, gastric ulcers, renal and hepatic toxicity (Sandiford, Kendoff & Muirhead-Allwood, 2020). The side effects are especially common among older patients and those on the drugs for extended periods. The third level is opioid-laced analgesics, especially for extreme pain. However, these (opioid-laced analgesics) are discouraged for the elderly owing to their side effects. The side effects include an increased risk of falling, dizziness, and constipation.
Nutripharmaceuticals are additional pharmacological interventions for OA. According to Sandiford, Kendoff, and Muirhead-Allwood (2020), the use of nutripharmaceuticals is encouraged given their “cartilage protective” feature. Glucosamine is one of the most common compounds in drugs and contains constituents of the extracellular matrix of cartilage. The compound catalyzes the manufacture of physiological proteoglycans while diminishing the actions of catabolic enzymes. The drugs largely reduce pain caused by the disease. While the drug may not have any lethal side effects, some of the most common side effects include difficulty in concentrating, gas, swelling of the abdomen, malaise, and decreased appetite.
There are several nursing interventions for care/comfort to the identified disease process. Given the high levels of joint pains that come with the onset and progress of the disease, analgesics are one of the interventions. Kendoff and Muirhead-Allwood (2020) aver that analgesics offer relief for the pain even as some reduce inflammation of the joints tapering the progression of the disease. Another effective nursing intervention is assistive devices. Among the symptoms of OA include stiffness and loss of flexibility, both of which can hamper movement. Canes, walkers, crutches, and shoe inserts can assist patients to move with ease as well as provide support especially at advanced stages of the disease. Physical therapy is an additional nursing intervention for patients with OA. Physical therapy helps in the reduction of pain and improvement of function, particularly for patients at the onset of the disease. With a wide scope that encompasses electrical stimulation, balance and perturbation training, strength training, manual therapy, and aquatic therapy, physical therapy helps in the reduction of pain and function improvement. Moreover, physical therapy helps improve the strength and stability of muscles generally slowing down the degenerative process of the disease.
Nursing Intervention to Reduce Risk
Reducing the risk of complications is an important part of OA treatment and management. Several nursing interventions are available for patients. One such intervention is patient education. Kendoff and Muirhead-Allwood (2020) argue that patient education helps patients understand the disease. The information then encourages their (patients) involvement in care including taking measures to reduce the risk of disease progression. Another intervention is weight loss. According to Plotnikoff et al. (2015), overweight and obesity are modifiable risk factors since they exert an increased load on joints. Healthcare personnel can, therefore, assist patients in their weight loss goals to reduce the risk of disease progression and permanent impairment. Further, exercise is an additional intervention to reduce risk. Much like physical therapy, activities such as biking, swimming, yoga, and walking help in exercising joints and muscles thus build muscle strength. The exercises help reduce the progression of the disease and contribute to weight loss hence reducing one of the risk factors (obesity and overweight) of the disease.
OA is the most common form of arthritis prevalent in women than in men. It affects more than 30 million people and at the advanced stage causes permanent impairment. The disease involves damage to joint cartilage often caused by biochemical and biomechanical factors. OA’s risk factors include gender, genetics, ethnicity, and joint injury. Analgesics and nutripharmaceuticals are among the pharmacological interventions although nursing interventions such as weight loss, exercise, physical therapy, patient education, and assistive devices can help in the reduction of the risks of the disease.
CDC. (2020). Osteoarthritis (OA). CDC. Retrieved from https://www.cdc.gov/arthritis/basics/osteoarthritis.htm.
Plotnikoff, R., Karunamuni, N., Lytvyak, E. et al. (2015). Osteoarthritis prevalence and modifiable factors: a population study. BMC Public Health, 15(1195). Retrieved from https://doi.org/10.1186/s12889-015-2529-0.
Sandiford, N., Kendoff, D. & Muirhead-Allwood, S. (2020). Osteoarthritis of the hip: Aetiology, pathophysiology and current aspects of management. Annals of Joint, 5(8), 1-11. Retrieved from http://aoj.amegroups.com/article/view/5539/html.