Osteoarthritis & Gouty Arthritis

OSTEOARTHRITIS & GOUTY ARTHRITIS

Maria Carmela L. Domocmat, RN, MSN

Instructor, School of Nursing Northern Luzon Adventist College

Overview 2

� Part 1: Degenerative & Metabolic bone disorders: � OA

� Gout and gouty arthritis

� Osteoporosis

� Paget’s dse

Osteomalacia

3/5/2012Maria Carmela L. Domocmat, RN, MSN

� Osteomalacia

� Part 2: Bone infections

� Part 3: Muscular disorders

� Part 4: Disorders of the hand

� Part 5: Spinal column deformities

� Part 6 : Disorders of foot

� Part 7: Sports Injuries

Osteoarthritis

� associated with the aging process and can affect any joint.

� The cartilage of the affected joint is


affected joint is gradually worn down, eventually causing bone to rub against bone.

� Bony spurs develop on the unprotected bones, causing pain and inflammation.

What’s the difference between RA and OA?


� Osteoarthritis is a deterioration of cartilage and overgrowth of bone often due to "wear and tear."

� Rheumatoid arthritis is the inflammation of a joint's


� Rheumatoid arthritis is the inflammation of a joint's connective tissues, such as the synovial membranes, which leads to the destruction of the joint's cartilage.

Osteoarthritis

� Known as the “wear-and-tear” kind of arthritis

� a chronic condition characterized by the breakdown of the joint’s cartilage.

� Cartilage is the part of the joint that cushions the ends


� Cartilage is the part of the joint that cushions the ends of the bones and allows easy movement of joints. The breakdown of cartilage causes the bones to rub against each other, causing stiffness, pain and loss of movement in the joint.

Osteoarthritis

� AKA

� degenerative joint disease,

� ostoarthrosis,

� hypertrophic arthritis


� degenerative arthritis.

Stages of osteoarthritis

� Cartilage loses elasticity and is more easily damaged by injury or use.

� Wear of cartilage causes changes to underlying bone. The bone thickens and cysts may occur under the


cartilage. Bony growths, called spurs or osteophytes, develop near the end of the bone at the affected joint.

Stages of osteoarthritis

� Bits of bone or cartilage float loosely in the joint space.

� The joint lining, or the synovium, becomes inflamed due to cartilage breakdown causing cytokines


(inflammation proteins) and enzymes that damage cartilage further.

� The main problem in knee OA is degeneration of the articular cartilage.

� Articular cartilage is the smooth lining that covers smooth lining that covers the ends of bones where they meet to form the joint. The cartilage gives the knee joint freedom of movement by decreasing friction.


� The articular cartilage is kept slippery by joint fluid made by the joint lining (the synovial

membrane). The fluid, membrane). The fluid, called synovial fluid, is contained in a soft tissue enclosure around synovial joints called the joint capsule.


� An important substance present in articular cartilage and synovial fluid is called hyaluronicacid. Hyaluronic acid acid. Hyaluronic acid helps joints collect and hold water, improving lubrication and reducing friction. It also acts by allowing cells to move and work within the joint.


� When the articular cartilage degenerates, or wears away, the bone underneath is uncovered and rubs uncovered and rubs against bone.

� Small outgrowths called bone spurs, or osteophytes, may form in the joint.


� Changes in the cartilage and bones of the joint can lead to pain, stiffness and use limitations. Deterioration of cartilage can:� Affect the shape and makeup of the joint so it doesn’t

function smoothly. - limp when walk or have trouble going


function smoothly. - limp when walk or have trouble going up and down stairs.

� Cause fragments of bone and cartilage to float in joint fluid causing irritation and pain.

� Cause bony spurs, called osteophytes, to develop near the ends of bones

� Mean the joint fluid doesn’t have enough hyaluronan, which affects the joint’s ability to absorb shock.

Causes and Risk factors

� There is no single known cause of osteoarthritis

� several risk factors

� Age

� Obesity


� Obesity

� Injury or Overuse

� Genetics or Heredity

� Muscle Weakness

� Other Diseases and Types of Arthritis

Long-Term Complications


Management


Management

�Weight reduction

�Use of splinting devices to support joints

�Occupational and physical therapy

�Pharmacologic management


�Pharmacologic management

Management


Paraffin wax


TENS


Physical Therapy

� There is no treatment to stop the erosion of cartilage in the joints, but there are ways to improve joint function. One of these is physical therapy to increase flexibility and is physical therapy to increase flexibility and strengthen the muscles around the affected joints. The therapist may also apply hot or cold therapies such as compresses to relieve pain.


Supportive Devices

� Supportive devices, such as finger splints or knee braces, can reduce stress on the joints and ease pain. If walking is difficult, canes, crutches, or walkers canes, crutches, or walkers may be helpful. People with osteoarthritis of the spine may benefit from switching to a firmer mattress and wearing a back brace or neck collar.


lumbosacral corsets


Osteoarthritis and Weight

� If you're overweight, one of the most effective ways to relieve pain in the knee or hip joints is to shed a few pounds.

� Even modest weight loss � Even modest weight loss has been shown to reduce symptoms of osteoarthritis by easing the strain on weight-bearing joints.

� Losing weight not only cuts down on pain, but may also reduce long-term joint damage.


Osteoarthritis and Exercise

� People with osteoarthritis may avoid exercise out of concern that it will cause pain.

� But low-impact activities such as swimming, walking, or bicycling can improve mobility and increase mobility and increase strength.

� Training with light weights can help by strengthening the muscles that surround your joints. For example, strengthening the quadriceps can reduce pain in the knees.


Let’s Exercise

� http://www.medicinenet.com/rheumatoid_arthritis_exercises_slideshow/article.htm


Treatment

� Acetaminophen (Tylenol)

� Topical analgesics OTC� Topical salicylates (Aspercreme)

� Capsaicin

� Nonsteroidal anti-inflammatory drugs (NSAIDs) or COX-2 medications


medications

� Tramadol

� Narcotic pain relievers

� Intra-articular steroids to decrease inflammation � Hyaluronans: Hyaluronate (Hyalgan) ad hylan GF 20 (Synvisc)

� Cyclobenzapine HCl (Flexeril)

� glucosamine and chondroitin sulfate

Acetaminophen

� Tylenol, Anacin-3, Panadal, Phenaphen, Valadol, and others)

� for mild to moderate osteoarthritis. � usually the first choice


usually the first choice

Nonsteroidal anti-inflammatory drugs (NSAIDs)

� for moderate to severe arthritic pain.� OTC NSAIDs� Prescription NSAIDs include


Drugs for Prevention NSAID-Induced

Ulcers

� If NSAID-induced ulcers are identified switch to alternative pain relievers.


Topical NSAIDs


$63.07

Capsaicin (Zostrix)

� is an ointment prepared from the active ingredient in hot chili peppers that has been helpful for relieving painful areas in other disorders.


� SALONPAS PAIN PATCH WITH CAPSAICIN


Tramadol (Ultram)

� is a pain reliever that has some properties that are similar to narcotics.

� not as addictive, however, and may be an alternative for patients who do not respond to


alternative for patients who do not respond to NSAIDs or less potent agents.

Narcotic pain relievers

� oxycodone, oxymorphone, or morphine� may be necessary for severe pain that does not

respond to less potent pain relievers.


Maria Carmela L. Domocmat, RN, MSN http://differncebetween.infoloommedia.netdna-cdn.com/wp-content/uploads/2009/11/oxycodone.png

Supplements

� Overall studies suggest no benefits of glucosamine and chondroitin –supplements available at pharmacies and health food stores touted for relieving pain and food stores touted for relieving pain and stiffness for people with osteoarthritis.

� Check with doctor before using chondroitin, especially if taking blood-thinners.


Intra-articular steroids

Generic Name Brand Name

betamethasone Celestone

methylprednisolone Depo-Medrolmethylprednisolone Depo-Medrol

triamcinolone Kenalog


Intra-articular steroids


Surgical treatment


Preventing Osteoarthritis

� The most important thing you can do to ward off osteoarthritis is keep your weight in check. Over the years, extra weight puts stress on the joints and may even alter the normal joint structure.

� Preventing injuries is also important. important.

� Take precautions to avoid repetitive motion injuries on the job.

� If you play a sport, use proper equipment and observe safety guidelines.


Gouty arthritis

� is a disease characterized by an abnormal metabolism of uric acid, resulting in an excess of uric acid in the tissues and blood causing inflammation


� People with gout either produce too much uric acid, or more commonly, their bodies have a problem in removing it.

Gouty arthritis

� AKA

� Gout

� The disease of kings

� The king of diseases


� The king of diseases

Gouty arthritis

� 2 major types

� Primary

� Secondary


Primary Gouty arthritis

� Inherited X-lined trait

� Caused by several inborn errors of purine metabolism � Uric acid- is the end-product of purine metabolism;

excreted in urine


excreted in urine

� Production of uric acid exceeds the excretion capability of kidneys

� Sodium urate is deposited in the synovium and other tissues which results in inflammation

� Males, 30’s and 40’s

Secondary Gouty arthritis

� Affects all ages

� Hyperuricemia : Excessive uric acid in blood caused by another diseaseRenal insufficiencyDiuretic therapy


Diuretic therapyMultiple myelomaCarcinomas

� Causes: � decreased normal excretion of uric acid and other waste

products� Increased production of uric acid

Four Stages Of Gouty Arthritis

� Asymptomatic Hyperuricemia

� Acute Gout / Acute Gouty Arthritis


� Interval / Intercritical

� Chronic Tophaceous Gout


� (1) Asymptomatic Hyperuricemia:

� Asypmptomatic but with elevated blood uric acid levels

Serum uric acid level (mg/dl) Incidence of gout


�Serum uric acid level (mg/dl) Incidence of gout

>9.0 7.0-8.9

7.0-8.9 0.5-0.37

<7.0 0.1%


� (2) Acute Gout / Acute Gouty Arthritis

� First “attack” of GA

� hyperuricemia has caused deposits of uric acid crystals in joint spaces, leading to gouty attacks.


� Excruciating pain and inflammation of one or more joints – esp metatarsophalangeal joints of the great toe (podagra)

� Increased ESR, WBC

� Note: Excessive alcohol and fad “starvation” diets can cause acute gouty attacks



http://cdn.nursingcrib.com/wp-content/uploads/gouty-arthritis.jpg

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� (3) Interval / Intercritical

� the periods between acute gouty attacks – may be months or years after the 1st attack

� Asymptomatic period


� No abnormality in joints

� (4) Chronic Tophaceous Gout:

� the disease has caused permanent damage

� Deposits or urate crytals under skin and within major organs (i.e., urate kidney stone formation)

Tophi

� Tophi – deposits of sodium urate crystals

� May occur anywhere; common in outer ear


http://www.hopkins-arthritis.org/images/gout_fig7.gif


http://www.cdaarthritis.com/images_slides/40_gout_b_toe1_360.jpg

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ated/editorial/cmecircle/2004/3689/images/cohen/slide019.gif


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Dx tests

� Synovial fluid analysis (shows uric acid crystals)

� Uric acid - blood

� Joint x-rays (may be normal)

� Synovial biopsy


� Synovial biopsy

� Uric acid - urine

Management

� Drug therapy

� Diet therapy


Management

� Drug therapy� acute gouty arthritis – inflammation subsides

spontaneously within 3 to 5 days

� But if cannot tolerate pain

� Colchicine (Colsalide, Novocolchicine) and NSAIDs


� Colchicine (Colsalide, Novocolchicine) and NSAIDs � Taken for 4-7 days

� (NSAIDs) -Indomethacin (Indocin), ibuprofen (Advil), and naproxen (Aleve), celecoxib (Celebrex)

� painkillers such as codeine, hydrocodone, and oxycodone

� Corticosteroids

Management

� Drug therapy: Chronic or repeated acute episodes

� Uricosuric drug

� 1. Allopurinol (Zyloprim)

� 2. Probenecid (Benemid, Benuryl)



� Combination drug� Probenecid and Colchicine (ColBenemid)

Management


� Uricosuric drug – promotes excretion of excess uric acid Promote uric acid excretion or reduce its production

� 1. Allopurinol (Zyloprim)


� A xanthine oxidase inhibitor – prevents conversion of xanthine to uric acid


� drink at least 2 liters of fluid a day while taking this medication (to help prevent uric acid kidney stones from forming).

Management


� Combination drug� Probenecid and Colchicine (ColBenemid)


� Probenecid and Colchicine (ColBenemid)

� Note: avoid aspirin – it inactivates the drug

� Monitor serum uric acid level

� Febuxostat (Uloric)

� first new medication developed specifically for the control of gout in over 40 years.

� Decreases formation of uric acid by the body and is a


very reliable way to lower the blood uric acid level.

� can be used in patients with mild to moderate kidney impairment.

� should not be taken with 6-mercaptopurine (6-MP), or azathioprine.

http://www.emedicinehealth.com/gout/page7_em.htm#Medications

Management: Diet therapy

� Controversial

� Strict low-purine diet

� Limit protein foods

� Avoid alcohol and fad “starvation” diets


� Avoid alcohol and fad “starvation” diets

Starvation Diet

� A potentially dangerous fad diet that provides 300–700 kcal/day, which must be supplemented with high quality protein; given the risk of death through cardiac arrhythmias, starvation diets should be limited in duration

� Adverse effects � Orthostatic hypotension due to loss of sodium,

decreased norepinephrine secretion, xeroderma


� decreased norepinephrine secretion,

� fatigue,

� hypothermia,

� cold intolerance,

� xeroderma,

� hair loss,

� dysmenorrhoea

Segen's Medical Dictionary. © 2011 Farlex, Inc. All rights reserved.

xeroderma

Fad diet

� Any of a number of weight-reduction diets that either eliminate one or more of the essential food groups, or recommend consumption of one type of


groups, or recommend consumption of one type of food in excess at the expense of other foods; FDs rarely follow modern principles for losing weight.

McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.


� Avoid

� alcohol

� anchovies

� sardines

� legumes (dried beans and peas)

� Gravies

� mushrooms� sardines

� oils

� organ meat (liver, kidney, and sweetbreads)

� spinach

� asparagus

� cauliflower

� baking or brewer's yeast


http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001459/


� Limit meat

� Avoid fatty foods such as salad dressings, ice cream, and fried foods.

� Eat enough carbohydrates.


� Eat enough carbohydrates.

� If losing weight, lose it slowly. Quick weight loss may cause uric acid kidney stones to form.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001459/

Maria Carmela L. Domocmat, RN, MSN http://s1.hubimg.com/u/1184832_f496.jpg


� Avoid all forms of aspirin and diuretics – may precipitate attack

� Excessive physical or emotional stress- can exacerbate disease


exacerbate disease

Prevention of kidney stone formation

� Increase fluid intake

� To prevent stone formation

� Dilute urine and prevent sediment formation

� Alkaline ash diet


� Alkaline ash diet

� Citrus fruits, juices, milk and certain dairy products

� Uric acid is more soluble in high pH urine – less likely to form urinary stones

Complications

� Chronic gouty arthritis

� Kidney stones

� Deposits in the kidneys, leading to chronic kidney failure


failure

Osteoarthritis & Gouty Arthritis

Health & Medicine

Transcript of Osteoarthritis & Gouty Arthritis