Osteoarthritis & Gouty Arthritis

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Musculoskeletal disorders Part 1 Degenerative & Metabolic Bone Disorders:
Osteoarthritis & Gouty Arthritis

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Osteoarthritis & Gouty Arthritis

  1. 1. OSTEOARTHRITIS& GOUTY ARTHRITISMaria Carmela L. Domocmat, RN, MSNInstructor, School of Nursing Northern Luzon Adventist College
  2. 2. Overview2 Part 1: Degenerative & Metabolic bone disorders: OA Gout and gouty arthritis Osteoporosis Paget’s dse 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 Maria Carmela L. Domocmat, RN, MSN 3/5/2012
  3. 3. Osteoarthritisassociated with theaging process and canaffect any joint.The cartilage of theaffected joint isgradually worn down,eventually causingbone to rub againstbone.Bony spurs develop onthe unprotected bones,causing pain andinflammation. Maria Carmela L. Domocmat, RN, MSN
  4. 4. What’s the difference between RAand OA? Maria Carmela L. Domocmat, RN, MSN
  5. 5. Maria Carmela L. Domocmat, RN, MSN
  6. 6. Osteoarthritis is a deterioration of cartilage andovergrowth of bone often due to "wear and tear."Rheumatoid arthritis is the inflammation of a jointsconnective tissues, such as the synovial membranes,which leads to the destruction of the jointscartilage. Maria Carmela L. Domocmat, RN, MSN
  7. 7. OsteoarthritisKnown as the “wear-and-tear” kind of arthritisa chronic condition characterized by the breakdownof the joint’s cartilage.Cartilage is the part of the joint that cushions the endsof the bones and allows easy movement of joints. Thebreakdown of cartilage causes the bones to rubagainst each other, causing stiffness, pain and loss ofmovement in the joint. Maria Carmela L. Domocmat, RN, MSN
  8. 8. OsteoarthritisAKA degenerative joint disease, ostoarthrosis, hypertrophic arthritis degenerative arthritis. Maria Carmela L. Domocmat, RN, MSN
  9. 9. Stages of osteoarthritisCartilage loses elasticity and is more easily damagedby injury or use.Wear of cartilage causes changes to underlying bone.The bone thickens and cysts may occur under thecartilage. Bony growths, called spurs or osteophytes,develop near the end of the bone at the affectedjoint. Maria Carmela L. Domocmat, RN, MSN
  10. 10. Stages of osteoarthritisBits of bone or cartilage float loosely in the jointspace.The joint lining, or the synovium, becomes inflameddue to cartilage breakdown causing cytokines(inflammation proteins) and enzymes that damagecartilage further. Maria Carmela L. Domocmat, RN, MSN
  11. 11. The main problem inknee OA isdegeneration ofthe articular cartilage.Articular cartilage is thesmooth lining that coversthe ends of bones wherethey meet to form thejoint. The cartilage givesthe knee joint freedomof movement bydecreasing friction. Maria Carmela L. Domocmat, RN, MSN
  12. 12. The articular cartilage is kept slippery by joint fluid made by the joint lining (the synovial membrane). The fluid, called synovial fluid, is contained in a soft tissue enclosure around synovial joints called the joint capsule.Maria Carmela L. Domocmat, RN, MSN
  13. 13. An important substance present in articular cartilage and synovial fluid is called hyaluronic 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.Maria Carmela L. Domocmat, RN, MSN
  14. 14. When the articularcartilage degenerates,or wears away, thebone underneath isuncovered and rubsagainst bone.Small outgrowthscalled bone spurs,or osteophytes, mayform in the joint. Maria Carmela L. Domocmat, RN, MSN
  15. 15. Changes in the cartilage and bones of the joint canlead 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 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. Maria Carmela L. Domocmat, RN, MSN
  16. 16. Maria Carmela L. Domocmat, RN, MSN
  17. 17. Causes and Risk factorsThere is no single known cause of osteoarthritisseveral risk factors Age Obesity Injury or Overuse Genetics or Heredity Muscle Weakness Other Diseases and Types of Arthritis Maria Carmela L. Domocmat, RN, MSN
  18. 18. Maria Carmela L. Domocmat, RN, MSN
  19. 19. Long-Term Complications Maria Carmela L. Domocmat, RN, MSN
  20. 20. Maria Carmela L. Domocmat, RN, MSN
  21. 21. Management Maria Carmela L. Domocmat, RN, MSN
  22. 22. Management Weight reduction Use of splinting devices to support joints Occupational and physical therapy Pharmacologic management Maria Carmela L. Domocmat, RN, MSN
  23. 23. Management Maria Carmela L. Domocmat, RN, MSN
  24. 24. Paraffin wax Maria Carmela L. Domocmat, RN, MSN
  25. 25. TENS Maria Carmela L. Domocmat, RN, MSN
  26. 26. 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 strengthen the muscles around the affected joints. The therapist may also apply hot or cold therapies such as compresses to relieve pain. Maria Carmela L. Domocmat, RN, MSN
  27. 27. 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 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. Maria Carmela L. Domocmat, RN, MSN
  28. 28. lumbosacral corsets Maria Carmela L. Domocmat, RN, MSN
  29. 29. Osteoarthritis and Weight If youre 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 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. Maria Carmela L. Domocmat, RN, MSN
  30. 30. 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 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. Maria Carmela L. Domocmat, RN, MSN
  31. 31. Let’s Exercise http://www.medicinenet.com/rheumatoid_arthritis_ exercises_slideshow/article.htm Maria Carmela L. Domocmat, RN, MSN
  32. 32. TreatmentAcetaminophen (Tylenol)Topical analgesics OTC Topical salicylates (Aspercreme) CapsaicinNonsteroidal anti-inflammatory drugs (NSAIDs) or COX-2medicationsTramadolNarcotic pain relieversIntra-articular steroids to decrease inflammationHyaluronans: Hyaluronate (Hyalgan) ad hylan GF 20 (Synvisc)Cyclobenzapine HCl (Flexeril)glucosamine and chondroitin sulfate Maria Carmela L. Domocmat, RN, MSN
  33. 33. Acetaminophen Tylenol, Anacin-3, Panadal, Phenaphen, Valadol, and others) for mild to moderate osteoarthritis. usually the first choice Maria Carmela L. Domocmat, RN, MSN
  34. 34. Nonsteroidal anti-inflammatory drugs(NSAIDs) for moderate to severe arthritic pain. OTC NSAIDs Prescription NSAIDs include Maria Carmela L. Domocmat, RN, MSN
  35. 35. Drugs for Prevention NSAID-InducedUlcers If NSAID-induced ulcers are identified switch to alternative pain relievers. Maria Carmela L. Domocmat, RN, MSN
  36. 36. Topical NSAIDs $63.07 Maria Carmela L. Domocmat, RN, MSN
  37. 37. 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. Maria Carmela L. Domocmat, RN, MSN
  38. 38. SALONPAS PAIN PATCH WITH CAPSAICIN Maria Carmela L. Domocmat, RN, MSN
  39. 39. 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 NSAIDs or less potent agents. Maria Carmela L. Domocmat, RN, MSN
  40. 40. Maria Carmela L. Domocmat, RN, MSN
  41. 41. 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
  42. 42. Maria Carmela L. Domocmat, RN, MSNhttp://differncebetween.infoloommedia.netdna-cdn.com/wp-content/uploads/2009/11/oxycodone.png
  43. 43. Supplements Overall studies suggest no benefits of glucosamine and chondroitin – supplements available at pharmacies and health food stores touted for relieving pain and stiffness for people with osteoarthritis. Check with doctor before using chondroitin, especially if taking blood- thinners. Maria Carmela L. Domocmat, RN, MSN
  44. 44. Intra-articular steroidsGeneric Name Brand Namebetamethasone Celestonemethylprednisolone Depo-Medroltriamcinolone Kenalog Maria Carmela L. Domocmat, RN, MSN
  45. 45. Intra-articular steroids Maria Carmela L. Domocmat, RN, MSN
  46. 46. Surgical treatment Maria Carmela L. Domocmat, RN, MSN
  47. 47. 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. Take precautions to avoid repetitive motion injuries on the job. If you play a sport, use proper equipment and observe safety guidelines. Maria Carmela L. Domocmat, RN, MSN
  48. 48. Maria Carmela L. Domocmat, RN, MSN
  49. 49. 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. Maria Carmela L. Domocmat, RN, MSN
  50. 50. Gouty arthritis AKA Gout The disease of kings The king of diseases Maria Carmela L. Domocmat, RN, MSN
  51. 51. Gouty arthritis 2 major types Primary Secondary Maria Carmela L. Domocmat, RN, MSN
  52. 52. 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 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 Maria Carmela L. Domocmat, RN, MSN
  53. 53. Secondary Gouty arthritis Affects all ages Hyperuricemia : Excessive uric acid in blood caused by another disease Renal insufficiency Diuretic therapy Multiple myeloma Carcinomas Causes: decreased normal excretion of uric acid and other waste products Increased production of uric acid Maria Carmela L. Domocmat, RN, MSN
  54. 54. Four Stages Of Gouty Arthritis Asymptomatic Hyperuricemia Acute Gout / Acute Gouty Arthritis Interval / Intercritical Chronic Tophaceous Gout Maria Carmela L. Domocmat, RN, MSN
  55. 55. Four Stages Of Gouty Arthritis (1) Asymptomatic Hyperuricemia: Asypmptomatic but with elevated blood uric acid levels 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% Maria Carmela L. Domocmat, RN, MSN
  56. 56. Four Stages Of Gouty Arthritis (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 Maria Carmela L. Domocmat, RN, MSN
  57. 57. Note: Excessive alcohol and fad “starvation” diets cancause acute gouty attacks Maria Carmela L. Domocmat, RN, MSN
  58. 58. Maria Carmela L. Domocmat, RN, MSN
  59. 59. http://cdn.nursingcrib.com/wp-content/uploads/gouty-arthritis.jpg Maria Carmela L. Domocmat, RN, MSN
  60. 60. http://img.medscape.com/slide/migrated/editorial/cmecircle/2004/3689/images/cohen/slide019.gif Maria Carmela L. Domocmat, RN, MSN
  61. 61. Four Stages Of Gouty Arthritis (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) Maria Carmela L. Domocmat, RN, MSN
  62. 62. Tophi Tophi – deposits of sodium urate crystals May occur anywhere; common in outer earhttp://www.hopkins-arthritis.org/images/gout_fig7.gif Maria Carmela L. Domocmat, RN, MSN
  63. 63. http://www.cdaarthritis.com/images_slides/40_gout_b_toe1_360.jpg Maria Carmela L. Domocmat, RN, MSN
  64. 64. http://img.medscape.com/slide/migrated/editorial/cmecircle/2004/3689/images/cohen/slide019.gif Maria Carmela L. Domocmat, RN, MSN
  65. 65. http://img.medscape.com/slide/migr ated/editorial/cmecircle/2004/3689/i mages/cohen/slide019.gifMaria Carmela L. Domocmat, RN, MSN
  66. 66. http://msnbcmedia1.msn.com/i/ms nbc/Components/Interactives/Healt h/MiscHealth/GOUT.gifMaria Carmela L. Domocmat, RN, MSN
  67. 67. http://img.medscape.com/slide/migrated/editorial/cmecircle/2004/3689/images/cohen/slide019.gif Maria Carmela L. Domocmat, RN, MSN
  68. 68. Dx tests Synovial fluid analysis (shows uric acid crystals) Uric acid - blood Joint x-rays (may be normal) Synovial biopsy Uric acid - urine Maria Carmela L. Domocmat, RN, MSN
  69. 69. Maria Carmela L. Domocmat, RN, MSN
  70. 70. Management Drug therapy Diet therapy Maria Carmela L. Domocmat, RN, MSN
  71. 71. Management Drug therapy acute gouty arthritis – inflammation subsides spontaneously within 3 to 5 days But if cannot tolerate pain 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 Maria Carmela L. Domocmat, RN, MSN
  72. 72. Management Drug therapy: Chronic or repeated acute episodes Uricosuric drug 1. Allopurinol (Zyloprim) 2. Probenecid (Benemid, Benuryl) Combination drug Probenecid and Colchicine (ColBenemid) Maria Carmela L. Domocmat, RN, MSN
  73. 73. Management Drug therapy: Chronic or repeated acute episodes 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 2. Probenecid (Benemid, Benuryl) drink at least 2 liters of fluid a day while taking this medication (to help prevent uric acid kidney stones from forming). Maria Carmela L. Domocmat, RN, MSN
  74. 74. Management Drug therapy: Chronic or repeated acute episodes Combination drug Probenecid and Colchicine (ColBenemid) Note: avoid aspirin – it inactivates the drug Monitor serum uric acid level Maria Carmela L. Domocmat, RN, MSN
  75. 75. Maria Carmela L. Domocmat, RN, MSN
  76. 76. 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 Maria Carmela L. Domocmat, RN, MSN
  77. 77. Maria Carmela L. Domocmat, RN, MSN
  78. 78. Management: Diet therapy Controversial Strict low-purine diet Limit protein foods Avoid alcohol and fad “starvation” diets Maria Carmela L. Domocmat, RN, MSN
  79. 79. 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, xeroderma decreased norepinephrine secretion, fatigue, hypothermia, cold intolerance, xeroderma, hair loss, dysmenorrhoeaSegens Medical Dictionary. © 2011 Farlex, Inc. All rights reserved. Maria Carmela L. Domocmat, RN, MSN
  80. 80. 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 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. Maria Carmela L. Domocmat, RN, MSN
  81. 81. Management: Diet therapy Avoid legumes (dried beans alcohol and peas) anchovies Gravies sardines mushrooms oils spinach organ meat (liver, asparagus kidney, and cauliflower sweetbreads) baking or brewers yeast http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001459/ Maria Carmela L. Domocmat, RN, MSN
  82. 82. Management: Diet therapy Limit meat Avoid fatty foods such as salad dressings, ice cream, and fried foods. 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
  83. 83. http://s1.hubimg.com/u/1184832_f496.jpg Maria Carmela L. Domocmat, RN, MSN
  84. 84. Management: Diet therapy Avoid all forms of aspirin and diuretics – may precipitate attack Excessive physical or emotional stress- can exacerbate disease Maria Carmela L. Domocmat, RN, MSN
  85. 85. Prevention of kidney stone formation Increase fluid intake To prevent stone formation Dilute urine and prevent sediment formation 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 Maria Carmela L. Domocmat, RN, MSN
  86. 86. Complications Chronic gouty arthritis Kidney stones Deposits in the kidneys, leading to chronic kidney failure Maria Carmela L. Domocmat, RN, MSN

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