OSTEOARTHRITIS OF THE UPPER By Charlene Giraldo, OTR/L
Arthritis From Greek arthro-, joint + -itis, inflammation Group of conditions involving damage to the joints of the body
Types of Arthritis Osteoarthritis Rheumatoid Arthritis Psoriatic Arthritis Septic Arthritis Gout Ankylosing Spondylitis
Osteoarthritis Most common form of arthritis Associated with wear-and-tear Characterized by the breakdown of the joint s cartilage Can affect almost any joint- most often affects the hands, knees, hips and spine Chronic condition that gradually worsens over time
Osteoarthritis Degenerative joint disease Affects nearly 27 million people in the US More women than men 25% of visits to primary care physicians 80% of population will have OA by age 65
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 develop near the end of the bone at the joint The joint lining becomes inflamed due to cartilage breakdown caused by enzymes that
Types of OA Primary Osteoarthritis Idiopathic Chronic degenerative disorder caused by aging Secondary Osteoarthritis Caused by other factors Trauma, congenital disorders, other joint disorders, obesity, or diseases such as diabetes and hypothyroidism
Risk Factors for OA Age Sex Obesity Previous injury Overuse Genetics or heredity Muscle weakness Other diseases and types of arthritis
Signs and Symptoms Joint pain Stiffness Tenderness Swelling Bony outgrowths
OA in the hand Enlargement of the last joint on the finger (Heberden s nodes), or at the middle joint (Bouchard s nodes) Enlargement of the joint at the base of the thumb may give the hand a squared appearance Pain, redness, tenderness and swelling in the affected joints, especially early on when the nodes are forming
Diagnostic Criteria Bony enlargement of at least two or more of ten selected joints Bony enlargements of two or more distal interphalangeal joints Fewer than three swollen metacarpophalangeal joints Deformity of at least one of the ten selected joints OA of the hand can often be diagnosed on these
Diagnosis History and physical examination Laboratory tests X-rays
Differential Diagnosis Rheumatoid Arthritis Osteoarthritis Metacarpophalangeal joints Heberden s nodes absent Joints feel soft, warm, tender Stiffness worse after resting (morning stiffness) Rheumatoid factor positive Distal interphalangeal joints Heberden s nodes present Joints feel hard and bony Stiffness worse after effort (evening stiffness) Rheumatoid factor negative
Course of OA Generally worsens over time, although it stabilizes in some patients Usually intermittent worsening, rather than slow decrease in function May be able to function normally despite pain, or may have varying degrees of disability Worsening disability may be correlated with coping styles
Goals of Treatment Controlling pain and other symptoms Improving function in daily activities Slow the disease s progress
Treatment Plan Medications Physical and occupational therapy Joint protection Weight control Exercise Surgery may be considered in severe cases
Medications Analgesics (Acetaminophen) Topical analgesics Oral NSAIDs (Ibuprofen, Naproxen) Topical NSAIDs (Diclofenac gel) Cox-2 drugs (Celecoxib) Injectable glucocorticoids ( cortisone shots )
Physical and Occupational Fabricate splints / braces to rest inflamed joints Provide education regarding joint protection, energy conservation and activity modification Heat treatments for pain control (hot packs, paraffin wax, fluidotherapy, ultrasound) Exercises for improving range of motion, flexibility and muscle strength Instruction in a tailored home management program
Principles of Joint Respect pain Distribute the load Reduce excess body weight Use good posture and body mechanics Use assistive devices Maintain strength and range of motion Use energy conservation techniques
Energy Conservation Planning Organizing Resting
Resources The Arthritis Foundation www.arthritis.org American College of Rheumatology www.rheumatology.org National Institute on Aging www.nia.nih.gov/ National Institute of Arthritis and Musculoskeletal and Skin Diseases www.nih.gov/ niams National Library of Medicine www.nim.nih.gov/ medlineplus/healthtopics.html Web MD www.webmd.com