Evidence-based clinical interventions.
Osteoarthritis.
It is a degenerative joint disease that develops when the joint cartilage breaks down to interfere with the smooth and gliding surface for joint motion. This tampers with cushioning that occurs between the bones at the joint region.
Presenting signs and symptoms.
The presentation of arthritis depends on the joint affected and its severity on the joint. The most common signs encompass pain and stiffness in the joint especially in the morning and after a period of inactivity or resting. The affected joint can also get swollen after a prolonged period of activity. The symptoms occur insidiously over time rather than abrupt onset(Geyer and Schönfeld, 2017). The symptoms increase with inactivity or overuse for the joint but reduce with moderate use of the joint. The patient may experience limited range of motion that is relieved by movement. Clicking or cracking sounds can also be heard when the joint bends. Osteoarthritis leads to difficulty in performing ordinary tasks in the client. When it affects fingers and hand joints, grasping and holding of objects may be made cumbersome.
The course of disease and age group affected.
Osteoarthritis develops gradually in the affected individuals. The probability of getting the disease increases with age. It mostly affects individuals who are 60 years and above. On the other hand, it can affect people in their 20s and 30s. This occurrence is, however, associated with underlying reasons, for instance, joint injuries and the repetitive joint stress like overuse in playing games.
Concomitant disease states associated with osteoarthritis.
Joint dislocation, injury and repetitive stressors to the joint are associated with the development of osteoarthritis.
Pathophysiology of osteoarthritis.
Osteoarthritis is caused by cartilage destruction that originates from both biomechanical and biochemical forces. Interleukin-1 and tumor necrosis factor- β activates the enzymes that leads to the proteolytic digestion of the joint cartilages (Geyer and Schönfeld, 2017). When this occurs, cartilage synthesis is enhanced and promoted by growth factors. Osteoarthritis develops when the rate of catabolism exceeds the rate of cartilage synthesis.
Differential diagnoses.
Osteoarthritis—the patient presents with stiffness and pain that develops gradually over time. The signs and symptoms aggravate with activity, and prolonged use of the joint or rest and are relieved by moderate exercise. The symptoms are common in the morning when an individual wakes up from sleep.
Rheumatoid arthritis—it predominantly affects wrists and the metacarpophalangeal and proximal interphalangeal joints. Is also associated with prominent and prolonged morning stiffness to the affected joint(Treede, 2017). The joints are overtly swollen and warm on touch. Radiology shows bone erosion.
Crystalline arthropathies—it entails deposition and accumulation of calcium phosphate crystals on one or more joints. It presents with sudden pain and stiffness to the joint. Swelling and tenderness occur in the joint and mostly affects the knee joint.
Evidenced-based treatment.
The primary diagnosis is osteoarthritis and according to Bruyère et al. (2016), the interventions towards osteoarthritis ought to be prioritized. The management should take the form of analgesics for the control of pain and function of the joint. According to the algorithm by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, step 1 entails therapy using symptomatic slow-acting drugs for osteoarthritis, e.g., acetaminophen. Topical NSAIDs may also be used at this stage. Step 2 uses oral NSAIDs to the management of persistent symptoms. Step 3 entails weekly injections by the intra-articular hyaluronic acids to manage the condition for up to 6 months. This step precedes slow titration of sustained-release tramadol. The final step is surgery that is conducted to provide corrective management to the damaged cartilages and the joint.
McGrory et al.,(2016) recommend peri-articular local anesthetic infiltration, peripheral nerve blockade, maintaining of a healthy weight, getting sufficient exercise that is scheduled and controlled, improving the joint mobility and flexibility as well as managing the signs and symptoms.
Expected outcomes.
With the administration of analgesics and anesthetic agents, the patient will experience reduced pain hence feel comfortable. Th medication will improve the functionality of the joint and improve the movement of the affected joint. After undergoing surgery for the repair of the cartilage and joint, the cushioning in the joint with be improved and less swelling experienced. This intervention will also reduce pain and improve function.
References:
Bruyère, O., Cooper, C., Pelletier, J. P., Maheu, E., Rannou, F., Branco, J., …& Martel-Pelletier,
- (2016, February). A consensus statement on the European Society for Clinical and
Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) algorithm for the
management of knee osteoarthritis—from evidence-based medicine to the real-life
setting. In Seminars in arthritis and rheumatism (Vol. 45, No. 4, pp. S3-S11). WB
Saunders.
Geyer, M., &Schönfeld, C. (2017). Novel insights into the pathogenesis of osteoarthritis.
Current rheumatology reviews.
McGrory, B., Weber, K., Lynott, J. A., Richmond, J. C., Davis III, C. M., Yates Jr, A., …&
Villanueva, T. (2016). The American Academy of Orthopaedic Surgeons evidence-based
clinical practice guideline on surgical management of osteoarthritis of the knee. JBJS,
98(8), 688-692.
Mobasheri, A., &Batt, M. (2016). An update on the pathophysiology of osteoarthritis. Annals of
physical and rehabilitation medicine, 59(5), 333-339.
Treede, R. D. (2017). SP0019 Signs, symptoms and co-morbidities of fibromyalgia.
