NURS 6501: Advanced Pathophysiology
Arthritis
Lorie Valentin RN, BSN
Arthritis
Osteoarthritis (OA) and Rheumatoid Arthritis (RA) are both diseases of the joints. Each is characterized by pain, swelling and stiffening of joints throughout the body (Huether & McCance, 2017). The most common joints affected are the hands, knees, hips and spine (Huether & McCance, 2017). In OA the breakdown of cartilage within the joints causes causing damage to the underlying bone and tissue. This breakdown causes a disruption of the fluid distribution mechanism within the joints allowing to much fluid into the cartilage, which in turn causes swelling in the joint and a weakening of the cartilage. As the cartilage weakens, breakdown occurs and causes further damage to the underlying boney structures, which leads to pain, inflammation and deformity of the joints. The most common cause of OA is repeated compression of the joints due to repetitive motion or constant pressure such as weight on the knees. In RA the causative factors are related to the increase of the synovial membrane comprised of pro-inflammatory cytokines (Hammer & McPhee, 2019). Where this increased lining comes in contact with out tissues such as cartilage and bone, it causes breakdown of those tissues.
Influencing Factors
Though the rates for developing the disease are relatively equal in all parts of the world women are 30 percent more likely to develop RA than men (Hammer & McPhee, 2019). However, though the incidence rates are relatively equal between men and women, as they age women are typically more profoundly affected by OA (Huether & McCance, 2017). Ethnicity does not appear to play a major role in either disorder as it strikes individuals equally in different areas of the world (Hammer & McPhee, 2019).
Diagnosis and Treatment
The diagnosis for OA is best achieved through thorough examination, in depth history, and radiological imaging to look for joint deformities (Huether & McCance, 2017). The treatment for OA is based on the severity of the deterioration of the adjacent bone tissue in the joint. For mild to moderate disease physical therapy and exercise along with anti-inflammatory medications can improve mobility and pain. By improving muscle tone and flexibility many of the symptoms can be relieved. Possible addition of supplements and changes in diet can help decrease the inflammation characteristic of OA. More aggressive treatment for progressive disease might include steroid injections or surgery to replace the joint.
The diagnosis for RA is much more complicated and is reliant on physical assessment, history and presentation. The most significant finding during evaluation that would point to RA is the swelling of the joints. Treatment should be immediate and aggressive to reduce the deterioration of the joint and the potential for damage to other organs within the body (Hammer & McPhee, 2019). Initial treatment for RA should be started with disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, sulfasalazine, or leflunomide (Huether & McCance, 2017). Like OA, RA treatment should also include physical and occupational therapy to improve muscle tone and flexibility as well as anti-inflammatory medications such as NSAIDS and steroids.
References
Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of disease: An introduction to clinical
medicine (8th ed.). New York, NY: McGraw-Hill Education
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis,
MO: Mosby
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