Content created by Edward Bartels, RN, BSN, MICN
Overview: Osteoarthritis
This content is intended as a Quick Reference for osteoarthritis and will cover an overview as well as nursing considerations utilizing the nursing process.
Osteoarthritis Etiology and Epidemiology
Osteoarthritis (OA) results in the most common type of arthritis. OA effects the joints and is routinely seen in the older adult population. Degenerative joint disease is another name to describe this condition. OA results from “wear and tear” of a joint or:
- Breakdown of the joint cartilage
- Osseous changes in the joints
- Weakening of joint ligaments and tendons
- Inflammation of the joint synovium
The two types of OA are classified as primary or idiopathic, and secondary. Primary is the most common. Primary OA is unrelated to anatomic anomalies, trauma, or a disease process. It is often found in multiple joints and diagnosed through exclusion.
Secondary OA is related to an associated anatomic anomaly, prior event, or a disease process. It is diagnosed in a single joint.
The exact causes of OA remain undetermined. A person’s risk for acquiring OA over a lifetime is about 46% (American College of Rheumatology, 2019). Although there is currently no cure for OA, symptoms can be managed with a reduction in disease progression.
OA routinely appears in adults 40 years and older. However, with multiple risk factors, OA could appear at an early age. Osteoarthritis impacts individuals of both sexes and all races, with a spike in incidence for females over the age of 50 (DynaMed, n.d.). Risk factors consist of:
- Older age
- Familial history of OA
- Obesity
- History of:
- Traumatic joint injury
- Joint overuse through movement repetition
- Joint deformities of:
- Anisomelia or leg length discrepancy
- Genu varum or bowlegs
- Genu valgum or knock knees
- Genetic predisposition
The Center for Disease Control and Prevention’s Interactive Summary of Health Statistics for Adults in 2019, found that 21% of the adult population over the age of 18 years was diagnosed with arthritis (Center for Disease Control and Prevention [CDC], 2021).
The genesis of OA begins with damage to the:
- Articulating cartilage
- Subchondral bone
- Synovium
From there, a cascade of effects occurs resulting in:
- Chondrocyte or cartilage cell response from:
- Previous damage
- Genetic predisposition
- Hormonal factors
- Cytokine release
- Enzyme stimulation
- Further joint damage
Osteoarthritis Diagnosis
OA can affect any joint but typically, it is diagnosed in the joints of the hands, spine, hips, knees, and great toes (CDC, 2020). Common symptoms are:
- Pain or aching in the joint
- Stiffness in the joint especially after not moving for extended periods, sleeping, or sitting
- Swelling and tenderness in the joint
- Muscle weakness around the involved joint
- Joint instability
- A clicking noise when moving the joint
- A decreased range of motion in the joint
Confirmatory studies vary in type and technique based on anatomical site of the OA and employ:
- Imaging
- X-rays
- MRI
- Ultrasound
- Laboratory
- Sedimentation rate
- Synovial fluid analysis
- C-reactive proteins
Osteoarthritis Management
Although there is no cure for OA, there are medications, assistive devices, physical therapy, and surgical options that can alleviate pain and restore mobility.
Medications include:
- Analgesics such as acetaminophen (Tylenol®) and a variety of opioids
- NSAIDs (Motrin®)
- Over the counter such as:
- Capsaicin (Capzasin P®)
- Menthol (Tiger Balm®)
- Lidocaine topicals (Aspercreme®)
- Corticosteroids (Deltasone®) by PO or injection
- Platelet-rich plasma
- Other drugs to treat OA pain such as duloxetine (Cymbalta®) and pregabalin (Lyrica®)
Nonpharmacologic conservative management includes:
- Physical therapy
- Regular exercise and muscle strengthening
- Regular walking
- Aquatic exercise
- Assistive devices
Surgical modalities include:
- Joint replacement when applicable
- Osteotomy and joint preserving procedures
Osteoarthritis Nursing Care Plan & Considerations
Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for osteoarthritis are listed below.
Assessment
- Check neurovascular status
- Assess ROM
- Investigate for signs of joint malalignment
- Check for crepitus
- Evaluate the quality of peripheral pulses distal from injury
- Assess the range of immobility created by the injury
- Assess health literacy and cultural practices of the individual
Osteoarthritis Nursing Diagnosis/Risk For
- Activity intolerance related to pain as evidenced by:
- Exertional discomfort
- Fatigue
- Elevated heart rate
- Acute pain related to shoulder joint trauma as evidenced by:
- Reports of pain
- Distraction
- Guarding
- Autonomic responses
- Impaired physical mobility related to limited use of affected extremity as evidenced by:
- Decreased purposeful movement of extremity
- Guarding of movement
- Limited range of motion
- Decreased strength
Interventions
- Perform routine neurovascular assessments
- Assist with removal of jewelry from affected extremity
- Assist with ice and heat applications as ordered
- Teach and assist use of ROM exercises
- Assist with self-care activities
- Teach care and use of assistive devices
- Collaborate with physical and occupational therapists
- Council on weight reduction and proper diet
Expected Outcomes
- Adheres to medication and treatment regimens as prescribed
- Verbalizes relief of discomfort
- Uses identified techniques to promote activity intolerance
- Progressive increases in joint ROM and activity in joints affected
- Reports measurable increase in activity tolerance
Individual/Caregiver Education
- Diagnosis and treatments
- Importance of ROM and strengthening exercises
- Signs of potential complications
- Prevention of re-injury
- Call the provider if:
- Pain or swelling gets worse
- Trouble moving an affected joint
- Manage pain with prescribed analgesics
- Follow physical therapy plan
- Rest and protect affected joint
- Use hot and cold packs as directed
- Avoid strenuous activity until medically cleared
- Medications they are prescribed
- Encourage the individual to follow-up with healthcare provider as recommended
Learn more and earn CEU credit with Nurse.com's extensive continuing education course catalog:
Managing Osteoarthritis CE Course
Additional Information
Content Release Date
4/1/2022
Content Expiration
12/31/2025
Content Contributor
The content was created by Edward Bartels, RN, BSN, MICN Ed has over 30 years of clinical and teaching experience, and his areas of expertise are emergency and critical care, skilled nursing, behavioral health, occupational health, and safety, and home care. Ed served in several senior nursing leadership roles including: Emergency Services Director, Physician Practices Director, and Administrative Director of Nursing at the executive level. Ed is certified in LEAN efficiency fundamentals and tactics, which he has successfully deployed over the years in multiple settings resulting in cost savings, improved quality, and patient safety. Ed is a certified clinical nursing instructor in North Carolina. He earned his Diploma in Nursing from St. Vincent's School of Nursing in Staten Island, New York, in 1990 and Bachelor of Science in Nursing from the University of North Carolina, Greensboro in 2006. Ed is retired from the U.S. Coast Guard with 34 years.
Resources
- American College of Rheumatology: Osteoarthritis. https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Osteoarthritis
References
- American College of Rheumatology. (2019). Osteoarthritis. https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Osteoarthritis
- Centers for Disease Control and Prevention. (2020). Osteoarthritis (OA). https://www.cdc.gov/arthritis/basics/osteoarthritis.htm
- Centers for Disease Control and Prevention. (2021). Arthritis. https://www.cdc.gov/nchs/fastats/arthritis.htm
- DynaMed. (n.d.). Osteoarthritis of the hip. Retrieved October 25, 2021. https://www.dynamed.com/condition/osteoarthritis-oa-of-the-hip