Osteoarthritis Health Article

Diagnostic imaging

There is no laboratory test specific to the diagnosis of OA. Laboratory tests are important, however, in ruling out other diseases that may be responsible for the symptoms the patient is presenting. Treatment is usually based on the results of diagnostic imaging, which is conducted by a radiologic technician or radiologist. The features of the disease are a loss of joint space, the presence of subchondral cysts, and evidence of new bone formation (i.e., bone spurs). The patient's symptoms, however, do not always correlate with x-ray findings. Magnetic resonance imaging (MRI) and computed tomography (CT), or computed axial tomography (CAT) scans can be used to more precisely determine the location and extent of cartilage damage.

Prognosis

Osteoarthritis is a progressive disorder without a permanent cure. In some patients, the rate of progression can be slowed by weight loss, appropriate exercise, surgical treatment, and the use of alternative therapies.

Health care team roles

Early detection and diagnosis are key factors that affect the outcome of the progression of OA. Patients may present with vague symptoms of joint pain and stiffness, which should be noted when taking the patient history. The patient should be asked when these symptoms began. Co-morbid conditions such as heart disease, hypertension, or other disease should be considered. After ongoing observation and consultation with the patient, a more complete diagnosis can be made.

As with other painful conditions, understanding of the patient's lifestyle changes and physical condition is of the highest priority. Patient education and follow-up

support can assist with the mental health treatment, if necessary. Health care staff should counsel the patient on the basic facts of OA, make themselves available for follow-up phone consultation, and track the patient's visits to other health care providers. If the patient seems especially distressed about the condition, staff may recommend to the physician that the patient seek mental health support.

Should a rheumatologist or other subspecialist be consulted by the patient, members of the health care team should coordinate and monitor the treatment prescribed outside of the team's environment.

Patient contact has been shown to be a valuable aspect of the management of OA. Optimal follow-up consists of staff members (i.e., nurses, nurse practitioners, physicians assistants) making phone calls to patients and recording changes in symptoms, compliance with treatment regimen, and any decline of condition. Nursing parameters can include pain control, assessment of medication efficacy, exercise, diet, means of joint protection, and awareness of psychosocial factors of depression/anxiety.

Knowledge of over-the-counter medications for OA can assist the patient in avoiding drug interactions or undue financial burden. Patients with limited range of motion may require special accommodations in waiting and treatment rooms; they may need an entrance to the building or a bathroom that is specially made to accommodate the handicapped, or a modified examination table.

Treatment

Treatment of patients with OA is tailored to the needs of each individual. Patient's symptoms vary widely due to the location of the joints involved, the rate of progression, the severity of symptoms, the degree of disability, and individual response to specific forms of treatment. Most treatment programs include several forms of therapy and include the participation of the entire health care team.

Patient education and psychotherapy

Patient education is an important part of OA treatment because of the highly individual nature of the disorder and its potential impact on the patient's life. Patients who are depressed because of changes in employment or recreation usually benefit from participation in self-help groups, or counseling. The patient's family or friends should be involved in discussions of coping, household reorganization, and other aspects of the patient's disease and treatment regimen.

Medications

Patients with mild OA may be treated only with pain relievers such as acetaminophen (i.e., Tylenol). Most patients with OA, however, are given nonsteroidal anti-inflammatory drugs (NSAIDs). These include compounds such as ibuprofen (e.g., Motrin, Advil), ketoprofen (e.g., Orudis), and naproxen (e.g. Naprosyn). NSAIDs have the advantage of relieving slight inflammation as well as pain. Patients taking NSAIDS, however, may experience side effects, including stomach ulcers, sensitivity to sun exposure, kidney disturbances, and nervousness/anxiety or depression. Topical capsaicin cream (e.g., AthriCare) may provide relief when applied to affected areas.

Some OA patients are treated with corticosteroids, which are injected directly into the joints to reduce inflammation. As of 2001, studies were being conducted regarding the use of hyaluronic acid, which is more commonly injected into the knee. Because the joint naturally contains some hyaluronic acid (for joint lubrication), the addition of extra hyaluronic acid can protect the joint, in some cases, for six months to one year.