10.1 Osteoarthritis and rheumatoid arthritis

Arthritis affects millions, causing joint pain and stiffness. Osteoarthritis results from wear and tear, while rheumatoid arthritis is an autoimmune condition. Both can significantly impact daily life, limiting mobility and causing discomfort.

Managing arthritis involves a mix of medications, lifestyle changes, and therapies. Patient education is crucial, focusing on exercise, medication use, and healthy habits. Regular assessment of treatment effectiveness helps optimize care and improve quality of life.

Osteoarthritis and Rheumatoid Arthritis

Osteoarthritis vs rheumatoid arthritis

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• Osteoarthritis (OA)
  • Pathophysiology involves degenerative changes in joint cartilage leading to breakdown, inflammation, osteophyte formation (bone spurs), and subchondral bone changes
  • Clinical manifestations include joint pain, stiffness, reduced range of motion, crepitus (crackling or grating sound), and joint enlargement, typically affecting weight-bearing joints (knees, hips, spine)
  • Management focuses on symptom relief and functional improvement through non-pharmacological approaches like exercise, physical therapy, weight management, and pharmacological options such as acetaminophen, NSAIDs (ibuprofen), and intra-articular injections (corticosteroids), with joint replacement surgery considered for advanced cases
• Rheumatoid arthritis (RA)
  • Pathophysiology involves an autoimmune disorder causing synovial inflammation, pannus formation (abnormal tissue growth), and erosion of cartilage and bone
  • Clinical manifestations include symmetrical joint pain, stiffness, swelling, prolonged morning stiffness (>30 minutes), fatigue, low-grade fever, and systemic involvement like rheumatoid nodules (subcutaneous lumps)
  • Management targets disease control and prevention of joint damage using pharmacological agents like DMARDs (methotrexate), biologics (TNF inhibitors), NSAIDs, glucocorticoids (prednisone), along with non-pharmacological approaches such as physical therapy, occupational therapy, and assistive devices, while monitoring for comorbidities and extra-articular manifestations

Impact on patient quality of life

• Physical limitations lead to reduced mobility, range of motion, difficulty with activities of daily living (ADLs) like dressing and bathing, and increased risk of falls and fractures
• Psychological impact includes chronic pain contributing to depression, anxiety, reduced self-esteem, sense of independence, social isolation, and relationship strain
• Occupational challenges arise from decreased work productivity, absenteeism, potential job loss or early retirement, and financial burden due to healthcare costs and lost income

Patient education for arthritis management

• Emphasize the importance of regular exercise and physical activity by providing guidance on joint-friendly exercises (swimming, cycling), proper technique, and encouraging participation in physical therapy and rehabilitation programs
• Teach proper medication use and adherence by explaining the purpose, potential side effects of prescribed medications (NSAIDs, DMARDs), and emphasizing the importance of taking them as directed and not discontinuing without consulting a healthcare provider
• Promote healthy lifestyle habits like weight management through a balanced diet, regular exercise, discussing the benefits of smoking cessation, and stress reduction techniques (meditation, deep breathing)
• Provide resources and support by connecting patients with local support groups, online communities (Arthritis Foundation), and offering educational materials and reliable online resources for further learning

Effectiveness of arthritis interventions

• Pharmacological interventions
  1. Assess pain relief and functional improvement with NSAIDs, acetaminophen, and opioids
  2. Monitor disease activity and progression with DMARDs and biologics in RA
  3. Evaluate the need for adjunctive therapies like topical agents (capsaicin cream) or intra-articular injections (hyaluronic acid)
• Non-pharmacological interventions
  1. Assess the impact of exercise and physical therapy on pain, mobility, and function
  2. Evaluate the effectiveness of assistive devices (canes, walkers) and orthoses (braces) in improving daily activities
  3. Consider the role of complementary therapies like acupuncture or massage in pain management
• Regularly reassess treatment plans by monitoring patient response to interventions and adjusting as needed, assessing adherence to treatment plans and addressing barriers to compliance, and collaborating with interdisciplinary teams (rheumatologists, physical therapists) to optimize patient outcomes