A Joint Project – Care of People with Osteoarthritis

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Kathryn Burks, PhD, R.N.

Arthritis is the most common activity-limiting chronic illness. It affects nearly 43 million Americans, or one in every six people (CDC, 2002). Although there are over 150 different kinds of arthritis, osteoarthritis is by far the most common type. Osteoarthritis (OA) may affect people at any age, but it is most often present in people over the age of 60.

Symptoms of OA include joint pain, morning stiffness that lasts less than 30 minutes, and loss of function in the affected joints. These symptoms are viewed by some as a natural result of getting older and are not recognized for the difficulties they bring. In reality, OA can affect the ability to carry out regular daily tasks, decrease mobility, and generally take the fun out of life.

The good news is that there are a number of treatment programs available for these patients. The bad news is that there is no one medication or treatment that will relieve all of the symptoms of this disease. A person with OA must be able to manage their OA treatment on a daily basis. With the help of nurses in all types of settings, OA patients can be successful in living a full and satisfying life.

What can you do to help your patient with osteoarthritis?

• Encourage them to get involved with their care.

Self-management education helps people with OA to become more knowledgeable about their disease and to combine strategies such as heat and cold treatments, exercise, joint protection, and stress reduction into a treatment program that works for them.

The Arthritis Self-Management Program is offered throughout the country by the Arthritis Foundation and has been found to effectively reduce pain, increase function, and improve quality of life (Lorig, 2001).

• Educate them about the various medications available.

Analgesic medications such as acetominophen are the first line of treatment. When taken in adequate doses they are effective in relieving joint pain and are very safe for most people (American Pain Society, 2002).

Anti-inflammatory medications such as ibuprofen and naproxen have been found to be effect in relieving joint pain, but need to be used with caution especially in older adults who have delicate stomachs (Brooks, 1998).

COX 2 Inhibitors such as Vioxx™ and Celebrex™ – also

anti-inflammatory agents – have been shown to have fewer side effects and relieve pain in much the same way as the other medications (Altman, Hochberg, Moskowitz, & Schnitzer, 2000).

• Educate them about new treatments available for specific conditions.

People with OA of the knee may benefit from intra-articular joint injections of a viscosupplementation agent such as SynVisc™ or

Hylan G-F 20™ that restore lubrication to the joint space and improve pain and function for some people (Goorman, Watanabe, Miller, & Perry, 2000).

• Remind them that taking care of arthritis can be fun.

For example, water aerobics provide the joints with warm, moist heat in addition to providing relief from weight-bearing during the exercise class.

When water aerobics are unavailable, the PACE (People with Arthritis Can Exercise) program, offers a land-based exercise alternative.

Both of these classes are often sponsored by the local chapter of the Arthritis Foundation or a local fitness center.

• Support people in making their own choices for treatment.

There are new emerging alternative treatments that have been found to be helpful in relieving symptoms safely.

Alternative therapies that have been used by people with OA include nutritional supplements such as glucosamine, herbal preparations, accupuncture, Tai Chi, and yoga (Adler, Good, Roberts, & Snyder, 2000; Horstman, 1999).

The National Center for Complimentary and Alternative Medicine is currently studying the safety and effectiveness of many of these therapies.

• Share with your OA patients the facts about joint replacement.

Although surgery is not an initial treatment for OA, replacement of the joint may be necessary when destruction of cartilage and misalignment of the joint result in unmanageable symptoms.

As the number of older people rises, the number of people suffering from OA will also increase. The progressive deterioration of the joints affect all aspects of a person’s life. The good news is that there are many treatments available for OA and nurses can help patients manage their arthritis.

Adler, P., Good, M., Roberts, B., & Snyder, S. (2000). The effects of Tai Chi on older adults with chronic arthritis pain. Journal of Nursing Scholarship, 32(4), 377.

Altman, R. D., Hochberg, M. C., Moskowitz, R. W., & Schnitzer, T. J. (2000).

Recommendations for the medical management of osteoarthritis of the hip and knee. Arthritis & Rheumatism, 43(9), 1905-1915.

Brooks, P. (1998). Use and benefits of nonsteroidal anti-inflammatory drugs. American Journal of Medicine, 104(3A), 9S--13S.

CDC. (2002). Arthritis: the nation's leading cause of disability. National Center for Chronic Disease Prevention and Health Promotion. Retrieved October 20, 2002 from http://www.cdc.gov/nccdphp/arthritis.

Goorman, S. D., Watanabe, T. K., Miller, E. H., & Perry, C. (2000). Functional outcome in knee osteoarthritis after treatment with Hylan G-F 20: a prospective study. Archives of Physical Medicine and Rehabilitation, 81, 479-483.

Horstman, J. (1999). The Arthritis Foundation's Guide to Alternative Therapies. Atlanta, GA: Arthritis Foundation.

Lorig, K. R. (2001). Arthritis self-management. In E. A. Swanson & T. Tripp-Reimer & K. C. Buckwalter (Eds.), Health promotion and disease prevention in the older adult: Interventions and recommendations (pp. 56-80). New York: Springer.

American Pain Society (2002). Guideline for the management of pain in osteoarthritis, rheumatoid arthritis, and juvenile chronic arthritis. Glenview, IL: American Pain Society.