Med-Surg - Musculoskeletal System, part 3: Osteoarthritis and Rheumatoid Arthritis
by Cathy Parkes November 12, 2021 Updated: December 07, 2022 8 min read 1 Comment
Hi, I'm Cathy with Level Up RN. In this video, I'm going to talk about osteoarthritis, rheumatoid arthritis, and then I will be highlighting the differences between these disorders. If you have our Level Up RN Medical-Surgical Nursing Flashcards, definitely pay close attention to the bold red text on these cards. There is a lot of important information as it relates to these two disorders, and that bold red text reflects the most important facts that you need to know about these conditions. At the end of this video, I'm going to give you guys a little quiz to test your knowledge of some of the key points I'll be covering in this video, so definitely stay tuned for that.
First, let's talk about osteoarthritis.
This is where we have the progressive degeneration of the articular cartilage in a joint. So in video one of this playlist, I showed you a picture of a synovial joint, and I pointed out the articular cartilage. So, when we have excessive mechanical stress on a weight bearing joint, that causes wear and tear on that articular cartilage. And this, in turn, causes the release of enzymes which results in inflammation, the development of bone spurs, and it also decreases the patient's mobility.
So, risk factors associated with osteoarthritis include older age, female gender, smoking, obesity, and repetitive stress on the joints.
Signs and symptoms include joint pain and stiffness, as well as enlarged joints and something called crepitus, which is like a crunching sound.
So I actually have osteoarthritis in both of my knees, because I played roller derby for a number of years. And when you play roller derby, you are going down on your knees a lot. And even though I had massive pads, it really took its toll on that cartilage. So, when you listen to me going up and down stairs, you're going to hear this crunch, crunch, crunch in my knees, and it doesn't hurt, but it sure sounds bad. And that's crepitus. So it's kind of like this crunching Rice Krispie type of sound.
Other signs and symptoms include these nodes, which are called Heberden's nodes and Bouchard's nodes, so you will find these on the fingers.
So, with Heberden's nodes, those are occurring here, in the distal interphalangeal joints. So they are higher up on the finger, which is our little cool chicken hint. H, for higher up on the finger.
And then the Bouchard's nodes occur here, at the proximal interphalangeal joint, so Bouchard's nodes are closer to the body.
So these two types of nodes are very common in a patient who has osteoarthritis.
In terms of medications that can be used to treat osteoarthritis, oral analgesics are an option, such as NSAIDs. We also have topical medications that could be used, such as Voltaren gel, which is a topical ibuprofen type of gel that is very effective for osteoarthritis. In addition, capsaicin, topical capsaicin can be used. So capsaicin is derived from chili peppers, and it's found to be effective in osteoarthritis. It can cause a mild burning sensation, so you definitely want to give your patients a heads up about that. In addition, glucosamine is a supplement that I actually take, and that patients with osteoarthritis can be prescribed. It helps to decrease inflammation, and to decrease further degeneration of that articular cartilage.
In addition, injections can be provided into that synovial joint to help with pain. So you can inject corticosteroids to help decrease inflammation. We can also inject hyaluronic acid into the joint.
In terms of patient teaching, we want to advise our patient to balance rest with activity. Losing weight can definitely help if that's applicable for the patient. Strength training and physical therapy are often very effective, because that helps to build up those supporting muscles, which helps to decrease pain in the joints. So I engage in a lot of strength training, and I have very little pain in my knees despite the fact that I have pretty significant osteoarthritis in those knees. Also, yoga and tai chi are good exercises for someone who has osteoarthritis.
You should also advise your patient to apply ice for acute exacerbations of the osteoarthritis, and then they can apply heat for stiffness. So, again, ice for acute pain and then heat for more of stiffness versus acute pain. And then splinting and assistive devices can also be used for patients with osteoarthritis.
Next, let's talk about rheumatoid arthritis.
So unlike osteoarthritis, which is a degenerative disorder, rheumatoid arthritis is an autoimmune disorder. And with this disorder, antibodies will attack the patient's synovium. And this leads to swelling, inflammation, and destruction of that articular cartilage and of the bone.
So just like other autoimmune disorders, rheumatoid arthritis is characterized by periods of exacerbation and of remission.
Females are more likely to get RA, as well as those between the ages of 20 and 50, and then a family history is also a risk factor associated with rheumatoid arthritis.
Signs and symptoms include bilateral and symmetrical joint pain and swelling. So this is different than osteoarthritis. With osteoarthritis, we often have unilateral joint pain. With RA, the joint pain will be bilateral and symmetrical.
Other signs and symptoms include morning stiffness, as well as ankylosis, which is where we have joint fixation and deformity. We also have what's called a swan neck and boutonniere deformities. We talked about the nodes with osteoarthritis.
With rheumatoid arthritis, we get this flexion and a hyperextension of some of those finger joints.
So with swan neck deformity, we have flexion of this distal interphalangeal joint and hyperextension of the proximal interphalangeal joint.
With the boutonniere deformity, we have extension here, hyperextension of the distal joint, and then we have flexion of the proximal joint. So it kind of looks like it's hard to do. Kind of looks like this. This is kind of what a boutonniere deformity looks like with RA. I'm having a hard time demonstrating the swan neck one. So definitely google that so you can see what that looks like.
Another symptom of RA is something called ulnar drift. This is where the fingers all start to kind of bend towards the pinky finger, so towards the ulna bone, which is why they call it ulnar drift.
Other symptoms include subcutaneous nodules. So these are the formation of all these little lumps under the patient's skin, as well as fever, red sclera, and lymphadenopathy. So swelling of the lymph nodes.
Abnormal labs that will be present in a patient with rheumatoid arthritis include a positive rheumatoid factor and a positive ANA titer. So ANA stands for anti-nuclear antibody. So these are abnormal antibodies that target the healthy tissue. So these are two key labs that will be positive in a patient with rheumatoid arthritis. We also may see elevation in white blood cells, as well as CRP and ESR, so that's C-reactive protein and erythrocyte sedimentation rate. So CRP and ESR are elevated when there is chronic inflammation in the body.
In terms of imaging tests that can be used, we can use an X-ray and MRI to help diagnose RA.
We can also do an arthrocentesis, which is something we talked about in the second video in this playlist, where we aspirate synovial fluid from the patient's joint and check it for elevated white blood cells, or that rheumatoid factor in that synovial fluid.
In terms of treatment, because this is an autoimmune disorder, we're going to be using immunosuppressants such as prednisone or methotrexate. We can also use NSAIDs for pain control, and then hydroxychloroquine is another medication that can be used in the treatment of RA.
In terms of procedures, a plasmapheresis can be used to help remove those harmful antibodies from the patient's blood. So we're basically filtering those out of the patient's blood. And then PT and OT. So physical therapy and occupational therapy are also helpful when treating a patient with rheumatoid arthritis.
In terms of nursing care, we're going to want to monitor for complications, which includes Sjogren's syndrome.
With Sjogren's syndrome, the patient has excessively dry eyes and a dry mouth.
And then we also want to provide teaching to our patient, they should take a warm shower in the morning to relieve that morning stiffness, which is very common with RA. We also want to encourage the patient to engage in physical activity to help preserve their range of motion. And then they should use assistive devices as needed to allow for safety.
The last thing I want to go over in this video are the key differences between osteoarthritis and rheumatoid arthritis. And I've touched on many of those throughout this video, but I want to tie it all together in a nice little bow. And if you have our cards, we have it all outlined very clearly in a table, so definitely check that out.
So, osteoarthritis is a degenerative disease as opposed to rheumatoid arthritis, which is an inflammatory disease caused by an autoimmune disorder.
With osteoarthritis, we often have this end-of-day pain. So the patient will have more pain with activity that is relieved with rest. So after sleeping all night, they will feel better in the morning. This is different than RA. Right?
With RA, patients will have morning stiffness and pain that is actually relieved through activity.
And then with osteoarthritis, this affects specific joints in the body, so it's often unilateral, as opposed to rheumatoid arthritis, which affects all joints. So it is bilateral and symmetrical.
And then with osteoarthritis, we had those Bouchard and Heberden nodes that we talked about. So osteoarthritis has, starts with O. Nodes has the letter O, and those nodes that the patient gets look like Os, too. So that will hopefully help you to remember that you have the formation of those nodes with osteoarthritis. And that's our little cool chicken hint here on the card.
With RA, we have the swan neck and boutonniere deformities, so we have another cool chicken hint here on the card. If you think about a swan that has rheumatoid arthritis, and he puts on a boutonniere, and he's going to the prom to dance. Because activity helps to improve his pain with the RA. So, hopefully that will help you remember that with RA, we get swan neck deformities and boutonniere deformities. So think about that swan with the boutonniere going to dance. Other deformities are present as well that we talked about, like that ulnar drift, etc.
And then, finally, when we run labs, a patient with osteoarthritis will have a negative rheumatoid factor, as opposed to a patient with rheumatoid arthritis who have a positive rheumatoid factor.
All right. Time for quiz. I'm going to do a little something different here with this quiz. I'm going to give you a symptom or a lab result, and you're going to tell me if that is indicative of osteoarthritis or rheumatoid arthritis. Okay, you ready? Number one, Heberden's and Bouchard's nodes. Those are indicative of osteoarthritis. Number two, a positive ANA titer. That would be indicative of rheumatoid arthritis. Number three, bilateral joint pain and swelling. That is also indicative of rheumatoid arthritis. Number four, swan neck and boutonniere deformities. You would find these with rheumatoid arthritis as well. Number five, pain with activity that gets better with rest. This typically occurs with osteoarthritis.
Okay. I hope this video has been super helpful. If so, be sure to like the video, leave me a comment, and if you haven't already done so, be sure to subscribe to our channel. Take care and good luck with studying.
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September 30, 2022
It’s very helpful to study for me thanq for good information in osteoarthritis rheumatoid arthritis