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Mary’s Health: Osteoarthritis (OA)

Mary was diagnosed with Stage 4 osteoarthritis (OA) and osteoporosis(OP) in 2012.

Diagnosis

  • Physical examination checks affected joints for tenderness, swelling, redness, and flexibility
  • Imaging tests
  • X-ray
  • Magnetic resonance imaging
  • Bone densitometry
  • Lab tests
  • Blood tests
  • Joint fluid analysis
Hand Hip
  • Pain on ROM
  • Hypertrophic changes at distal and proximal interphalangeal joints (Heberden nodes-1 & Bouchard nodes-2)
  • Tenderness over carpometacarpal joint of thumb
  • Pain on ROM
  • Pain in buttock
  • Limitation of ROM, especially internal rotation
Shoulder Foot
  • Pain on ROM
  • Limitation of ROM, especially external rotation
  • Crepitus on ROM
  • Pain on ambulation, especially at 1st metatarsophalangeal joint
  • Limited ROM of 1st metatarsophalangeal joint, hallux rigidus
  • Hallux valgus deformity
Knee Spine
  • Pain on ROM
  • Joint effusion
  • Crepitus on ROM
  • Presence of popliteal cyst (Baker cyst)
  • Lateral instability
  • Valgus or Varus deformity
  • Pain on ROM
  • Limitation of ROM
  • Lower extremity sensory loss, reflex loss, motor weakness (nerve root impingement)
  • Pseudoclaudication (spinal stenosis)

Overview

  • Called degenerative joint disease
  • Most common form of arthritis
  • Affecting millions of people worldwide
  • Occurs when the protective cartilage that cushions the ends of the bones wears down over time
  • Can damage any joint
  • Most commonly affects joints in hands, knees, hips & spine
  • OA can cause pain, stiffness & swelling
  • Can cause reduced function & disability

4 Stages of Osteoarthritis

A comparison image of a joint with and without OA.

Stage 1 – Minor

  • Very minor wear & tear and bone spurs, unlikely to feel pain or discomfort
  • Treatment-supplements (glucosamine & chondroitin), regular exercise

Stage 2 – Mild

  • Noticeable bone spurs on x-ray, stiffness and discomfort
  • Treatment-OTC pain medications, stricter exercise routine

Stage 3 – Moderate

  • Cartilage is affected, narrow gap between bone and joint
  • Joint becomes inflamed, discomfort with ADLs
  • OTC pain medication or prescription pain medications, hyaluronic injections

Stage 4 – Severe

  • Cartilage is almost completely gone, bone spurs have multiplied, very painful
  • Inflammatory response from the joint
  • OTC pain medication or prescription pain medications, hyaluronic injections
  • Bone realignment surgery for knee & hip

X-rays

An xray image of a right hand.

Osteoarthritic Hip and Spine

A diagram depicting different types of spinal degeneration.
Types of spinal degeneration. (a–b) Horizontal degeneration. Initial degeneration of the intervertebral disc (a) subsequently leads to the facet joint osteoartritis (b). (c–d) Adjacent segment disease. Severe degenerative changes on a segment result in abnormalities in the level above

Stepped-Care Approach for the Treatment of OA

OA cannot be reversed. However, treatments can reduce pain and improve movement.

The "stepped care" approach for OA treatment, which introduces more intensive treatment options as the disease progresses.

Medications Commonly Used for OA

Medication Typical Dosage
Acetaminophen 650 to 1000 mg QID
Celecoxib (Celebrix) 50 to 400 mg OD
Diclofenac/misoprostol (Arthrotec) 50 mg/200 mcg BID-TID
Ibuprofen (OTC) 400 to 600 mg TID
Meloxicam (Mobic) 7.5 to 15 mg OD
Nabumetone 500 mg BID
Naproxen (OTC) (Aleve) 220 to 440 mg BID
Oxaprozin (Daypro) 1200 mg OD
Sulindac (Clinoril) 150 to 200 mg BID

OTC Medications Aren’t Working…

A tablet of OxyContin
Strong medications may be prescribed if OTC medications lose effectiveness:

Opioids

  • Low dosages and careful monitoring
  • May cause chronic constipation
  • Older patients at risk of falls

Intra-articular injections of corticosteroids or hyaluronic acid

  • Short-term relief lasting 4 to 8 weeks
  • May cause flare-up within the first 24 hours
  • Improvement from baseline at 48 hours

License

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Multi-Course Case Studies in Health Sciences Copyright © 2021 by Laura Banks; Brenda Barth; Robert Balogh; Adam Cole; Mika Nonoyama; Elita Partosoedarso; and Otto Sanchez is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.

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