Osteoarthritis

Osteoarthritis (OA) is a degenerative disease of the cartilage of joints and is the most common form of joint disease.

Risk factors
Risk factors associated with OA include advancing age, major trauma, and chronic excess body weight. There is also growing evidence that certain occupational groups are at increased risk for OA.

Diagnosis
OA affects either one or more joints. Commonly affected joints include finger joints,   knee, hip, and spine (back and neck). Initially, the disease is characterized by joint pain occurring with motion and relieved by rest. As the disease progresses, pain can occur with minimal motion and even at rest. Although joint stiffness can occur, it is usually of short duration (less than 30 minutes). There is also an absence of systemic symptoms, such as fatigue, weight loss, and fever.

Physical examination
Joints affected by OA may show decreased range of motion, joint deformity, and occasionally fluid accumulation in the joint. Pain on passive and active movement, and mild tenderness may be found. Evidence of inflammatory changes are usually absent. During late stages of OA there may be demonstrable joint instability.

Laboratory findings
There are no specific laboratory tests for OA.

Treatment
1. Nonpharmacologic management (such as excercise, physical therapy, etc.)
2. Medications: Pharmacologic approaches to the treatment of OA include acetaminophen (tylenol), salicylates, nonsteroidal anti-inflammatory drugs, and steroids. Acetaminophen is advocated for use as first-line therapy by some authors, but salicylates and NSAIDs are still the most commonly used first-line medication for the relief of pain related to OA.
3. Surgical intervention.
4. Treating psychosocial issues, i.e., depression, anxiety, and poor coping skills related to the patient’s disability can contribute to impairment and should be addressed. Involvement in community support groups may be beneficial.

Prevention
1. Primary prevention.
Primary prevention aims at weight reduction, avoidance of traumatic injury, prompt treatment of injury, and work site programs designed to minimize work-related mechanical joint stress.
2. Secondary prevention.
This includes screening for decrements in physical functional status (i.e., activities of daily living, instrumental activities of daily living, and mobility).
3. Tertiary prevention.
Tertiary prevention includes the prescription of appropriate adaptive equipment and mobility aids to reduce disability in the patient with known osteoarthritis.

Rheumatoid Arthritis

RA is a chronic, systemic, inflammatory joint disease.

Diagnosis
Diagnostic criteria include:
1. Early morning stiffness for more than 6 weeks
2. Arthritis involving more than three joints for more than 6 weeks
3. Wrist, or finger joint involvement
4. Symmetric arthritis
5. Rheumatoid nodule or nodules
6. Positive rheumatoid factor titer
7. Bony radiographic change

Laboratory findings
Laboratory findings are often not very useful for diagnosis; they are more useful in defining other causes of arthritis. However, the rheumatoid factor is frequently positive.

Treatment
Early diagnosis and appropriate therapy are important to minimize disability and deformity. Patients frequently complain little of joint pain but often limit or modify motion due to pain. Decreased activity, morning stiffness, and “gelling” are common.
1. Aspirin is the basic anti-inflammatory medication.
2. At age 14 or older, any of the non-steroidal anti-inflammatory agents can be used.
3. Steroids and other agents are avoided but may be used in severe cases.
5. Exercise

Prevention
There are no known preventive interventions for rheumatoid arthritis.