ARTHRITIS

Definition
● Arthritis is the swelling and tenderness of one or more joints. Arthritis describes
over 100 conditions that involve inflammation and damage in the joints, the
tissues around the joint, and other connective tissues.
Causes
● There is no single cause of all types of arthritis. The causes vary according to the
type or form of arthritis.
● Possible causes may include:
- an injury, which can lead to degenerative arthritis
- an abnormal metabolism, which can cause gout and calcium
pyrophosphate deposition disease (CPPD)
- a genetic inheritance, which can lead to developing osteoarthritis
- an infection such as Lyme disease, which can trigger arthritis symptoms
- an immune system dysfunction, such as the type that causes RA and
lupus
Types
● Osteoarthritis, rheumatoid arthritis, and psoriatic arthritis are three types of
arthritis.

Kinds
1.) Inflammatory arthritis
Inflammatory arthritis is characterized by damaging inflammation that does not
occur as a normal reaction to injury or infection. This type of inflammation is
unhelpful and instead causes damage to the affected joints, resulting in pain,
stiffness, and swelling.
Examples of inflammatory arthritis include:
- RA (Rheumatoid Arthritis)
- Reactive arthritis
- Ankylosing spondylitis
 - Psoriatic arthritis
2.) Degenerative or mechanical arthritis
Degenerative or mechanical arthritis refers to a group of conditions that mainly
involve damage to the cartilage that covers the ends of the bones. This type of
arthritis causes the cartilage to become thinner and rougher.
To compensate for the loss of cartilage and changes in joint function, the body
begins to remodel the bone in an attempt to restore stability. This can cause
undesirable bony growths to develop, called osteophytes. The joint can become
misshapen. This condition is commonly called osteoarthritis.
3.) Infectious arthritis
A bacterium, virus, or fungus that enters a joint can sometimes cause
inflammation.
Organisms that can infect joints include:
- Salmonella and shigella, which spread through food poisoning or
contamination
- Chlamydia and gonorrhea, which are sexually transmitted diseases
(STDs)
- Hepatitis C is a blood-to-blood infection that may be spread through
shared needles or transfusions
4.) Metabolic arthritis
Uric acid is a chemical created when the body breaks down substances called
purines. Purines are found in human cells and several foods. Most uric acid
dissolves in blood and travels to the kidneys.
Uric acid builds up and accumulates in some people and forms needle-like
crystals in the joint, resulting in sudden spikes of extreme joint pain or a gout
attack.
Gout can either come and go in episodes or become chronic if uric acid levels
are not reduced.
It commonly affects a single joint or a small number of joints, such as the big toe
and hands. It usually affects the extremities.
5.) Childhood arthritis
This can refer to a number of types of arthritis. Juvenile idiopathic arthritis (JIA),
also known as juvenile rheumatoid arthritis (JRA), is the most common type.
Arthritis in childhood can cause permanent damage to joints, and there is no
cure. However, remission is possible, during which time the disease remains
inactive.
6.) Septic arthritis
Septic arthritis is a joint inflammation that results from a bacterial or fungal
infection. It commonly affects the knee and hip. It typically affects 2-6 people per
100,000.
It may develop when bacteria or other disease-causing microorganisms spread
through the blood to a joint, or when the joint is directly infected with a
microorganism through injury.
 Bacteria such as Staphylococcus, Streptococcus, or Neisseria gonorrhoeae
cause most cases of acute septic arthritis. Organisms such as Mycobacterium
tuberculosis and Candida albicans cause chronic septic arthritis.
The following conditions increase the risk of developing septic arthritis:
- Existing joint disease or damage
- Artificial joint implants
- Bacterial infection elsewhere in the body
- Presence of bacteria in the blood
- Chronic illness or disease (such as diabetes, RA, and sickle cell disease)
- Older age

Classification
● Arthritis can be monoarticular (single joint - an inflammation of one joint that
may later involve other joints of the body, ex. Gout), oligoarticular (2-4 joints - it
causes joint inflammation, stiffness, and pain in large joints of the body like
knees, elbows, and uvea, ex childhood arthritis which is Juvenile Rheumatoid
Arthritis), or polyarticular (several joints - client experiences arthritis in many
joints at once, ex. Rheumatoid arthritis).

Pathophysiology of Osteoarthritis

NON-MODIFIABLE FACTORS:
Age
Sex
Ethnicity
Genetics
MODIFIABLE FACTORS:
Excess Weight
Occupation and Sports
Joint Injury (Injury Prevention)
Joint Position and Strength
INFLAMMATION: OA causes inflammation, changes in bone shape, and cartilage
deterioration. It is primarily a disease affecting the cartilage
INCREASED PRO-INFLAMMATORY MARKERS: People with the condition have higher
levels of pro-inflammatory markers, which indicate inflammation, and proteases, which
are enzymes that break down protein.
JOINT DETERIORATION: These eventually cause joint deterioration.
ARTICULAR CARTILAGE: In most cases, the first changes that occur in the body due
to OA affects the articular cartilage.
CARTILAGE: This is the cartilage covering the ends of the bones where they meet at
the joint. The articular cartilage may erode or become irregular, split, or frayed. If there
are erosions in the cartilage, these may gradually expand down to bone level and affect
more of the joint surface.
Cartilage consists of water and the matrix, which is a gel-like substance containing
different types of protein:
COLLAGEN
PROTEOGLYCANS
NON-COLLAGENOUS PROTEINS
CHONDROCYTES: Articular cartilage contains a group of cells called chondrocytes,
which produce and maintain the matrix.
DAMAGED MATRIX: Injury or damage to the cartilage can cause damage to the matrix,
resulting in chondrocytes multiplying and forming clusters
This causes bony lumps to form called BONE SPURS
Damage to the matrix can also cause thickening of the bone underneath the cartilage
and may sometimes cause fluid-filled areas in the bone called BONE CYSTS.
Alongside these changes to the cartilage, there may be INFLAMMATION OF THE
JOINT’S SYNOVIUM.
These changes can occur gradually, and people may slowly start to experience
symptoms of OA, such as pain, stiffness, and limited range of motion.

Complications
● Arthritis can affect people’s quality of life due to pain and immobility.
● It can lead to problems with sleep, fatigue, depression, and anxiety.
 ● Some types of arthritis also increase the risk of developing other chronic
conditions such as lung disease, diabetes, and cardiovascular disease.
● Lack of physical activity due to the pain of arthritis can lead to frailty, loss of
function, loss of independence, and social isolation.

Nursing Interventions
● Evaluate and manage chronic and severe pain: pillow supports, warm
compressed to loosen rigid joints/ relax muscles, cold compress to alleviate pain
and decrease swelling
● Administer PRN meds
● NSAIDS are given to decrease inflammation and alleviate pain
● Boost positive self-image - patients with joint deformities can encounter a
negative body image
● Encourage exercise - patients fatigue easily, but daily exercise might help loosen
joints
● Nutrition and lifestyle instruction: wholesome diet (mainly a plant-based diet,
where minimally processed foods are preferred such as veg and fruits,
whole-grain products, potatoes, and dairy products, fish, and less salt foods),
avoid smoking, and alcohol.

Treatment may include:

For the affection of patella, femoral, and tibial components; osteoarthritis

References:
● https://www.medicalnewstoday.com/articles/7621#summary
● https://oaaction.unc.edu/oa-module/oa-pathology-and-risk-factors/#:~:text=Non%
2Dmodifiable%20risk%20factors%20for,joint%20malalignment%20and%20quadr
iceps%20weakness.
● https://www.medicalnewstoday.com/articles/pathophysiology-of-osteoarthritis
● https://www.healthdirect.gov.au/arthritis#:~:text=Quit%20smoking.-,Complications
%20of%20arthritis,disease%2C%20diabetes%20and%20cardiovascular%20dise
ase.
● https://care24.co.in/nursing/arthritis/