NCLEX Review Guide: Osteoarthritis (Degenerative Joint Disease)

Disease Process

• Osteoarthritis (OA) is a degenerative joint disease characterized by progressive breakdown of articular cartilage leading to bone-on-bone contact and joint deformity.
• Most commonly affects weight-bearing joints including knees, hips, spine, and hands (especially DIP and PIP joints).
• Primary risk factors include advanced age, obesity, joint trauma, repetitive joint use, and genetic predisposition.

Clinical Manifestations

• Joint pain that worsens with activity and improves with rest (opposite of rheumatoid arthritis).
• Morning stiffness lasting less than 30 minutes (key differentiator from RA).
• Joint crepitus, decreased range of motion, and progressive joint deformity.
• Heberden's nodes (DIP joints) and Bouchard's nodes (PIP joints) in hands.

Pain Management

• First-line treatment includes acetaminophen and topical NSAIDs to minimize systemic side effects.
• Monitor for GI bleeding, kidney function, and cardiovascular risks with oral NSAID use, especially in elderly patients.
• Apply heat before activity to reduce stiffness; apply cold after activity to reduce inflammation and pain.

Activity & Mobility

1. Encourage low-impact exercises such as swimming, walking, and cycling to maintain joint mobility.
2. Teach proper body mechanics and joint protection techniques during daily activities.
3. Promote weight loss if obese to reduce stress on weight-bearing joints.
4. Recommend use of assistive devices (canes, walkers) to reduce joint stress.

NCLEX Success Strategies

• Remember: OA = "Wear and Tear" - affects older adults and overused joints.
• Key differentiator: Pain increases with use in OA (opposite of inflammatory conditions).
• Focus on conservative management - surgery is last resort.