Osteoarthritis Clinical Questions

A 62-year-old client with progressive joint pain asks why the condition started. The nurse replies that osteoarthritis most often results from:

• Autoimmune attack on synovial membrane

• Gradual cartilage destruction due to wear and tear

• Deposition of immune complexes in capillaries

• Viral infection of the joint

• Sudden metabolic crisis

Answer explanation

Osteoarthritis is primarily caused by gradual cartilage destruction due to wear and tear over time, leading to joint pain. This distinguishes it from other conditions like autoimmune diseases or infections.

Risk factors for osteoarthritis include:

• Obesity

• Prior ACL injury

• Decreased estrogen after menopause

• Positive anti-CCP antibody

• Regular moderate exercise

Answer explanation

Obesity increases joint stress, prior ACL injuries can lead to joint instability, and decreased estrogen after menopause affects cartilage health, all contributing to osteoarthritis risk. Regular exercise is beneficial, not a risk.

Which symptom best differentiates OA from an inflammatory arthritis?

• Joint pain that increases with activity and improves with rest

• Symmetric morning stiffness >1 hour

• High fever and systemic malaise

• Prominent eyelid swelling

• Diffuse rash on sun-exposed areas

Answer explanation

Osteoarthritis (OA) is characterized by joint pain that worsens with activity and improves with rest, unlike inflammatory arthritis, which typically presents with prolonged morning stiffness and systemic symptoms.

A client with OA has visible bony nodules at the distal finger joints. The nurse documents:

• Heberden’s nodes

• Rheumatoid nodules

• Bouchard’s nodes

• Gouty tophi

• Tenosynovitis

Answer explanation

Heberden’s nodes are bony nodules that form at the distal interphalangeal joints, commonly seen in osteoarthritis (OA). Bouchard’s nodes occur at the proximal joints, while rheumatoid nodules and gouty tophi are associated with other conditions.

A clinician orders tests for suspected OA. Which finding is most likely?

Answer explanation

In suspected osteoarthritis (OA), the most likely finding is joint space narrowing on X-rays, along with osteophyte formation. These changes reflect the degenerative nature of OA.

Which nonpharmacologic strategy from the notes is recommended to reduce OA joint stress?

• Rapid calorie restriction to lose weight quickly

• Low-impact exercise such as swimming or stationary bike

• Prolonged complete bed rest

• High-impact jogging daily

• Avoid assistive devices

Answer explanation

Low-impact exercise, like swimming or using a stationary bike, is recommended to reduce OA joint stress as it minimizes impact while promoting mobility and strength, unlike high-impact activities or complete bed rest.

A client with OA asks about medications. Which is the usual first-line analgesic?

• Methotrexate

• Acetaminophen

• Hydroxychloroquine

• Enbrel (etanercept)

• Allopurinol

Answer explanation

Acetaminophen is the usual first-line analgesic for osteoarthritis (OA) due to its effectiveness in pain relief and safety profile. Other options listed are not first-line treatments for OA.

Select all that apply — Contributing etiologic factors for RA from the notes:

• Genetic and environmental triggers

• Formation of abnormal IgG with autoantibody production

• Supersaturation of bile with cholesterol

• Direct cartilage wear from repetitive motion

• Periods of remission and exacerbation

Answer explanation

The contributing factors for RA include genetic and environmental triggers, the formation of abnormal IgG with autoantibody production, and the nature of the disease with periods of remission and exacerbation.

A client presents with symmetric small joint pain, prolonged morning stiffness, and fatigue. Which lab test is most specific for RA?

• ESR

• CRP

• Anti-CCP (anti-cyclic citrullinated peptide)

Answer explanation

Anti-CCP antibodies are highly specific for rheumatoid arthritis (RA), making them the best lab test for diagnosis. In contrast, ESR and CRP are nonspecific markers of inflammation and can be elevated in various conditions.

A client with RA develops firm subcutaneous nodules over the elbow. These are:

• Rheumatoid nodules

• Heberden’s nodes

• Bouchard’s nodes

• Pannus growths

• Psoriatic plaques

Answer explanation

The firm subcutaneous nodules over the elbow in a client with rheumatoid arthritis (RA) are known as rheumatoid nodules. They are a common manifestation of RA, unlike Heberden’s and Bouchard’s nodes, which are related to osteoarthritis.