Patients Care

OSTEOARTHRITIS

Osteoarthritis (OA, also known as degenerative arthritis or degenerative joint disease), is a group of diseases and mechanical abnormalities involving degradation of joints. Clinical manifestations may include joint pain, tenderness, stiffness, creaking, locking of joints and sometimes local inflammation.

Causes

  • Exercise, including running in the absence of injury, has not been found to increase one's risk of developing osteoarthritis. Some investigators believe that mechanical stress on joints underlies all osteoarthritis.
  • Primary osteoarthritis in the left knee of an elderly female is a chronic degenerative disorder related to but not caused by aging, as there are people well into their nineties who have no clinical or functional signs of the disease.
  • As a person ages, the water content of the cartilage decreases causing the cartilage to be less elastic, the collagen fibers of the cartilage can become susceptible to degradation and thus cause the degeneration.
  • A number of studies have shown that there is a greater prevalence of the disease between siblings and especially identical twins, indicating a hereditary basis. Up to 60% of cases are thought to result from genetic factors.
  • Both primary generalized arthritis and erosive arthritis are sub sets of primary arthritis, erosive are less common.
  • Secondary arthritis is caused by other factors but the resulting pathology is the same as for primary arthritis.
  • Congenital disorders of joints.
  • Diabetes.
  • Injury to joints, as a result of an accident.
  • Septic arthritis ( a infection of a joint ).
  • Obesity causes osteoarthritis by increasing the mechanical stress on the cartilage. In fact, next to aging, obesity is the most powerful risk factor for osteoarthritis of the knees.
  • The early development of osteoarthritis of the knees among weight lifters is believed to be in part due to their high body weight. Repeated trauma to joint tissues (ligaments, bones and cartilage) is believed to lead to early osteoarthritis of the knees in soccer players. Interestingly, recent studies have not found an increased risk of osteoarthritis in long-distance runners.
  • Crystal deposits in the cartilage can cause cartilage degeneration and osteoarthritis. Uric crystals cause arthritis in gout, while calcium pyrophosphate crystals cause arthritis in pseudo gout.
  • Some people are born with abnormally formed joints (congenital abnormalities) that are vulnerable to mechanical wear, causing early degeneration and loss of joint cartilage. Osteoarthritis of the hip joints is commonly related to structural abnormalities of these joints that had been present since birth.
  • Hormone disturbances, such as diabetes and growth hormone disorders, are also associated with early cartilage wear and secondary osteoarthritis.

Sign and Symptoms

  • The main symptom is acute pain, causing loss of ability and often stiffness.
  • "Pain" is generally described as a sharp ache, or a burning sensation in the associate muscles and tendons. It can cause a crackling noise when the affected joint is moved or touched and patients may experience muscle spasm and contractions in the tendons.
  • Occasionally, the joints may also be filled with fluid. Humid and cold weather increases the pain in many patients.
  • It commonly affects the hands, feet, spine and the large weight bearing joints, such as the hips and knees, although in theory any joint in the body can be affected.
  • As arthritis progresses, the affected joints appear larger, stiff and painful and usually feel worse, the more they are used throughout the day, thus distinguishing it from rheumatoid arthritis.
  • In smaller joints, such as at the fingers, hard bony enlargements may form and though they are not necessarily painful, they do limit the movement of the fingers significantly.
  • Arthritis at the toes leads to the formation of bunions, rendering them red or swollen. Some people notice these physical changes before they experience any pain.
  • Arthritis is the most common cause of joint effusion, sometimes called water on the knee in lay terms, an accumulation of excess fluid in or around the knee joint.
  • In Arthritis shoulder pain, wrist pain, limited range of motion, morning stiffness, joint stiffness and tenderness is also present.

Management

  • The management of osteoarthritis consists of exercise, manual therapy, lifestyle modification, medication and other interventions to alleviate pain.
  • Lifestyle modification, No matter the severity or location of arthritis, conservative measures such as weight control, appropriate rest, exercise and the use of mechanical support devices can be beneficial.
  • In arthritis of the knees, knee braces can be helpful. A cane, or a walker can reduce pressure on involved leg joints which can be helpful for walking and support.
  • Regular exercise such as walking or swimming, or other low impact activities are encouraged. Applying local heat before and cold packs after exercise, can help relieve pain, as can relaxation techniques.
  • Physical measures, Proper advice and guidance by health care providers such as chiropractors, physical therapists, occupational therapists and medical doctors is important in management, enabling people with this condition to improve their quality of life.
  • Functional, gait and balance training has been recommended, balance and strength in individuals with lower extremity arthritis.
  • Moderate exercise leads to improved functioning and decreased pain in people with osteoarthritis of the knee.
  • Adequate joint motion and elasticity of tissues are necessary for cartilage nutrition and health, protection of joint structures from damaging impact loads, function and comfort in daily activities. Exercise to regain or maintain motion and flexibility by low-intensity, controlled movements that do not cause increased pain.
  • Muscle weakness around osteoarthritis joint is a common finding. Progressive resistive/strengthening exercises load muscles in a graduated manner to allow for strengthening while limiting tissue injury.
  • Patient education has been shown to be helpful in the self-management of patients with arthritis in decreasing pain, improving function, reducing stiffness, fatigue and reducing medical usage. Analysis has shown patient education can provide on average 20% more pain relief when compared to NSAIDs alone in patients with hip or rheumatoid arthritis.
  • Medication like Paracetamol is commonly used to treat the pain. NSAIDs appear to be more potent, but pose greater risk of side-effects.
  • In more severe cases, non-steroidal anti-inflammatory drugs (NSAID) reduce both the pain and inflammation
  • There are several NSAIDs available for topical use with little, if any systemic side-effects and at least some therapeutic effect.