Osteoarthritis

What Is Osteoarthritis?

Knee osteoarthritis

Osteoarthritis (OA), commonly known as wear-and-tear arthritis, is a condition in which the natural cushioning or shock observers between joints also known as cartilage got wears away. When this happens to our joints, the bones of the joints rub more closely against one another with less of the shock-absorbing benefits of cartilage. This rubbing results in pain, swelling, stiffness, decreased ability to move and, sometimes the formation of bone spurs which are commonly seen in X-ray.

Who Gets Osteoarthritis of the Knee?

Osteoarthritis is the most common type of arthritis. While it can occur even in young people commonly the chance of developing osteoarthritis rises after age 45 Osteoarthritis (OA) is the most common type of arthritis in both developed and developing countries.  It is a chronic, progressive musculoskeletal disorder characterized by gradual loss of cartilage in joints which results in bones rubbing together and creating stiffness, pain, and impaired movement.  Women are more likely to have osteoarthritis than men.

Treatment of osteoarthritis

1.       Education

It is reported that patient education in disease management, weight reduction and exercise is quite effective in reducing joint pain. Effective educational techniques include individualized education, group education, social support, patient coping skills, and spouse assisted coping skills (coping skills : enhance patients’ ability to control and decrease pain by increasing use of adaptive coping strategies such as distraction, relaxation, and changing activity patterns as pain is affected by thoughts, feelings, and behaviors).

   2.       Physical Therapy and Exercise

   a.       Exercise is the most important intervention in the management of OA. Exercise builds muscle strength and endurance, improves joint flexibility and motion. Exercise is beneficial even to those patients who are at a healthy weight because increased muscle strength can reduce some of the complications of OA. 

     With the doctor’s advice low impact activities that will not increase the chance of exacerbating symptoms of OA should be encouraged. Simple activities like walking around the neighborhood or taking a fun, easy exercise class can reduce pain and help maintain (or attain) a healthy weight.

     b.     Strengthening exercises build muscles around OA-affected joints.

c.       Stretching: slow, gentle stretching of joints may improve flexibility, decreases stiffness and reduces pain. Exercises such as yoga and tai chi can be practiced to manage stiffness.

     d.      Range-of-motion exercise helps maintain and improve joint flexibility and reduce stiffness.

    e.      Aerobic exercise helps to improve stamina and energy levels and also help to reduce excess weight.

    f.        Wax bath: most effective to relax the sore muscles and to prevent pain at chronic stages.

   g.       Weight loss (another most effective) Overweight and obese patients with osteoarthritis experience more pain and disability than patients who are not overweight. Excess weight adds additional stress to weight-bearing joints, such as the hips, knees, feet and back. Lifestyle behavioral weight management (BWM) interventions such as eating fewer calories and increasing physical activity should be encouraged to lose weight.

h.      Physical aids- Other Non-pharmacological therapy includes a referral to a physical therapist; knee braces, orthotics, and appropriate footwear can reduce pain and improve function in people with poor alignment.

i.         Heat and cold- Heat or cold (or combination of the two) can be used in OA. Heat can be applied with warm towels, hot packs, or warm bath (it increases blood flow and reduces pain and stiffness). In some cases cold packs can relieve pain or numb the sore area by reducing inflammation.

j.        Contrast bath: this is the application of heat and cold to the joint in the ration of 3:1 means apply heat and cold water for time 3:1. You have to start with hot and end with hot.

Electro therapy helps us to cope with the situation it provides optimum condition to heal.

    1.        Pulsed ultrasound,

2.       Transcutaneous electrical nerve stimulation (TENS),

    3.       Inferential therapy (IFT),

          

    4.       electro-acupuncture,

    5.       Low level laser therapies are newer therapies.

Pharmacological therapy (medicines for osteoarthritis)

The primary strategy for pharmacological management of OA is to control pain and improve function and quality of life for the patient, while limiting drug toxicity as there is no cure for OA.

Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs can be used for relieving pain in OA (However, treatment with NSAIDs is associated with gastrointestinal effects and potential toxicity, especially in the elderly persons). New classes of NSAIDS called Cyclooxygenase-2 (COX’2) inhibitors are also in use (one of the class, refecoxib was found to increase the risk of cardiovascular events (Adverse effects)  and was withdrawn in 2004, celecoxib and eterocoxib are in use).


Paracetamol (Acetaminophen): Paracetamol (acetaminophen) is a commonly prescribed oral analgesic to treat mild to moderate OA pain.

Topical NSAIDs, in the form of cream, patches, gels, solutions, have been found to be effective in reducing pain associated with musculoskeletal conditions, including OA. The benefit of topical NSAIDs is that they eliminate the gastrointestinal side effects of oral treatment. However, they have been associated with certain local adverse effects and they may be less effective than oral NSAIDs.

Opioids may be used for pain relief in patients who cannot use either NSAIDs or acetaminophen; however drug abuse is high with Opioids.

Intra-articular corticosteroids (Steroid injections): Treatment with corticosteroids injected directly into the joint (intra-articular) has been shown to be effective, especially in OA of the knee.

Viscosupplementation: This involves a series of injections of either hyaluronan or hylan products (hyaluronan is a polysaccharide and is one of the main components of the extracellular matrix).

Surgical Management:

Joint replacement surgery: Patients who experience severe pain and show extensive narrowing of joint space and medicines are not effective; these patients are eligible for joint replacement surgery. Joint replacement surgery is removing a damaged joint and putting in an artificial one.

Osteotomy: Osteotomy is the cutting and reshaping of bones with the purpose of altering the area of the joint which bears weight.