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
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.
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.