Osteoarthritis

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1. OSTEOARTHRITIS JOHNY WILBERT, M.Sc [N] LECTURER, APOLLO INSTITUTE OF HOSPITAL MANAGEMENT AND ALLIED SCIENCE

2. DEFINITION Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. It occurs when the protective cartilage on the ends of the bones wears down over time.

3. SITES Osteoarthritis can damage any joint in the body, but the disorder most commonly affects joints in the hands, knees, hips and spine.

4. RISK FACTORS Older age. Sex.  Obesity.  Joint injuries.  Certain occupations.  Genetics.  Bone deformities.  Other diseases. Having diabetes or other rheumatic diseases such as gout and rheumatoid arthritis can increase the risk of osteoarthritis.

5. PATHOPHYSIOLOGY Osteoarthritis occurs when the cartilage that cushions the ends of bones in the joints gradually deteriorates. Cartilage is a firm, slippery tissue that permits nearly frictionless joint motion. In osteoarthritis, the slick surface of the cartilage becomes rough. Eventually, if the cartilage wears down completely, bone rubbing on the bone occurs.

6. SIGNS & SYMPTOMS Pain.  Tenderness.  Stiffness.  Loss of flexibility.  Grating sensation.  Bone spurs. 

7. DIAGNOSTIC EVALUATIONS Physical examination. To examine the affected joint, check for tenderness, swelling or redness, and for range of motion in the joint. Imaging tests To take pictures of the affected joint can be obtained during imaging tests. Examples include: X-rays.   Magnetic resonance imaging (MRI).   Lab tests Blood tests.  Blood tests may help rule out other causes of joint pain, such as rheumatoid arthritis. Joint fluid analysis.  The doctor may use a needle to draw fluid out of the affected joint. Examining and testing the fluid from the joint can determine the inflammation and the pain is caused by gout or an infection.

8. TREATMENT   Medications Acetaminophen. Acetaminophen (Tylenol, others) can relieve pain, but it doesn't reduce inflammation. It has been shown to be effective for people with osteoarthritis who have mild to moderate pain. Nonsteroidal anti-inflammatory drugs (NSAIDs).  NSAIDs may reduce inflammation and relieve pain. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve, others). They should not be used by people over 65 years of age and those who have stomach bleeding.

9. Therapy Exercising and achieving a healthy weight are the best and most important ways to treat osteoarthritis. Physical therapy.  A physical therapist can work to create an individualized exercise program that will strengthen the muscles around the joint, increase the range of motion and reduce pain. Occupational therapy.  An occupational therapist can help to discover ways to do everyday tasks or do job without putting extra stress on the already painful joint.

10. Braces or shoe inserts.  The doctor may recommend shoe inserts or other devices that can help reduce pain while standing or walking. These devices can immobilize or support the joint to help take pressure off it. A chronic pain class. These classes teach skills that help to manage osteoarthritis pain. And the patient meets other people with osteoarthritis and learn their tips and tricks for reducing and coping with joint pain.

11. Surgical and other procedures Cortisone shots.  Injections of corticosteroid medications may relieve pain in the joint. During this procedure the doctor numbs the area around the joint, then places a needle into the space within the joint and injects medication. Lubrication injections.  Injections of hyaluronic acid may offer pain relief by providing some cushioning in the knee. Hyaluronic acid is similar to a component normally found in the joint fluid.

12. Realigning bones.  During a surgical procedure called an osteotomy , the surgeon cuts across the bone either above or below the knee to realign the leg. Osteotomy can reduce knee pain by shifting the body weight away from the worn-out part of the knee. Joint replacement.  In joint replacement surgery ( arthroplasty ), the surgeon removes the damaged joint surfaces and replaces them with plastic and metal parts. The hip and knee joints are those most commonly replaced.