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Information for Patients

Sports-Medicine Kalyan-Dombivali

Questions & Answers About Osteoarthritis

Who Is Affected?
What Are Risk factors For OA?
How Will It Affect Me?
What Are Joints Affected?
Can It Occur Secondary To Some Other Disease Of Joint?
What Are Causes of Joint Pain In OA?
What Are Investigations Required?
What Are Principles Of Treatment?
What Is The Recommended Treatment For OA?
This commonest form of arthritis mainly affects cartilage. The cartilage begins to fray and may entirely wear away.

Who Is Affected?

It may occur to anyone of any age, though it is increased in frequency with increased age.

Men under 45 years are more commonly affected than females whereas prevalence is greater in women after age 55 years

What Are Risk factors For OA?

  • Age

  • Repetitive stress e.g. vocational

  • Female Sex

  • Obesity

  • Race

  • Congenital/development

  • Genetic factors

  • Defects

  • Major Joint Trauma

  • Prior inflammatory joint disease

  • Metabolic/ endocrine disease

What Happens?

In this disease, the cartilage becomes pitted, rough and brittle. The bone underneath broadens out & becomes thick to reduce load on the cartilage. The bone may outgrow from outer edges of the joint resulting in knobby appearance of joint (osteophyte). There is reduction in joint space & thickening of joint capsule & synovial membrane. The joint becomes painful & stiff.

In advanced cases part of the cartilage breaks away from the bone resulting in naked bone ends. These bone ends may rub against each other causing lot of pain. The ligaments tend to become strained & weakened & there may be change in the shape of the joint.

How Will It Affect Me?

The disease varies from person to person, for some people it may be mild & not progressive whereas in others it may progressively worsen. The presentation is usually gradual with soreness, pain and stiffness specially during activity being the major feature.

In some people the overall disease may finish & they become pain free & able to carry out most every day activities.

Diagram : Osteoarthritic hand - Click here

What Are Joints Affected?

Hands, feet, knees, hips, spine (lower lumbar & cervical), temporomandibular joint

Can It Occur Secondary To Some Other Disease Of Joint?

This may develop in following disease processes

  • Acute Trauma                                    
  • Chronic Trauma
  • Excessive bleeding disorders
  • Metabolic Disorders
  • Neurological Disorders
  • Overuse of Intra-articular steroid injection
  • Diabetes
  • Frost Bite
What Are Causes of Joint Pain In OA?

  Source              

- Synovium                  

- Osteophyte               

- Ligaments                 

- Capsule                    

- Muscle                      

- Subchondral bone    

  Mechanism                

- Inflammation

- Stretching of nerve endings

- Stretch

- Inflammation, stretch

- Spasm

- Increase inside pressure &

  microfracture

What Are Investigations Required?

  • Plain x-rays in 2 planes are usually enough
  • In case of OA of lumbar spine, doctor may ask for CT Scan & MRI
  • In doubtful cases doctor may ask for blood investigations to rule out inflammatory arthritis, gout or any predisposing disorders.

What Are Principles Of Treatment?

  1. Prevention of occurrence of the disease
  2. To provide symptomatic relief & retard further progression if patient presents early
  3. To rehabilitate in case of advance arthritis

What Is The Recommended Treatment For OA?

American college of rheumatology subcommittee has issued certain guidelines, according to which following treatment is recommended:

Non Pharmacologic Therapy

Patient education

Self management programs (e.g. Institute of Arthritic Care & Prevention Self Management Program)

Weight loss (if overweight)

Aerobic exercise programs

Physical therapy, range of motion exercise

Muscle strengthening exercise

Assistive devices for ambulation

Appropriate footwear

Orthotic devices & braces

Occupational therapy

Joint protection & energy conservation

Assistive devices for activities of daily living

Phramacologic Therapy:

Oral:

Acetaminophen

COX-2 specific inhibitor

Non selective NSAID plus misoprostol or protein pump inhibitor

Nonacetylated Salicylate

Other Pure Analgesic Tramadol

Opioids

Intraarticular

Glucocorticoids

Hyalyuronan

Topical

Capsaicin

Methylsalicylate

Suggested treatment algorithm : Diagram