Dr TARIQ JAGNARINE
FAMILY MEDICINE, ENDOCRINOLOGY/ DIABETES
Osteoarthritis (OA) is the most common type of arthritis. It tends to occur in middle age or due to an injury or obesity. Sometimes called wear and tear arthritis, this occurs when the smooth cushion between bones (cartilage) breaks down, joints can get painful, swollen and hard to move. OA can affect any joint, but it occurs most often in hands, knees, hips, lower back and neck. OA can happen at any age, but it commonly starts in the 50s and affects women more than men. This disease starts gradually and worsens over time. However, there are ways to manage OA to prevent or minimize pain and keep mobile. Some people never develop OA.
CAUSES
Osteoarthritis was long believed to be caused by the wearing down of joints over time. Nevertheless, scientists now see it as a disease of the joint compounded with various genetic and environmental risk factors.
Risk factors that may contribute to OA include:
* Age. The risk of developing OA increases when someone gets older because bones, muscles and joints are also aging.
* Joint injury. A break or tear, can lead to OA after years.
* Overuse. Using the same joints repeatedly in a job or sport can result in OA.
* Obesity. Extra weight puts more stress on a joint and fats cells promote inflammation.
* Weak muscles. Joints can get out of the right position when there’s not enough support.
* Genes. People with family members who have OA are more likely to develop OA.
* Sex. Women are more likely to develop OA than men.
SYMPTOMS
Symptoms tend to build over time rather than show up suddenly. They include:
* Pain or aching in the joint during activity, after long activity or at the end of the day.
o Hips. Pain is felt in the groin area or buttocks and sometimes on the inside of the knee or thigh.
o Knees. A “grating” or “scraping” feeling when moving the knee.
o Fingers. Bony growths (spurs) at the edge of joints can cause fingers to become swollen, tender and red. There may be pain at the base of the thumb.
o Feet. The big toe feels painful and tender. Ankles or toes may swell.
* Joint stiffness usually occurs first thing in the morning or after resting.
* Limited range of motion that may go away after movement.
* Clicking or cracking sound when a joint bends.
* Swelling around a joint.
* Muscle weakness around the joint.
* Joint instability or buckling (knee gives out).
As OA gets worse, cartilage may get uneven edges and cracks. Bones may harden, change shape and get bumpy. Once cartilage breaks down, it doesn’t grow back on its own.
DIAGNOSIS
Medical history, a physical examination and lab tests help to make an OA diagnosis. The doctor will go over medical history information, symptoms, how the pain affects activities, as well as medical problems and medication use. The doctor will look at and move the joints. These tests help to make the diagnosis:
* Joint aspiration. After numbing the area, a needle is inserted into the joint to pull out fluid. This test will look for infection or crystals in the fluid. The results can help rule out other medical conditions or other forms of arthritis.
* X-ray. X-rays can show joint or bone damage or changes related to osteoarthritis as well as stage of OA
* MRI. Magnetic resonance imaging (MRI) gives a better view of cartilage and other parts of the joint.
HEALTH EFFECTS AND COMPLICATIONS
Pain, reduced mobility, side effects from medications and other factors associated with osteoarthritis can lead to negative health effects not directly related to the joint disease.
* Obesity, Diabetes and Heart Disease
Knee or hip pain may make it harder to exercise. That can cause or worsen weight gain and lead to obesity. Being overweight or obese can lead to the development of high cholesterol, diabetes, heart disease and high blood pressure.
* Falls
People with osteoarthritis experience as much as 30 percent more falls and have a 20 percent greater risk of facture than those without OA. Having OA can decrease function, weaken muscles and make it more likely that someone has a fall. Side effects from pain medications, such as dizziness, can also contribute to falls.
TREATMENT
There is no cure for OA, but medication, nondrug methods and assistive devices can help to ease pain. As a last resort, a damaged joint can be surgically replaced with a metal, plastic or ceramic one.
* Medications
Pain and anti-inflammatory medicines for osteoarthritis are available as pills, syrups, patches and creams, or they are injected into a joint. They include:
* Analgesics. These are pain relievers and include acetaminophen (Panadol) and opioids. Acetaminophen is available over-the-counter (OTC), and a doctor must prescribe opioids.
* Nonsteroidal anti-inflammatory drugs (NSAIDs). These are the most commonly used drugs to ease inflammation and pain. They include aspirin, ibuprofen, Diclofenac, etc. They are available OTC or by prescription, but the OTC versions only help the pain.
* Counterirritants. These OTC products have ingredients like capsaicin, menthol and lidocaine. They irritate nerve endings, so the painful area feels cold, warm or itchy to take focus away from the actual pain.
* Corticosteroids –These prescription anti-inflammatory medicines works in a similar way to a hormone called cortisol, by reducing inflammation around the joints. They can be delivered orally or injected into the joint.
* Platelet-rich plasma (PRP). Available specialized clinics and are delivered by injection, this product has proteins that help ease pain and inflammation.
* Other drugs. The anti-depressant duloxetine (Cymbalta) and the anti-seizure drug pregabalin are oral medicines that are FDA-approved to treat OA pain.
Nondrug Therapies
* Exercise
Movement is an essential part of an OA treatment plan. Getting 150 minutes of moderate-to-vigorous exercise per week should be the goal according to the American Heart Association (AHA). A good exercise program to fight OA pain and stiffness has four parts:
* Strengthening exercises build muscles around painful joints and helps to ease the stress on them.
* Range-of-motion exercise or stretching helps to reduce stiffness and keep joints moving.
* Aerobic or cardio exercises help improve stamina and energy levels and reduce excess weight.
* Balance exercises help strengthen small muscles around the knees and ankles and help prevent falls.
* Weight Loss
Weighing more than what is healthy puts extra stress on the hips, knees, feet and back. Losing weight helps to reduce pain and stop or slow down joint damage. Every pound of weight lost removes four pounds of pressure on lower-body joints.
* Physical Therapies and Assistive Devices
Physical therapists, occupational therapists and chiropractors can provide:
* Specific exercises to help stabilize joints and ease pain.
* Braces, shoe inserts or other assistive devices.
* Surgery
Joint surgery can improve function or replace damaged joints to restore mobility and relieve pain. Hips and knees are the joints most commonly replaced. An orthopaedic surgeon can determine the best procedure based on how badly damaged the joint is.
While developing Osteoarthritis may become challenging physically, mentally and even financially. Self-care is important, a carefully plan diet, exercise, weight management, assistive devices, medication and regular medical check-ups can help reduce the impact of Osteoarthritis.
