image courtesy of BruceBlaus , some rights reserved.
Osteoarthritis is a degenerative disease of the joint is most common in older age especially above 40 years. It affects mainly weight-bearing joints. The mechanism of osteoarthritis involves the degeneration of joint cartilage and new bone formation within the joint (osteophyte formation). secondary osteoarthritis occurs due to joint injury – may be intraarticular injury or extra-articular injury. Osteoarthritis is absolutely a bony disease, none other systemic involvement. It is seronegative arthritis like ankylosing spondylitis. Knee osteoarthritis is very common.
SIGN AND SYMPTOMS
- JOINT STIFFNESS – Initial symptom of Osteoarthritis is articular stiffness.
- JOINT PAIN – is the most important symptom of Osteoarthritis. It occurs after repetitive use of the affected joint.
- SWELLING – Joint swelling also occurs in Osteoarthritis. It is often seen in the knee joint.
- JOINT MOVEMENT LIMITATION – As Osteoarthritis is a degenerative disease, certain joint movements are restricted during the course of the disease.
- CREPITUS – is found often on knee Osteoarthritis.
- BOUCHARD’S NODES – Found in osteoarthritis of the PIP (Proximal Inter Phalangeal) joint is a bony growth.
- HEBERDEN’S NODES – Like Bouchard’s node bony overgrowth of DIP (Distal Interphalangeal) joint.
Osteoarthritis is diagnosed by X-Ray or MRI. Loss of joint space, osteophyte formation, etc. are key to diagnosis. Skyline’s view of X-Ray gives a better view of knee Osteoarthritis. Osteoarthritis in the hip AP view or PA view can be done.
Treatment of Osteoarthritis includes –
- ICE PACK – Pain and swelling, during acute attacks of the Osteoarthritis ice pack is given for at least 15 minutes. It reduces pain.
- EXERCISE – Exercise and physiotherapy are beneficial. Knee bending should be avoided in a patient of knee Osteoarthritis. Splinting is beneficial in the case of the 1st carpometacarpal joint.
- PARACETAMOL (Acetaminophen) – is beneficial for mild Osteoarthritis. High doses of acetaminophen should be avoided due to hepatotoxic.
- NSAIDs – NSAIDs are most commonly used to treat Osteoarthritis. These drugs reduce pain and inflammation by inhibiting enzyme cyclooxygenase, Ibuprofen, Naproxen Sodium, Aceclofenac, Diclofenac, Indomethacin, piroxicam, Etoricoxib, etc are beneficial for symptomatic treatment of Osteoarthritis. These drugs cause gastric irritation and gastritis. PPI like Pantoprazole, Omeprazole, Rabeprazole should be used along with NSAIDs.
- INJECTION CORTICOSTEROID – Severe Osteoarthritis or no responsive to NSAIDs are treated with intraarticular Corticosteroid.
- TOPICAL NSAIDs – Diclofenac topical ointment is used to treat Osteoarthritis. Capsaicin ointment is also beneficial for it and reduces substance P and decreases pain.
- GLUCOSAMINE SULFATE – is used orally for Osteoarthritis treatment but the role of glucosamine in Osteoarthritis is still controversial.
- DIATHERMY – Short wave diathermy is useful for chronic osteoarthritis.
- SURGERY – Severe osteoarthritis with restricted joint movement is treated by surgical intervention. Osteotomy ( the surgical cutting of a bone, especially to allow realignment ) and arthroplasty are commonly done advanced osteoarthritis. Osteotomies can be done for hip and knee osteoarthritis and arthroplasty can be done for a hip, knee, shoulder and first carpometacarpal joint. Total joint replacement is done for knee or hip osteoarthritis when ll other surgical treatment is failed. Total joint replacement is needed for only a few cases of Osteoarthritis. Joint replacement helps to improve the quality of life in a severe knee or hip Osteoarthritis patient.
- WEIGHT REDUCTION – Weight reduction is a very essential step for reveling symptoms of hip Osteoarthritis of knee Osteoarthritis. Weight reduction should be encouraged for hip and knee osteoarthritis patients.
- USING AIDS – Along with surgical and medical treatments, some supportive measures must be taken. Use of shock-absorbing footwear, walking stick helps to reduce the symptoms of Osteoarthritis.