andpresentWhat to advise patientsWhat to advise patientswith osteoarthritis?with osteoarthritis?
An aerobic activity every day Maintains joint flexibility and good muscle tone Made easier by wearing shoes with thick, flexiblesoles to cushion the impact on the joints or, forpatients with genu varum, with corrective insoles During "inflammatory"* flares: avoid undue stresson the joint, standing for prolonged periods of timeand carrying heavy loads2*The joint is more painful than usual and is hot and swollen.Chevalier X. Arthrose du genou et de la hanche. Rev Prat Med Gen 2012;21:987-91.
Fight the flab! A risk factor for the onset andprogression of osteoarthritis Obesity is known to promote theonset of knee osteoarthritis and also,to a lesser extent, hip and handosteoarthritis3 Even minimal weight loss of about 5% reduces osteoarthritis-inducedpain, functional impairment and disability There is no specific diet for osteoarthritis patients.A balanced, low-calorie diet is recommended for overweight patientsChevalier X. Arthrose du genou et de la hanche. Rev Prat Med Gen 2012;21:987-91.Société française de rhumatologie. Osteoarthritis file.
4Advanced femorotibial kneeosteoarthritis.Primary osteoarthritis,CT-arthrography.MRI of both hands: axial images in 3-D gradient echo sequences with suppressionof the fat signal, with and without injection of gadolinium focussing on themetacarpophalingeal joints.
Aerobic activity and strengtheningexercice requiredThis will not intensify the knee or hip osteoarthritis-related painOn the contrary, taking regular exercise can provide relief, improverange of motion and delay the need for replacement surgeryThe recommended regimen is to gradually work up to30 to 60 minutes, three times a week5Bonan I. Rôle de la rééducation dans le traitement de la gonarthrose. Rev Prat 2012;59:1246-47.
Do the right exercises There are specific exercises recommended for each form ofosteoarthritis: they are designed to maintain tendon flexibilityand joint range of motion, prevent bad posture and reinforcethe muscles A few sessions of physiotherapy are required to: gradually start exercising again learn the right exercises to do regularly at home6Bonan I. Rôle de la rééducation dans le traitement de la gonarthrose. Rev Prat 2012;59:1246-47. Regular training is required
Dont forget home exercises for handosteoarthritis7 Beauvais C. Education thérapeutique en rhumatologie. Rev Prat Med Gen 2012;26:155-60.
For overweight patients, combine dietand exercise A diet alone may not be sufficient to provide effective relief The combination of diet and aerobic exercisein overweight patients with knee osteoarthritis: significantly improves pain, function and muscle strength is more beneficial than each measure applied individually8Ghroubi S, et al. Apport de l’exercice physique et du régime dans la prise en charge de la gonarthrose chez l’obèse. Annales de réadaptation et de médecine physique vol. 51, 2008. p.663-670.
Choose the right sports(for the more athletic!)Gentle, low impact sports are recommended: swimming,cycling (on flat ground or on an exercise bike),stretching exercises, etc.High impact sports (skipping, tennis, etc) arenot recommended for patients with establishedknee or hip osteoarthritis: they may aggravate the disorder10Patients may continue to run as long as they wearappropriate footwear (thick, flexible rubber or air/geltype soles to cushion the impact) and run, whereverpossible, on soft ground. Power walking is a goodalternativeChevalier X. Arthrose du genou et de la hanche. Rev Prat Med Gen 2012;21:987-91.Société française de rhumatologie. Osteoarthritis file.
Dont forget thermotherapy Application of cold or heat can provide effectiveshort-lasting relief from the symptoms of hip or kneeosteoarthritis (ice for inflammatory flares and heatfor joint stiffness) Thermotherapy could be effective against the paincaused by hand osteoarthritis11Zhang W, et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSIevidence-based, expert consensus guidelines. Osteoarthritis Cartilage 2008;16(2):137-62.Chevalier X. Arthrose des doigts. Rev Prat Med Gen 2010;24:162-163.
Protect your jointsThere are many gadgets (long-handled shoe horn, door openers, etc.)available to help osteoarthritis sufferers in their daily lives whichcan be purchased either directly from retailers or from specialist mailorder catalogues12Société française de rhumatologie. Osteoarthritis file.Beauvais C. Education thérapeutique en rhumatologie. Rev Prat Med Gen 2012;26:155-60.These will help reduce pain and maintain range of movement
Use walking aidsThis may help reduce the pain of hip or knee osteoarthritisDuring inflammatory flares, it is essential to rest the joint:use crutches if necessaryBetween inflammatory flares: a walking stick will take the pressureoff the joint in daily life and will provide comfort and reassurance Sticks or crutches should be carried on the side opposite to the damaged joint Some patients find using a cane difficult to accept; it should be noted that,in most cases, a cane or stick will no longer be required after the hip or kneereplacement procedure13Zhang W, et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage 2008;16(2):137-62.Société française de rhumatologie. Osteoarthritis file
Envisage hydrotherapy (crenotherapy) Proven to provide pain relief The combination of physical treatments, physiotherapyand advice from ergotherapists and dieticians contributeto their beneficial effects14Société française de rhumatologie. Osteoarthritis file