Diagnosis of Osteoarthritis Risk factors for Osteoarthritis Treating active persons with Osteoarthritis
Disease of the joints characterized by:– Progressive articular cartilage loss– New subchondral bone formation– New bone and cartilage formation at joint margins– Low level synovitis & PAIN!
OA is a group of diseases and mechanical abnormalities entailing degradation of joints, including articular cartilage and the subchondral bone next to it OA is derived from the Greek word ‘ostoe’, meaning ‘of the bone’, ‘arthro’, meaning ‘joint’, and ‘itis’, meaning inflammation
Also known as degenerative joint disease or “wear and tear arthritis”. Progressive loss of cartilage with remodeling of subchondral bone and progressive deformity of the joint (s). Cartilage destruction may be a result of a variety of etiologies
Primary OA: No known causeSecondary OA Pre-existing joint damage: RA, Gout, Seronegative spondyloarthropathy, Septic arthritis, Pagets disease, Avascular necrosis, e.g. corticosteroid therapy Metabolic disease: Chondrocalcinosis, Hereditary haemochromatosis, Acromegaly Systemic diseases: Haemophilia- recurrent haemarthrosis, Haemoglobinopathies, e.g. sickle cell disease, Neuropathies
Signs Joint tenderness Crepitus on movement Limitation of range of movement Joint instability Joint effusion and variable levels of inflammation Bony swelling Wasting of muscles.
Generally speaking, the process of clinically detectable osteoarthritis is IRREVERSIBLEand typical treatment consists of medication or other interventions that can reduce the pain of OA and thereby improve the function of the joint
Non pharmocologic Measures Education, Weight loss, Exercise, & Bracing Pharmacologic Measures Analgesics, Glucosamine, Injectables Alternative Therapies Acupuncture, Magnets, Balneotherapy, Thermotherapy Surgery
I recommend in ALL patients with knee and hip OA GS 1500 mg/ CS 800 mg 3 month trial, evaluate efficacy; continue if helping Consider indefinite use even if no pain relief for joint space preservation
Based on research dating back to the 1980’s Increases the viscosity and elasticity of OA synovial fluid Stimulates endogenous hyaluronic acid production Inhibits induction and activity of degradative enzymes Reduces inflammatory response Analgesic effect
TENS effective in some with knee or hip OA Short-term, 2-4 weeks Acupuncture relieves pain Heat/Ice thermotherapy Balneotherapy