Osteoarthritis - What You Must Know About This Disease

Osteoarthritis is a degenerative disease of the joint capsule and underlying bones, characterized by a slow and steady progression of degeneration and disintegration of the cartilage that covers the end of the bones.

Unlike rheumatoid arthritis, osteoarthritis does not show periods of remissions and there are no systemic symptoms. It is less crippling than the rheumatoid arthritis. It affects mainly the knee, hip and spine joints. Its effects is crippling only when the hip joint is involved.

Incidence
The disease starts as early as the middle 30's and progresses gradually. It becomes more pronounced in the middle age and old age. It affects more women than men.

Aetiology
i. Joint trauma (repeated)
ii. Aging - Affects quite a number of people who are 50 years and above
iii. Heredity
iv. Obesity - Because of increase weight on the joints
v. Sex - Commoner among women than men. The signs of the disease may become obvious during menopause or the signs become increased during this period if they have previously been there
vi. Poor posture
vii. Excessive use of certain joints

Pathophysiology
Osteoarthritis is generally a product of aging. The disease progresses slowly and affects mostly the joints of the spine, hip and knee. The cartilage degenerates and becomes soft and wears away. The bone edges become thin and ragged and are no longer able to spring to shape after normal use.

The fibrillar component of the joint break down (though collagen is retained) causing small bone fragments to occasionally break off thereby causing severe pain. The synovial membrane gradually becomes thickened. There is ossification of the fibrous tissue around the joint. There is however no ankylosis of the joint. The changes in the joint cause pain and limitation of movement of the affected joint.

Signs and symptoms
i. Pain in the joint. Particularly affected are the spine, knee, hip joint, etc. Pain is aggravated by exercise.
ii. Stiffness of the joint especially in the mornings
iii. Grating of the joint when moved
iv. Mild swelling due to fluid accumulation in the joint
v. Wasting of the muscle (atrophy)
vi. Limitation of movement may occur
vii. Bony enlargement of the joint may also occur

Diagnosis
Laboratory tests are usually normal. But X-ray of the affected joints reveals:
i. Hardening of the joint (sclerosis)
ii. Cartilage loss
iii. New bone formation

Management
Osteoarthritis has no cure but a lot could be done to reduce the pain being experienced by the patient.
i. Weight reduction: Obese patient should be encouraged to lose excess weight so as to reduce the strain on the joints.
ii. Patient should maintain good posture
iii. Apply heat to affected joints
iv. Surgery may be advocated to fix the joint in permanent position (Arthrodesis).

Drug therapy
Drug therapy is similar to that of Rheumatoid arthritis.
Nursing management
Nursing management is the same as for Rheumatoid arthritis.