Osteoarthritis - The Risk Factors and Management Options

Osteoarthritis is the most common type of arthritis, occurring in up to about 10% of adults, with as many as 50% of the elderly suffering from it. It is basically a degenerative form of arthritis, in which the cartilage, whose function is to cushion the joints, gets worn out with age.

This "wear-and-tear" of the cartilage over time, results in the bone surfaces becoming less protected and increases friction between the bones during movement. This friction eventually results in pain, swelling and loss of mobility. In more advance stages, the joint loses it normal shape and bony spurs may grow on the edges of the joint. Bits of bone or cartilage may break off and float inside the joint space, further causing pain and loss of mobility.

WHAT CAUSES OSTEOARTHRITIS?

The cause is multi-factorial, but the following would increase your risk:

• Being overweight


• Getting older


• Previous injury to the joint


• Mechanical stresses on the joint from high impact sports, certain jobs, pathological or congenital mal-alignment of bones

SYMPTOMS

Symptoms in the initial stages may include pain, tenderness, stiffness, creaking and locking of the affected joint. As the arthritis progresses, there may be swelling of the joint due to collection of synovial fluid within the joint. In the more advanced stages, there is bony deformity (caused by bony spurs) and mal-alignment of the limb (eg. "varus" deformity of the knee). Patients experience increasing pain upon weight bearing, thus limiting walking, and ultimately, even standing.

Osteoarthritis commonly affects the hands, feet, spine and weight-bearing joints, such as the hips and knees. In the smaller joints, such as in the fingers, hard bony swellings called Heberden's nodes and Bouchard's nodes may form. These are typically not painful, but they do limit joint movement.

DIAGNOSIS

Diagnosis can often be made by your doctor with reasonable certainty by a thorough physical examination. X-rays are used to confirm the diagnosis as well as to document progressive X-ray changes (thinning of cartilage, bony spurs, loose bodies, mal-alignment of joint etc) as the condition progresses.

TREATMENT

1. Non-Pharmacological:

• Weight loss - Excess body weight puts more strain on the knee joints. A typical vicious cycle exists: (1) Overweight person develops knee osteoarthritis (2) painful knees reduce mobility (3) with reduced mobility, more weight is gained (4) more weight worsens the arthritis.


• Regular exercise - regular aerobic, strengthening and range of motion exercises help strengthen muscles that stabilize the joints.


• Adequate intake of Calcium and Vitamin D for bone strength.


• Warm soaks and heat packs to help relief pain.


• Avoid excessive walking during periods of acute pain.


• Orthoses and walking aids - splints and braces help with joint alignment and weight redistribution. Walking frames and crutches help take load away from the arthritic knee.


• Physiotherapy


• Acupuncture

2. Pharmacological Measures:

• Pain-killers - paracetamol-based medication, Non-steroidal anti-inflammatory drugs (NSAIDS) etc.


• Glucosamine and/or chondroitin sulfate.


• Topical rubs with NSAIDS or capsaicin.


• Intra-articular joint injections

3. Surgical Treatment:

• Joint lavage (wash out) and arthroscopic debridement (clearing)


• Osteotomy - a wedge of bone located near the damaged joint is removed to realign the knee. This causes a shift of weight from the area of damaged cartilage to the area where there is more healthy cartilage.


• Total Joint Replacement - considered to be the last resort option in which the severely arthritic joint, having failed more conservative methods of therapy, is replaced with a prosthetic joint.

The decision to treat as well the type of treatment appropriate must be individualized according to the needs of the patient.

For example, young athlete with arthritis to the knee from a previous injury, will require treatment because his arthritis impacts his activities. For him, conservative treatment with possible arthroscopic lavage and debridement would be more appropriate than total joint replacement, in view of his young age.

In contrast, severe osteoarthritis of the knee in an elderly gentleman, which when examined in isolation, would lead one to consider total knee replacement. However, if this knee belonged to a bed-bound gentleman, then perhaps simple pain-killers would be all that is needed.

Dr Ang C.D.

SingaporeDoc.com