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ARTHRITIS
Arthritis refers to different medical condition associated with the disorder of the primary structures that determine joint function such as bones, cartilage, and synovial membrane
Osteoarthritis (OA) is the most common form of arthritis. Also called Degenerative joint disease.
PATHOGENESIS OF OSTEOARTHRITIS.
Osteoarthritis is a chronic disease of the joint that causes patients to suffer a progressive functional disability. This disease is not age related per se, but once patent, it progresses with aging. It is related to a loss of joint functional ability of the principal lubricating protein (proteoglycan) in our cartilage, tendons, ligaments, synovial fluid and mucous membrane leading to an imbalance in regeneration process of these functional elements of the joint and is characterized by continuous pain, inflammation, joint tenderness, swelling, redness, warmth. It is associated with a breakdown of cartilage in joints and can occur in almost any joint in the body. Bones begin to grind against each other causing pain and difficulty moving the joint. Osteoarthritis can be limited to one joint or start in one joint usually the knee, hip, hand, foot or spine or it can involve a number of joints. If the hand is affected usually many joints of the finger become arthritics.
RISK FACTORS.
- Increasing age
- Lack of physical activity
- Obesity/overweight
- Hereditary
- Joint infection/injury
- Chronic inflammation caused by previous rheumatic illness such as Rheumatoid arthritis.
- Repeated episodes of bleeding into the joint e.g. Hemophilia.
SYMPTOMS.
- Joint pain and swelling after activity or in response to a change in weather.
- Limited flexibility, especially after not moving for a while.
- Bony lumps at the end of fingers called HEBERDEN’S NODE or on the middle joint of finger called BOUCHARD’S NODE.
- A grinding sensation when the joint is moved.
- Numbness or tingling in an arm or leg, which can happen if the arthritis has caused bone changes that are putting pressure on a nerve e.g. in the neck or lower back.
People who have osteoarthritis often complain of a deep ache, centered in the joint. Typically the pain is aggravated by using the joint and relieved by rest.
However, as the disease worsens, the pain becomes more constant. Often, when the pain is significant during the night, it interferes with sleep.
DIAGNOSIS.
- The diagnosis is typically based on a medical history and physical examination which can reveal tenderness, warmth and swelling around the joint or joints.
- X-rays can be recommended but osteoarthritis only shows up on x-rays in the later stages of the disease.
- Joint aspiration, a procedure in which fluid is drained from the affected joints and examined, and blood tests also may be used to rule out other forms of arthritic conditions.
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MANAGEMENT
Treatment plans often include a combination of drugs, rest, physical activity, joint protection and physical or occupational therapy.
PHYSIOTHERAPY
- Maintain an ideal body weight: Obesity is often considered a risk factor in arthritis. Weight control is important for prevention of and to slow the progression of osteoarthritis affecting the weight bearing joints (knees and hips) and low back. For every one pound of weight lost, there is a four pound reduction in the load exerted on the knee for each step taken during daily activities. Weight loss of only 15 pounds can cut knee pain in half for overweight individuals with arthritis.
- Exercise: It can be your best tool against osteoarthritis because exercise strengthens your muscles and works to keep your joints flexible. Exercise can also help you to maintain a healthy weight (or lose weight if necessary).Don’t overdo high impact aerobics such as running and if a particular joint (for example, those in your knee, ankle, and feet) start to suffer from overuse, change your exercise regimen. Low-impact exercise such as walking, swimming, bike, dance and stretching exercises to loosen your joint increase your range of motion, strengthen your muscles.
- Heat/Cold therapy: this involves the application of hot/cold water bottles to the affected joint to ease the pain. Ice cubes, hot compressions can be used.
CHEMOTHERAPY
- Medication: Chemotherapy is aimed at relieving pain, reducing inflammation and regenerating the articular functions(cartilage,ligaments,tendons)
- Analgesics .e.g. Acetaminophen, non-steroidal anti-inflammatory agents (NSAIDS.e.g. Ibuprofen, Naproxen, ketoprofen, aspirin), Cyclooxygenase-2(COX-2) inhibitors (celecoxib).The use of analgesics is to relief pains; however the degree to pain resolution varies. Acetaminophen will only offer suboptimal pain relief, compared to NSAIDS/COX-2 inhibitors which offer better relief. But the adverse effect profile of these classes of drugs limits its use especially for people who have had ulcers in the past and the elderly.
- Corticosteroids: this class of drugs is used only to suppress the inflammation caused by immune malfunctioning. Intra articular corticosteroids like hydrocortisone, prednisolone and triamcinolone are widely used. These drugs are effective and safe only in the short run. Long term treatments have been implicated in dramatic osteoporosis (thinning of the bone), obesity, diabetes, poor wound healing, high blood pressure and cataract. Multiple administrations which could result to cartilage damage also limit its use.
- Natural/Alternative therapy: Anti-oxidants (Vitamin A, C, E, Beta carotene, grape seed extract, turmeric extract,) Glucosamine sulphate, Chondroitin sulphate, methyl sulfonyl methane, boswellia extract.
- Surgery: This is an important consideration in people with advanced osteoarthritis associated with joint damage and marked limitations in joint function. Surgery is to correct deformity in a joint or to reconstruct or replace a hip or knee joint.
THE IDEAL AGENT
Should have
- Pain reduction properties
- Anti-inflammatory properties
- Antioxidant properties
- Cartilage regeneration
- Modification of disease progression
- Low side effect profile
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