Osteoarthritis Flashcards
Definition of osteoarthritis
A type of arthritis that occurs when flexible tissue at the ends of bones wears down.
The wearing down of the protective tissue at the ends of bones (cartilage) occurs gradually and worsens over time.
Causes of osteoarthritis
Hereditary Obesity Injuries Muscle weakness Age Joint overuse Authoimmune disorders
Signs and symptoms
Joint pain Hand pain Hip pain Knee pain Lower back pain Neck pain
Investigations
X-rays of the affected joints are the main way osteoarthritis is identified.
Complications
Possible complications of osteoarthritis include: Rapid, complete breakdown of cartilage resulting in loose tissue material in the joint (chondrolysis). Bone death (osteonecrosis). Stress fractures (hairline crack in the bone that develops gradually in response to repeated injury or stress). Bleeding inside the joint. Infection in the joint. Deterioration or rupture of the tendons and ligaments around the joint, leading to loss of stability. Pinched nerve (in osteoarthritis of the spine).
Differential diagnosis
The following disorders should also be considered in the differential diagnosis:
Crystalline arthropathies (ie, gout and pseudogout)
Inflammatory arthritis (eg, rheumatoid arthritis)
Seronegative spondyloarthropathies (eg, psoriatic arthritis and reactive arthritis)
Septic arthritis or postinfectious arthropathy
Fibromyalgia
Tendonitis
Management
There is no cure for osteoarthritis. Mild to moderate symptoms are usually well managed by a combination of pharmacologic and non-pharmacologic treatments. Medical treatments and recommendations include:
Medications (topical pain medicines and oral analgesics including nonsteroidal anti-inflammatory medications, NSAIDs).
Exercise (land- and water-based).
Intermittent hot and cold packs (local modalities).
Physical, occupational, and exercise therapy.
Weight loss (if overweight).
Healthy eating, managing diabetes and cholesterol.
Supportive devices such as braces, orthotics, shoe inserts, cane, or walker.
Intra-articular injection therapies (steroid, hyaluronic acid “gel”).
Complementary and alternative medicine strategies, including vitamins and supplements.
Surgery may be helpful to relieve pain and restore function when other medical treatments are ineffective or have been exhausted, especially with advanced OA.
The goals of treatment are to:
Decrease joint pain and stiffness and delay further progression.
Improve mobility and function.
Increase patients’ quality of life.
The type of treatment regimen prescribed depends on many factors, including the patient’s age, overall health, activities, occupation, and severity of the condition.
Medications
Unlike other forms of arthritis where great advances have been made in recent years, progress has been much slower in osteoarthritis. There are no medications yet available that have been shown to reverse or slow the progression of osteoarthritis. Currently, medications are focused on decreasing symptoms of the disease. Pain-relieving medications include acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs). Narcotic pain medications are not recommended due to the chronic nature of the disease and the possibility of tolerance and addiction. Topical medications in the form of analgesic patches, creams, rubs, or sprays may be applied over the skin of affected areas to relieve pain.
Although many of these medications are available in over-the-counter preparations, individuals with osteoarthritis should talk to a health care provider before taking the medications. Some medications may have dangerous or unwanted side effects and/or may interfere with other medications that are being taken. Some over the counter medications still require routine laboratory testing.
The antidepressant duloxetine hydrochloride (Cymbalta®) was approved by the FDA in 2010 to treat the pain of osteoarthritis, such as lower back pain. That has been a big help for people who can’t tolerate NSAIDs or other treatments.
Supportive devices
Supportive or assistive devices help decrease stress on affected joints. Braces and orthotics help to support and stabilize painful, damaged joints. Medical devices should be used as instructed and under the direction of a health professional such as a physical/ occupational therapist or your licensed healthcare provider. Shoe lifts/ inserts, a cane or a walker may be helpful to take pressure off certain joints and improve body and gait mechanics.
Exercise
Exercise is important to improve flexibility, joint stability and muscle strength. Regimens such as swimming, water aerobics, and low-impact strength training are recommended. These have been shown to decrease the amount of pain and disability that osteoarthritis sufferers experience. Excessively vigorous exercise programs are best avoided, as they may increase arthritis symptoms and potentially hasten the progression of the disease. Physical therapists or occupational therapists can provide appropriate and tailored exercise regimens for individuals with osteoarthritis.
Hot and cold therapies
Intermittent hot and cold treatments may provide temporary relief of pain and stiffness. Such treatments include a hot shower or bath and the careful application of heating or cooling pads or packs.
Weight control
Since obesity is a known risk factor for osteoarthritis, working to better manage weight may help prevent and improve osteoarthritis. Weight loss in overweight persons who have osteoarthritis has been shown to reduce stress and the amount of pain in weight-bearing joints as well as moderate the inflammatory processes that contribute to OA.
Surgery
When osteoarthritis pain cannot be controlled with medical management and it interferes with normal activities, surgery may be an option. Surgery is usually reserved for those people who have significant osteoarthritis. Several types of techniques can be employed, including minimally invasive joint replacement techniques. Although it has risks, joint surgery today can be very effective at restoring some function and reducing pain for appropriate individuals.
Alternative medicine
Supplements and alternative medicine nutraceuticals, a term derived from “nutrition” and “pharmaceutical”, are compounds that are available in pharmacies and health food stores without a prescription and are not licensed by the FDA as drugs. They include nutritional supplements, vitamins, minerals and other compounds sometimes referred to as “natural,” “homeopathic,” or “alternative” therapies. As this market is less regulated than the food and drug companies - many preparations exist, the actual quantity of active ingredients may vary, and there is no guarantee as to the accuracy of the label and the product.
Glucosamine and chondroitin are components of normal cartilage. As a supplement, they are most widely available as sulfate compounds. Clinical research results on glucosamine and chondroitin seem to vary, however, some trials indicate possible pain-relieving properties, particularly in osteoarthritis of the knee. Exactly how they work remains unclear and there is no strong scientific evidence supporting the claim that they build bone and cartilage. In general, glucosamine and chondroitin appear to be safe and well-tolerated however should first be discussed with your healthcare provider.
Fish oils have some anti-inflammatory activity, but these oils have been studied more extensively for rheumatoid arthritis. Supplements can potentially interact with prescription medicines and can have side effects, they should always first be reviewed with your healthcare provider.
Other modalities of alternative medicine include acupuncture, acupressure and meditation.
