Answer - Osteoarthritis, also known as degenerative arthritis is one of the commonest diseases affecting the joints and the symptoms usually occur as we age. It is caused by the breakdown and eventual loss of the cartilage of one or more joints. Cartilage is a protein substance that serves as a "cushion" between the bones of the joints.
Answer - The weight bearing joints like the hips and knees are most commonly affected in most of the cases. Less commonly, the non-weight bearing joints like the shoulder, elbow, finger and ankle may get affected.
Answer - Pain and stiffness of the joint affected is the most common symptom to the patient. Redness and swelling of the affected joints may also occur. Joints, particularly in the fingers, may become permanently deformed by osteoarthritis. Painless bony bumps, known as Heberden's nodes, may also appear symmetrically on the fingers of both hands or on toe joints as well.
Answer - Osteoarthritis can be primary or secondary.
1- Primary Osteoarthritis is mostly related to aging. With aging, the water content of the cartilage increases, and the protein makeup of cartilage degenerates.
2- Secondary Osteoarthritis is caused by another disease or condition. Conditions that can lead to secondary Osteoarthritis include obesity, repeated trauma or surgery to the joint structures, abnormal joints at birth (congenital abnormalities), gout, diabetes, Rheumatoid arthritis and hormone disorders.
Answer - Strongest risk factor for osteoarthritis of all joint sites is age. Women are more likely to have osteoarthritis than men and they may have more severe osteoarthritis as well. There is a definite increase in osteoarthritis in women around the time of menopause. Up to 65% osteoarthritis may occur on a genetic basis. Heritability may vary by sex and joint site. The role of obesity in osteoarthritis also may differ by joint site; while obesity is strongly associated with knee osteoarthritis, it does not appear to be as consistently associated with hip osteoarthritis. The effects of obesity in knee osteoarthritis may also be different in men and women.
Answer - Recreational physical activity and sports participation in the absence of joint injury do not lead to osteoarthritis. Significant injury to the structures of a joint, particularly a structure within the joint can result in a significantly increased risk of a future osteoarthritis.
Answer - Occupations requiring heavy physical labour have long been associated with osteoarthritis of the knee and hip. Osteoarthritis of the knee has been associated with heavy physical labour, repetitive knee bending and squatting. Farmers have increased risk of osteoarthritis of hip, particularly with jobs requiring prolonged standing and heavy lifting.
Answer - Sound heard or felt while moving the joint could be a feature of osteoarthritis. But these types of sounds could be heard while moving the normal joint also. So only when there is pain associated with the sound while moving the joint, one should seek medical attention.
Answer - Osteoarthritis can be diagnosed in two ways: patient reported symptoms such as pain and disability or by physical signs on examination: presence of crepitus, tenderness, swelling or restricted movement of the affected joint. It can be confirmed y radiographs of the affected joints. For early diagnosis MRI scans of the affected joints are required.
Answer - Treatment modalities can be classified as follows
1. FOR SYMPTOM RELIEF:
Non-pharmacological:
Exercises
Weight reduction.
Participation in self management programmes.
Use of medially directed patellar tapping.
Use of insoles, walking aids.
Participation in Tai chi programmes
Pharmacological :-
Acetaminophen.
NSAIDS- oral and topical
Opoids.
Nutraceuticals.
Intra- articular – steroids and viscosupplementation.
Surgical intervention:
Arthoplasty
Joint replacement surgery
DISEASE MODIFICATION :
This is a new concept that is coming up, though not accepted by everyone. Lot of work is being done to understand the pathogenetic pathways of osteoarthritis and agents which can bring a change in these pathways and thus help in disease modification.
1. Reduce your body weight as much as you can. This is important because while getting up from sitting or squatting position about 250-300 times of your body weight passes through the knee joint. So even if you lose one or two kilograms that will help the progression of the diseases.
2. Please don’t use Indian toilet and use only European toilet.
3. Please don’t climb stairs. As far as possible try to use lift.
4. If you belong to Muslim community kindly do namaz or daily prayers while sitting on a chair.
5. If you belong to Hindu community please do not sit down while performing pooja or feasting.
Answer - Exercise therapy decrease pain and improve functional capacity. It is more helpful in osteoarthritis of the knees rather than hips. Osteoarthritis of the knees can have pain intermittently or there can be exacerbation already existing pain. In painful episodes, exercises in a non weight bearing position (cycling, quadriceps contraction exercises) or in partial weight bearing position (aquatic exercises) should be done.
In painless episodes stretching exercises of the knees should be performed. The exercises should be performed at least 3-7 times a week. Efficacy is better in compliant patients.
Answer - Management of hand osteoarthritis is slightly different from hip or knee osteoarthritis. Intra- articular therapy is not recommended for hand osteoarthritis. The main aim is to provide pain relief by using oral or topical NSAIDS and provide assisted devices which may help patients to perform their daily activities without difficulty.
Answer - They are indicated in those patients who have swollen knees with lot of fluid. Once injected the patients has to limit their activities for 24- 48 hours. They act by inhibiting the production of inflammatory cytokines and thereby reducing pain and inflammation of the joint. The duration of the effect depends upon the preparation and the compound used. Upto 4 injections can be given in a year. Some patients do experience increase in pain 24- 48 hours after the therapy. It can be managed with local ice fomentation and with analgesics.
Answer - Viscosupplementation involves removal of the diseased joint fluid and replacing it with a substance that has cushioning and lubricating properties. They are indicated to patients with early disease. The objective is to supplement elasticity and viscosity along with reducing the pain and improving mobility. The products are hyaluronan and hylan derivatives.
Answer - Until now Viscous supplementation were available as a three - five injection regimens which were administered directly in the knee joint on a weekly basis by a medical expert. The latest advancement in Viscous supplementation is a single injection (FDA approved) which provides pain relief to the patient for at least 6- 12 months. it has only some minor side- effects at the local site –pain, swelling, redness, warmth, itching and bruising. If requires these injections can be repeated after 6 months.
