OsteoArthritis

OSTEO-ARTHRITIS

Osteo stands for bone while Arthron pertains to body joints. All inflammatory conditions have been suffixed with word, -itis. Therefore Osteo arthritis is a painful clinical state in and around the joint or joints. It is a degenerative joint disease presenting with Pain, limitation of movement, stiffness, limited flexibility and joint crepitus. In elderly people, most frequent musculoskeletal condition above 60 years of age are Osteo arthritis(83%), Old fractures(32%),and soft tissue rheumatism. By age of 40 years 90 % of all persons have some minimal degenerative changes and subsequent disease in weight bearing joints like knee joint which may not always present clinically.
Men and Women are equally affected by osteoarthritis. It is understood that in less than 45 years of age, the prevalence is greater in man while it is greater in women after 55 years of age. Factors like overweight and obesity play an important role in having an increased frequency of osteoarthritis in weight bearing joints. This wear and tear type of arthritis is the most common form of arthritis. Osteo arthritis may be a result of :

1. Old age
2. obesity/Overweight
3. Genetic misalignment of the joint.
4. Trauma leading to irregular joint surface.
5. Disease leading to damaged articular surfaces of the joints.
6. Inflammatory joint conditions like Sepsis, frostbite, Diabetes etc.
   Factors important in causation of Osteo arthritis are –
7. Genetic predisposition (Hereditary)
8. Obesity
9. Metabolic diseases like Diabetes, Gout
10. Occupation as top class Athletes and Mill worker who have to keep in standing posture for long hours.
11. Over use
12. Improper Biomechanics in using Joints.

Osteo arthritis usually develops gradually over a period of several years and sometimes it may suddenly flare up. The joint structure at the ends of two bones have articulating cartilages opposite to each other which are kept slippery with the help of a lubricating fluid in between joint surfaces called Synovial Fluid.

Through different stages of disease progression, articular surfaces which are in close contact get injured and rubbed off. This abraded surface exposes the underlying bone. Articular Cartilage is very resistant to abrasion as small quantity of lubricating Synovial fluid is present within the joint cavity. Because of presence of 80% Water, Articular cartilage remains moist. The lubricating factor in joint space is oil like viscous fluid.

COMPLAINTS IN OSTEO ARTHRITIS:
Joint commonly involved with elderly people are weight bearing joints such as lumber Spine, Hip joint, Knee Joint, thumb Joint, Great toe Joint, Cervical joints(Neck). In Western world Hip joint while in Asian countries knee joint are the most common joints to suffer with this degenerative disease. Pain is the foremost complaint. It may be a mild to moderate dull ache, poorly localized and intermittent in beginning. Pain usually gets aggravated after use of joint while Pain is relieved after taking rest. With Progression of disease, Pain becomes sever and persistent and movements get progressively restricted due to pain. Eventually it becomes persistent even on rest and can even disturb your sleep. Spasms i.e. involuntary contraction of Muscles around the joint are narrated as sharp agony which may add to pain.

Stiffness of affected joint may occur following periods of inactivity while pain enhances with activity and improves with rest. Stiffness of the joint on awakening in morning and after periods of inactivity during the day is common. After prolonged activity like sitting for a long time the joint may be locked. In early stages the stiffness is temporary but as the disease progresses and worsens the range of movement through the joint gradually reduces.

TREATMENT PROTOCAL FOR OSTEO ARTHRITIS:

1. Immobilize the joint affected for 3 weeks or less in acute pain situation with or without restriction in movement through the range.
2. Apply elastic support to the joint like Knee cap in Osteo arthritis of the knee joint.
3. Local Ice Fomentations in acute stage of osteo arthritis for edema of the inflamed joint. Ice can be applied with ice – packs or Ice in a simple poly pack for 20 minutes several times a day for first 24 hours after commencement of the pain. After 48 hours when the pain and swelling have subsided, moist heat can be of much help as it facilitates fresh blood in the local area for healing. Ice application can also be done even after mild to moderate work outs when the disease is in early stages
4. Non weight bearing Isometric exercises on daily basis are to be done. Isometric exercises are done with static pressure where length of the muscle is not changed.
5. Continuous Passive mobilization of the affected joint at slow pace is also beneficial. It keeps the range of motion of the joint maintained along with contraction of muscles in and around the affected joint.
6. Weight reduction
7. Use of prosthetic braces with active and passive exercises is must to prevent contracture and atrophy of the muscles.
8. Pain reduction has different measures and modalities in management of Osteo arthritis.
9. Modification of daily activities includes:
   · Correction of defective biomechanics as in walking, running or in standing posture.
   · Use of biomechanical designed molded sole shoes for walking or other sports activities.
   · Supportive equipments for affected joint like elastic wrap, braces etc.
   · Rest periods alternated with exercise/activity.
10. Non surgical treatment includes medicinal and physiotherapeutic methods/modalities.
    · Oral drugs (Pain killers)
    · Local applications in form of Gel/Ointment/Cream.
    · Injections of steroids in the affected joint.
    · Physiotherapy which includes Exercise therapy and Electro therapy:
    o Exercise therapy is needed to strengthen the muscles of joint to provide due stability to joint.
    o Electrotherapy includes superficial heat with the help of Infra red Lamp.
    o Deep heat with the help of Short Wave Diathermy.
    o TENS and Interferential therapy treatment.
11. Joint replacement:
    The ultimate surgical treatment of osteo arthritis is Total Joint Replacement. Most commonly involved joint with this disease in India is Knee Joint and their replacement surgeries are very much available at Metro and semi metro cities. The indications of joint replacement are:

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