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Dr. Paramaguru .'s Profile
Prevention and management of osteoarthritis
Almost one in five indian. adults (46 million people) has arthritis and an estimated 67 million people will be affected by 2030. Osteoarthritis, the most common type of arthritis that wears away the cartilage cushioning the knee joint, currently affects more than 27 million people in the asian.
Most indian are unaware of the seriousness of arthritis and the impact it can have on their lives. Arthritis is the nationís most common cause of disability and costs the indian economy more than $128 billion annually. Knee osteoarthritis, the most frequent form of lower extremity arthritis, contributes to 418,000 knee replacement procedures annually and in 2010 accounted for 496,000 hospital discharges and $19 billion in hospital charges.

One of the largest longitudinal studies to monitor the onset and progression of knee and hip osteoarthritis suggests nearly one in two people (46%) will develop painful knee osteoarthritis over their lifetime, with the highest risk among those who are obese. The study found that a personís lifetime risk rose as their body mass index or BMI increased, with the greatest risk found in those whose weight was normal at age 18 but were overweight or obese at 45 or older. While there were no significant differences in risk by sex, race and education, the study found that nearly two in three people (65%) who are obese would develop knee osteoarthritis over their lifetime. The study also found that those with a prior knee injury had a lifetime risk of 57%.

According to the Arthritis Foundation, the study underscores the immediate need for the public to understand what they can do to reduce the tremendous pain, disability and cost associated with arthritis. Arthritis is exploding in an aging population.

To reduce the pain and disability of arthritis, the Arthritis Foundation recommends the following:

Control weight. For those already living with symptoms, losing 15 pounds can cut knee pain in half. Maintaining a healthy weight also can lower a personís risk of osteoarthritis. In fact, one study showed that women who lost as little as 11 pounds halved their risk of developing knee osteoarthritis and itís accompanying joint pain.
Get active. Many people think that physical activity can worsen arthritis. Nothing could be further from the truth. Physical activity can help decrease symptoms of osteoarthritis. In addition, physical activity is an important component of weight control and helps maintain healthy bones, muscles and joints. For joint-safe exercise programs, try the Arthritis Foundationís Life Improvement Series land or water exercise programs.
consult orthopaedician to avoid oa knee and learn the things for prvention of oa knee. a self-management course that teaches people with arthritis how to manage the pain and challenges that arthritis imposes. The course has been shown to lead to a 40% reduction in pain.
Osteoarthritis Overview

Osteoarthritis is not a single disease but rather the end result of a variety of disorders leading to the structural or functional failure of 1 or more of your joints. Osteoarthritis involves the entire joint including the nearby muscles, underlying bone, ligaments, joint lining (synovium), and the joint cover (capsule).

* Osteoarthritis also involves an advancing loss of cartilage. The cartilage tries to repair itself, the bone remodels, the underlying (subchondral) bone hardens, and bone cyst form. This process has several phases.

o The stationary phase of disease progression in osteoarthritis involves the formation of osteophytes or joint space narrowing.

o Osteoarthritis progresses further with obliteration of the joint space.

o The appearance of subchondral cysts (cysts in the bone underneath the cartilage) indicates the erosive phase of disease progression in osteoarthritis.

o The last phase in the disease progression involves bone repair and remodeling.

* Definitions

o Joint cartilage is a layer of tissue present at the joint surfaces that sustains joint loading and allows motion. It is gel-like, porous, and elastic. Normal cartilage provides a durable, low-friction, load-bearing surface for joints.

o Articular surface is the area of the joint where the ends of the bones meet, or articulate, and function like a ball bearing.

o Bone remodeling is a process in which damaged bone attempts to repair itself. The damage may occur from either an acute injury or as the result of chronic irritation such as that found in osteoarthritis.

o Collagen is the main supportive protein found in bone tendon, cartilage, skin, and connective tissue.

o Osteophytes are bony outgrowths or lumps, especially at the joint margins. They are thought to develop in order to offload the pressure on the joint by increasing the surface area on which your weight is distributed.

o Synovium is a membrane found within the joints that secretes a fluid that lubricates tissues where friction would otherwise occur.

o Subchondral bone is the part of bone under the cartilage.............Osteoarthritis Causes

The causes of osteoarthritis are varied.

* Endocrine: People with diabetes may be prone to osteoarthritis. Other endocrine problems also may promote development, including acromegaly, hypothyroidism, hyperparathyroidism, and obesity.

* Posttraumatic: Traumatic causes can be further divided into macrotrauma or microtrauma. An example of macrotrauma is an injury to the joint such as a bone break causing the bones to line up improperly (malalignment), lose stability, or damage cartilage. Microtrauma may occur over time (chronically). An example of this would be repetitive movements or the overuse noted in several occupations.

* Inflammatory joint diseases: This category would include infected joints, chronic gouty arthritis, and rheumatoid disease.

* Metabolic: Diseases causing errors of metabolism may cause osteoarthritis. Examples include Paget's disease and Wilson disease.

* Congenital or developmental: Abnormal anatomy such as unequal leg length may be a cause of osteoarthritis.

* Genetic: A genetic defect may promote breakdown of the protective architecture of cartilage. Examples include collagen disturbances such as Ehlers-Danlos syndrome.

* Neuropathic: Diseases such as diabetes can cause nerve problems. The loss of sensation may affect how the body knows the position and condition of the joints or limbs. In other words, the body can't tell when it is injured.

* Other: Nutritional problems may cause osteoarthritis. Other diseases such as hemophilia and sickle cell are further examples.
Osteoarthritis Symptoms

The following signs and symptoms may be seen:

* Pain: Aching pain, stiffness, or difficulty moving the joint may develop in 1 or more joints. The pain may get worse with overuse and may occur at night. With progression of this arthritis, the pain can occur at rest.

* Specific joints are affected.

o Fingers: Bone enlargements in the fingertips (first joint) are common. These are called Heberden nodes. They are usually not painful. Sometimes they can develop suddenly and are painful, swollen, and red. This is known as nodal osteoarthritis and occurs in women older than 45 years.

o Hip: The hips are major weight-bearing joints. Involvement of the hips may be seen more in men. Farmers, construction workers, and firefighters have been found to have an increased incidence of hip osteoarthritis. Researchers think that a heavy physical workload contributes to OA of the hip and knee.

o Knees: The knees are also major weight-bearing joints. Repetitive squatting and kneeling may promote osteoarthritis.

o Spine: Osteoarthritis of the spine can cause bone spurs or osteophytes, which can pinch or crowd nerves and cause pain and potentially weakness in the arms or legs.
When to Seek Medical Care

When to call the doctor

* Pain with no benefit from common pain relievers

* Confusion regarding the diagnosis (Osteoarthritis can be confused with rheumatoid arthritis.)

* Disability or loss of mobility, especially if sudden

When to go to the hospital

* Trauma: Injuries from trauma such as falls, especially sports-related injuries, may require x-rays.

* Signs of infection: Fever, redness, or joint swelling may indicate inflammation or an infection involving the joint. A joint infection is a serious problem requiring prompt diagnosis and antibiotic therapy. Gout can also have similar symptoms.

* Sudden inability to walk, bear weight, or a significant change in function would be a reason to seek immediate medical help.
Exams and Tests

* Imaging

o X-rays: Approximately a third of people with osteoarthritis on x-rays have symptoms such as pain or swelling. X-rays can show narrowing of the space between the joint (articular surface), osteophytes, cyst formation, and hardening of the underlying bone. Scoring systems have been used by doctors to assess the extent of the bony changes on x-rays. Separate scoring systems for the different joints have been studied and found to be predictive of disease status. An important finding from these studies was that the presence of osteoarthritis of the hands was a predictive sign of deterioration of the knee joint. In other words, people with finger joint osteoarthritis were more at risk to show a rapid progression of their knee.

o MRI: This study is a complex, noninvasive imaging technique that is unlike x-rays. X-rays provide information mainly on bones. However, MRI is capable of visualizing all structures within the joint. MRI technology is sophisticated and requires an expert to interpret the study.

o CT scan: This study may be used to image a joint. CT scanning mainly provides information on the bony structures of the joint but in greater detail than plain x-rays.

* Joint fluid analysis: Fluid may be drawn from the knee with a needle in cases in which the diagnosis is uncertain or if an infection is suspected.

* Blood tests: No currently accepted blood test or marker for this disease exists. Blood tests may be drawn in cases in which infection is suspected.
Osteoarthritis Treatment

Self-Care at Home

Lifestyle changes may delay or limit osteoarthritis symptoms.

* Weight loss: One study suggested that, for women, weight loss may reduce the risk for osteoarthritis in the knee.

* Exercise: Regular exercise may help to strengthen the muscles and potentially stimulate cartilage growth. Avoid high-impact sports. The following types of exercise are recommended: range of motion, strengthening, and aerobic.

* Diet: Antioxidant vitamins C and E may provide some protection. Vitamin D and calcium are recommended for strong bones. The recommended daily dose of calcium is 1000-1200 mg. The current guideline for vitamin D is 400 IU per day. Avoid more than 1200 IU of vitamin D per day.

* Heat: Hot soaks and warm wax (paraffin) application may relieve pain.

* Orthoses: These assistive devices are used to improve function of moveable parts of the body or to support, align, prevent, or correct deformities. Splints or braces help with joint alignment and weight redistribution. Other examples include walkers, crutches or canes, and orthopedic footwear.

* Over-the-counter (OTC) medications

o Acetaminophen (Tylenol) is the first drug recommended for osteoarthritis.

o Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for arthritis pain. These include aspirin, ibuprofen (Motrin or Advil), naproxen (Aleve), and ketoprofen (Orudis).

o Newer OTC preparations include chondroitin and glucosamine sulfate, which are natural substances found in the joint fluid. Chondroitin is thought to promote an increase in the making of the building blocks of cartilage (collagen and proteoglycans) as well as having an anti-inflammatory effect. Glucosamine may also stimulate production of the building blocks of cartilage as well as being an anti-inflammation agent. Glucosamine was found to increase blood sugar in animal studies, so people with diabetes should consult their doctor first. A recent study showed that glucosamine slowed progression of osteoarthritis in the knee.
Medical Treatment

The overall goal of treatment is early elimination of risk factors, early diagnosis and surveillance of the disease, and appropriate treatment of pain. Itís also important to help people regain their mobility. These goals may be reached through a logical approach to care including the overlapping of treatment that does not involve medications and treatment with medication and possibly surgical management.

Treatment that does not involve medications includes education, physical and occupational therapy, weight reduction, exercise, and assistive devices (orthoses). Surgery

Surgery may relieve pain and improve function.

* Arthroscopy is the examination of the inside of a joint using a small camera (endoscope). Arthroplasty is the repair of a joint in which the joint surfaces are replaced with artificial materials, usually metal or plastic.

* Osteotomy is incision or cutting of bone.

* Chondroplasty is surgical repair of the cartilage.

* Arthrodesis is a surgical fusion of the bony ends of a joint preventing joint movement. For example, fusion of an ankle joint prevents any further joint movement of the ankle itself. This is done as a result of many years of significant joint pain resulting from a previous significant injury or severe osteoarthritis. The procedure is performed to help block further pain by preventing any further joint movement.

* Joint replacement is removal of diseased or damaged bony ends and replacement with a manmade joint composed of a combination of metal and plastic. Knee joint replacement and hip replacement are the most common. Some joints, such as those of the spine, cannot be replaced presently.

No absolute way to prevent osteoarthritis is available. But lifestyle changes may reduce or limit symptoms. THANK YOU....... DR.PARAMAGURU.D.ortho- consultant orthopaedic surgeon.

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