The most common form of arthritis, Osteoarthritis (OA) affects an estimated 40% of the adult population. Of these, only 10% seek medical advice and only 1% are severely disabled.
In OA, you will have no problem in the morning on arising but as the day progresses your discomfort will increase.
In the evening, there will be a dull ache in the area of the affected joint.
Other symptoms include:
The changes associated with degenerative arthritis tend to involve similar joints. Whereas in post-traumatic degenerative arthritis where there is a history of acute or chronic trauma, the changes tend to be isolated to the specific joints injured.
Osteoarthritis (OA) means inflammation of the joints although it is better known as a degenerative disease due to the inflammation of the joints with thinning of the articular cartilage. The cartilage in our joints allows for the smooth movement of joints. When it becomes damaged due to injury, infection or gradual effects of ageing, joints movement is hindered. As a result, the tissues within the joint become irritated causing pain and swelling within the joint.
Old age As a person grows older, it becomes more likely that the cartilage may be worn away. OA is uncommon in people below 40 years of age.
Gender Women are more likely to suffer from OA, especially after menopause.
Previous joint injury Someone with a previous injury to the cartilage within the joint, e.g. after a fracture involving the joint or after a sporting injury to the joint will have a higher risk of developing OA later in life.
Weight A greater than normal body weight puts more stress on the weight-bearing joints such as the hip and knee, increasing the likelihood of developing OA in these joints.
Bone deformities People born with deformed joints or abnormal cartilage have an increased risk of OA.
Other diseases that affect the joints Bone and joint diseases that increase the risk of OA include other arthritic conditions such as rheumatoid arthritis and gout.
Genetics Genetic factors may predispose to the development of OA.
The specialist will begin by taking a detailed history of your problem and past medical problems, followed by a physical examination. He may then proceed to other tests, such as:
X-raysThis is the most commonly performed test to evaluate the status of the affected joint and the alignment of the joint. Normal x-rays are safe, simple and pain-free.
Blood tests Depending on the clinical findings, blood may be drawn for special testing, to rule out other causes of joint pain, e.g. due to rheumatoid arthritis, gout or infection.
Joint aspirationOccasionally, especially when the joint is very swollen, the doctor may choose to suck some fluid out of the swollen joint for special testing. Removal of joint fluid also sometimes relieves pain.
The goals for treatment for osteoarthritis are:
The treatment for OA depends on the severity of the disease and the patient’s own lifestyle expectations.
Early cases of OA can generally be treated with:
In OA of the hand, rest can be accomplished by selectively immobilising the joint in a splint. Splinting is initially done for a period of 3 - 4 weeks, during which the splint is worn continuously.
This is usually combined with non-steroidal anti-inflammatory medication (NSAIDs) taken at the same time. If there is improvement in symptoms, use of the splint during the day is progressively diminished over the course of the coming month/s.
Use of NSAIDS
Types of medication
The most commonly prescribed medications are painkillers. The type of painkiller prescribed depends on the severity of the pain. For early disease with mild and occasional pain, simple painkillers such as paracetamol (Panadol®) can be effective, although more severe pain may require the use of non-steroidal anti-inflammatory drugs (NSAID’s) for relief. Analgesic (painkillers) creams and adhesive patches can also be used.
Glucosamine, with or without chondroitin, has also become a popular drug treatment in recent years. It can be purchased without a doctor’s prescription.
However, it is ineffective in many patients, especially those with severe OA. The duration of its symptomatic relief also tends to be temporary. There is no evidence that glucosamine or chondroitin is able to result in cartilage repair.
For the treatment of OA, your doctor may sometimes recommend a steroid injection into or around the joint if you have not responded to conservative treatment indicated above. While pain relief can be impressive, it is usually only temporary, and your doctor will limit the number of steroid injections that you can receive as repetitive injections can weaken tendons further worsening the already damaged cartilage.
Surgery is usually only offered for severe disease that has not responded to conservative treatments mentioned. Both the type of surgery and the decision for surgery are made following careful discussions between you and your doctor.
For many joints in the hands, arthodesis or fusion of the joint is the method of choice. In joint fusion, the arthritic surface is removed and bones on either side of the joint are fused to eliminate movement from the problem joint.
There may be some loss of movement but the pain ablation and stability may functionally improve the joint that is severely affected by the degenerative joint disease.
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