Osteoarthritis, or degenerative joint disease, is a disorder that ultimately leads to pain in the affected joint, and functional degeneration of the affected joint. Over 12 million people over the age of 65 are affected by this disease. The most commonly affected joints are those of the knee, hip and hand. OA is responsible for 400,000 hospital visits, and up to eight billion dollars for hip and knee replacements annually. The most common risk factors include advanced age, obesity, past occupation, participation in certain sports, joint trauma, and family history. Symptoms include joint stiffness in the morning, or after a period of inactivity of thirty minutes or less, limited or reduced range of motion, and joint deformity in later stages.
The first place where treatment should start include preventive measures including weight loss, quitting smoking, and reducing joint damage by avoiding activities that involve high impact on joints and repetitive motion such as typing, writing, kneeling, squatting, or heavy lifting. Patient education should be the first step in the treatment of OA. Education should cover the progression of the disease, the patient prognosis, and appropriate treatment options. Also, proper resources that the patient can consult for efficient self management information and programs. The most important modifiable risk factor for the development of OA is obesity. It is shown that a three to fourfold increase in the risk of joint replacement is associated with increased body weight. This should be a major focus for individuals with OA in the knee and hip. An eighteen month program of caloric restriction and exercise resulted in a twenty-four percent improvement in physical function and a thirty percent reduction in knee pain. Physical and occupational therapy is shown to be beneficial for patients who do not benefit from home exercise programs or need further instruction in range of motion, joint protection, or muscle-strengthening principles. Exercise programs focused on the quadriceps, adductor, and abductor muscles have be shown to improve knee and hip stabilization. Surgery is recommended as a last resort effort tom manage OA symptoms in patients whose disease is refractory to less-invasive management methods. Joint replacement should not be delayed in order to best preserve optimal restorative function. In terms of pharmacologic treatment options, the first medication that should be used is acetaminophen, which is shown to be effective for mild-to-moderate pain relief. Non-steroidal anti-inflammatory drugs are shown to be more effective that acetaminophen, but due to the large side effect list of NSAID's, including nausea, abdominal pain, peptic ulcers, edema, increase in blood pressure, and renal insufficiency, acetaminophen is preferred as the first line of therapy. If symptoms persist, NSAID's should be used, and the choice of NSAID's should be based on patient comorbidities, cost, and side-effect profile. Topical analgesics are used for patients unable to tolerate systemic agents. If symptoms persist, intra-articular glucocorticoid injections are used to bring relief to a localized area. Then opioid analgesics are used, for a short time period only in order to avoid addiction. If none of these things help, the last resort is surgery.
This topic hits particularly close to home as my mom, my dad, and my grandmother are all affected by OA. My mom has gone through many series of injections, and ultimately a recent surgery to reduce the arthritis in her thumb joint. My dad will be forced to have a total hip replacement in both of his hips, and his knees are pretty bad. My grandmother has been dealing with arthritis of the hand and wrist for quite some time now. Since I have a rare bone disease myself, called fibrous dysplasia, I hope that I am not at a higher risk of developing OA later in my life.
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