Health Tips

Osteoarthritis: Can I really prevent it?

Osteoarthritis (OA) is no new disease and it is the most common form of arthritis with many names such as degenerative arthritis and ‘wear and tear’ arthritis. It brings about disability and a reduced quality of life. OA can occur in different joint locations such as in the hands (specifically at finger joints),hip, knee and even the spine.

How it occurs 

If it is a wear and tear arthritis, can osteoarthritis be prevented? Although it is known as such, there are many factors that contribute to OA from biomechanical factors, proinflammatory mediators and proteases. The articular cartilage that acts as a shock absorber undergo changes as they experience maximal loading, the synovium experiences some degree of inflammation which contributes to cartilage destruction, pain and disease progression while bone and soft tissue are also affected.

Symptoms

Primary symptoms:

• Joint pain - progressive over the years, worsens with usage, relieved by rest. Different stages of OA has different characteristics of pain itself. Variable pain intensity, night pain in severe OA. affects one or more joints at the same time

• Stiffness (short-lived, early morning or due to inactivity) and tenderness

• Restriction of movement - with weak local muscles, crepitus

Signs

• Bony swelling with or without synovial fluid hypertrophy

• Joint deformity - a late sign of OA as advanced joint damage has occurred

• Instability  

Risk factors and Preventable measures we can take for modifiable risk factors

• Age >50 years old

• Female Gender 

• Genetics

• Joint Injury - brings about post traumatic OA. Knee is the most common joint injured and an Anterior Cruciate Ligament (ACL) ruptures associated with early onset OA.

• Anatomic factors such as joint malalignment - varus or valgus alignment of the knee, developmental dysplasia of the hip (DDH) or femoroacetabular impingement (FAI) of the hip

• Obesity - the most important risk factor as it influences the development and severity of the disease. Weight loss can improve pain symptoms and delay progression of joint damage.

• Occupation - related to regular wear and tear repetitive movements or heavy physical workload jobs

OA Grading

Grading is done by looking at a radiograph classified by Kellgren-Lawrence (KL) grading scale

Management of OA

The goal of management is to minimize pain, optimize function and beneficially modify the process of joint damage by targeting modifiable risk factors. 

• Non-pharmacologic - weight management, exercise (aerobic & strengthening exercises), braces, foot orthoses, and education of assistive devices can help patients with malalignment

• Pharmacologic - NSAIDs [topical only if one or few joints affected; oral if topical is inadequate, symptomatic OA with multiple joint involvements, and hip OA]

• Surgery - an option in advanced knee and hip OA (total joint replacement) if conservative therapies fail 

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Reference: 

1.  

   Clinical manifestations and diagnosis of osteoarthritis - UpToDate. Accessed November 22, 2019. https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-osteoarthritis?search=osteoarthritis&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2

2. Pathogenesis of osteoarthritis - UpToDate. Accessed November 22, 2019. https://www.uptodate.com/contents/pathogenesis-of-osteoarthritis?search=osteoarthritis&source=search_result&selectedTitle=5~150&usage_type=default&display_rank=4

3. Epidemiology and risk factors for osteoarthritis - UpToDate. Accessed November 22, 2019. https://www.uptodate.com/contents/epidemiology-and-risk-factors-for-osteoarthritis?search=osteoarthritis&source=search_result&selectedTitle=8~150&usage_type=default&display_rank=7

    

Picture Credits:

1. https://m.dailyhunt.in/news/india/english/lybrate+english-epaper-lybraten/can+you+prevent+osteoarthritis+in+old+age-newsid-89236385

2. https://www.uptodate.com/contents/image?imageKey=RHEUM%2F105815&topicKey=RHEUM%2F105723&search=osteoarthritis&rank=1~150&source=see_link

3. https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoarthritis/contents/what-is-osteoarthritis

4. https://www.researchgate.net/figure/The-KL-grading-system-to-assess-the-severity-of-knee-OA_fig6_315695691

5. https://milltownphysiotherapy.com/what-exercise-is-good-for-osteoarthritis/

Written by

Dr. Jessamine Chong Sze Lynn