What is Osteoarthritis? Things to know about Osteoarthritis.

Dr. Rajan Poudel 
MBBS(BS/MD)
Health Care Team Leader at UN CAMMAY Volunteer 2020

 Most common joint disease cause of disability in the elderly. Commonly affected joints are the cervical and lumbosacral spine, hip, knee and first MTP.

–In the hands, the distal and proximal ITP’s and base of the thumb are often involved.

–Wrist, elbow and ankles are usually spared.

Risk factors include genetic disposition, age, injury, weight, stress on the joint, and previous surgery involving the joint.

•Prevalence increases sharply for women after age 40 years and after age 50 for men.

•Joint pain is activity-related, starting as episodic and progressing continuously with accompanying brief morning stiffness (<30 min) that gradually resolves.

Diagnosis:

–No blood tests are routinely indicated

–Synovial fluid analysis reveals a non-inflammatory pattern

–Joint imaging correlates poorly with presence and severity of pain:

•May be normal in early stages.

•Advanced stages may show joint space narrowing, subchondral sclerosis, osteophytes.

Management:

–Goal is to relief pain and prevention of disability.

–Non-Pharmacologic and Adjunctive Management.

•Exercise with brief periods of rest for the involved joint.

•Weight management (weight loss of 5 kg) translates to 50% reduction in pain): core treatment for obese and overweight adults with knee OA.

•Correction of possible malalignment (knee, braces, orthotics)

Pharmacologic Management:

•Acetaminophen (dose up to 1000 mg QID): initial pharmacologic treatment of choice.

•Low-dose NSAIDs or selective-COX-2 inhibitors.

•Glucosamine and chondroitin sulfate.

•Intra-articular injections (steroids and hyaluronans)

•Opioids (tramadol)

•Topical capsaicin

•Surgery (arthroscopic debridement and lavage, meniscectomy, arthroplasty)

Case:

•O.A., 49 year old female, Nepali, married, college instructor presented complaining of ongoing left hip pain and occasional low back stiffness, which reported starting to notice five to six months prior after she started a nightly walking routine.

•She complained that the left hip pain started deep in the groin region and referred laterally into the gluteal region and was worst at night, with some short term stiffness in the morning. She rated the pain  6/10 ( 10 being the worst pain).

•She described it as constantly stiff and throbbing in certain positions. Aggravating factors included getting out of a car, sitting with her knees up, stepping off a curb, stair climbing and after long walks.

•She said that she sits most of the time now during lectures because it’s hard for her to stand and move for a long time and also difficult to walk straight because of low back pain. Patient is having a hard time to lift heavy objects.

•She reported that her diet was “average”, non-smoker, drank alcohol occasionally in moderation.

She stated that she slept “well “with 6-8 hours per night, but she was interrupted because of her left hip pain. Previous accidents included a bike accident which led to a cervical  spine injury and contusions, as well as motor vehicle collision as a pedestrian which led to knee contusions.

•Her relevant family history included breast cancer, thyroid conditions, hypertension and osteoporosis. Other complaints included bilateral foot pain (on the ball of the foot and first metatarsal), occasional low back stiffness and that she was attempting to lose weight because she is overweight.

Impairment:

•Joint pain

•Loss of mobility

•Morning stiffness 

Disability:

•hard to stand and move for a long time.

•difficult to walk straight.

•hard time to lift heavy objects.

•Cannot sleep well because of pain  felt at the hip.