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Submitted by:
Javier, Jomar
While osteoarthritis can affect any joint in your body, the disorder most commonly
affects joints in your:
Hands
Hips
Knees
Neck
Lower back
Osteoarthritis gradually worsens with time, and no cure exists. But osteoarthritis
treatments can relieve pain and help you remain active. Taking steps to actively
manage your osteoarthritis may help you gain control over your symptoms.
Causes
Primary osteoarthritis is mostly related to aging. With aging, the water content of the cartilage increases, and the
protein makeup of cartilage degenerates. Eventually, cartilage begins to degenerate by flaking or forming tiny
crevasses. In advanced cases, there is a total loss of cartilage cushion between the bones of the joints. Repetitive
use of the worn joints over the years can irritate and inflame the cartilage, causing joint painand swelling. Loss of the
cartilage cushion causes friction between the bones, leading to pain and limitation of joint mobility. Inflammation of
the cartilage can also stimulate new bone outgrowths (spurs, also referred to as osteophytes) to form around the
joints. Osteoarthritis occasionally can develop in multiple members of the same family, implying a hereditary (genetic)
basis for this condition.
Sex. Women are more likely to develop osteoarthritis, though it isn't clear why.
Bone deformities. Some people are born with malformed joints or defective
cartilage, which can increase the risk of osteoarthritis.
Joint injuries. Injuries, such as those that occur when playing sports or from an
accident, may increase the risk of osteoarthritis.
Tenderness. Your joint may feel tender when you apply light pressure to it.
Stiffness. Joint stiffness may be most noticeable when you wake up in the
morning or after a period of inactivity.
o Heberden’s nodes
o Bouchard’s nodes
Diagnosis:
XRAY
If the doctor suspects other conditions, or if the diagnosis is uncertain, additional tests
are necessary.
It is important to note that a negative x-ray does not rule out osteoarthritis. Likewise,
some people may have minimal symptoms even though an x-ray clearly shows they
have arthritis.
An MRI exam of an arthritic joint is generally not needed, unless the doctor suspects
other causes of pain.
X-rays are a form of ionizing radiation that can penetrate the body to form an image on
film. Structures that are dense (such as bone) will appear white, air will be black, and
other structures will be shades of gray depending on density. X-rays can provide
information about obstructions, tumors, and other diseases, especially when coupled
with the use of barium and air contrast within the bowel.
Physical Exam
The affected joint in patients with osteoarthritis will generally be tender to pressure right
along the joint line. Joint movement may cause a crackling sound. The bones around
the joints may feel larger than normal. The joint's range of motion is often reduced, and
normal movement is often painful.
Blood Tests
Blood test results may help identify other causes of arthritis (if present) besides
osteoarthritis. Some examples include:
A number of other blood tests may help identify other rheumatological illnesses.
Arthroscopy
INTERVENTIONS
Pain management
The choice and frequency of pain medication depends on the severity of your symptoms
and the risk of side effects and may range from acetaminophen and non-steroidal anti-
inflammatory drugs (NSAIDs) to narcotic drugs and steroids. You need to be aware of
possible side effects, such as gastrointestinal upset and bleeding. Other pain
management treatments include acupuncture and topical creams (such as capsaicin
and methylsalicylate).
Nutritional counseling
Lack of mobility and sedentary lifestyle often lead to increased weight, putting strain on
your already damaged joints. A nutritional assessment helps to develop a healthy
weight-maintenance or health-reduction plan. Because osteoporosis is common with
osteoarthritis, your diet should contain adequate vitamin D and calcium.
Exercise program
Bone health and mobility are dependent on exercise, so you need to develop a plan of
exercise that includes some aerobic conditioning, such as walking. Exercise programs
must begin slowly, allowing you to increase your endurance over time to avoid
increasing joint inflammation. You should plan regular exercise at the time of day when
your pain is least intense and after pain medication.
Heat/cold therapy
Heat therapy (warm bath, compresses, shower) is especially effective to relieve
stiffness and may be used 2 to 3 times a day for a half hour each time. Using heat
therapy before activities can increase endurance. Cold therapy (compresses, ice packs)
is often effective to relieve swelling and discomfort when a joint is inflamed.
Assistive devices/equipment
Hyaluronic injection
Injecting hyaluronic acid into an osteoarthritic joint has been shown to improve joint
health by:-
Increasing synovial fluid levels of hyaluronic acid improving its viscosity, and
freedom of joint movement.
Decreasing levels of prostaglandins improving pain,
Increasing the cartilage depth on load bearing surfaces,
Having effects on these parameters for more than 6 months.
SURGICAL MANAGEMENT
Excision arthroplasty. In this method one or both of the articular ends of the
bones are simply excised, so that a gap is created between them (Fig. 13). The
gap fills with fibrous tissue, or a pad of muscle or other soft tissue may be sewn
in between the bones. By virtue of its flexibility the interposed tissue allows a
reasonable range of movement, but the joint often lacks stability. The method is
applicable to all the joints for which arthroplasty is practicable except the knee
and ankle. It is used most commonly at the metatarso-phalangeal joint of the
great toe, in the treatment of hallux valgus and hallux rigidus. At the hip it may be
used as a salvage operation after failed replacement arthroplasty.
Total joint arthroplasty- Arthroplasty in which both joint surfaces are replaced
with artificial materials, usually metal and high-density plastic.
CASTS