What is Osteoarthritis (OA)?

  • Commonly referred to also as Degenerative Joint Disease (DJD)
  • It is “wear and tear” arthritis – very common in most of us as we age
  • It is a progressive disease with degenerative changes in the ends of the bones that forms joints
  • OA is a degenerative arthritis meaning it gets worse over time
  • It is not reversible.

What causes OA?

  • Primary osteoarthritis – Due to:
    • Age
    • Genetic factors
  • Secondary osteoarthritis – Due to any condition that:
    • Damages cartilage directly (past accidents and trauma)
    • subjects joint surfaces to abnormal repetitive forces (repetitive trauma /sports)

It is likely in most people as they age there is an amount of both primary and secondary osteoarthritis.

Incidence

  • Is the most common type of arthritis
  • Most common in weight-bearing joints
    • Knee, Hip, Ankle, Spine (lower back and neck) and end joints of fingers
  • Occurrence
    • 10% of entire adult population
    • 50% of those >60 years of age
    • 85% of those >80 years of age

The disease process

  • Gradual loss of cartilage in the joint/s & loss of the joint space
  • Thickening of adjacent bone & possible cysts
  • Formation of bone cysts in joint areas
  • Extra boney growths (Osteophyte) formation at the joint margins
  • Chronic, non-specific inflammation resulting in stiffening & thickening of the joint capsule.

Possible Signs and symptoms

  • Pain
    • Most common -local or referred – Gradual onset
    • possible acute episodes or ‘flare-ups”
    • Worse with too much or inappropriate activity and at night, better with rest
  • Stiffness
    • Decreased range of motion common after inactivity (ie: sitting all day, or getting out of bed)
  • Swelling
    • Can be intermittent or continuous, usually associated with ‘flare-up’
  • Loss of function
    • due to joint damage, pain, muscle wasting etc
  • Crepitus
    • Audible & palpable ‘grating’ of joint surface.
  • Joint involvement is often asymmetrical in joints outside of the spine

How To Manage Your Condition

You cannot undo the damage that has been done. Unfortunately, osteoarthritis is degenerative and progressive.
You can however somewhat manage your condition; slow the progression rate and help to avoid and treat ‘flare-ups.’

  • Understanding what Osteoarthritis is and knowing what activities possibly flare or irritate it for you.
  • Rest (during acute ‘flare-ups’ only)
  • Osteopathic management
    • An osteopath can advise you on exercise, posture and ways to relieve pain.
    • They can use regular treatments to keep your joints and muscles as flexible as possible and help to manage your condition
    • They can help to relive acute episodes of pain where there is muscle spasm and joint stiffness
    • Most people benefit from monthly treatment for OA.

In your day-to-day life

  • Avoid sitting for prolonged periods at the desk or driving – take regular breaks (hourly) and do gentle movement.
  • Avoid long hours of standing, walking or exercise without a break.
  • Make sure you have good ergonomics at your desk, car etc
  • Ensure you have a supportive mattress and pillow
  • Always wear good footwear – low heal, well balanced and rubber sole for less impact
  • Lift correctly – using legs, bend knees & back straight.
  • Caution with bending down to dishwasher, pets etc
  • Caution with gardening, cleaning and household activities that may require a lot of physical effort, bending, lifting etc
  • Be careful with strong physical activity that you are not used to.

Exercise

  • You will need to seek advice on your condition specifically, but as a general guide if Osteoarthritis affects your back.

Do’s

  • Lying on bed or floor Rock knees to chest and side to side to keep mobility in the spine.
  • Do gentle mobility exercises before and after bed.
  • Walking daily – gentle, avoid steep hills if possible
  • Swimming (excellent as it is very low impact on joints)
  • Cross trainer (good low impact cardio exercise)
  • Bike riding – with care for posture

Don’ts

  • High impact exercises or sports that involve repetitive jarring of the spine
  • Lift very heavy weights
  • Lift using or bending your back
  • Commence a weights training program without supervision
  • Lifting and twisting exercises

Strengthening exercises prescribed specially for you

  • Eg: Abdominal strengthening
  • Core muscle – exercises
  • Use of a fit/medicine ball

Stretches that are good for your low back and hip when done properly. Your Osteopath can take you through these.

  • Hamstrings
  • Quadriceps
  • Glutes
  • Lumbar curls

Heat
Generally heat (warm shower or wheat pack is good for your condition EXCEPT in acute flare –ups where you should seek advice

  • Glucosamine and joint support supplements including Fish oil supplements high in EPA.
    Glucosamine is a normal constituent of a substance found in joint cartilage and synovial fluid.

In the 1990s multiple, small, variable quality studies were performed, mainly in Europe, to test the efficacy of glucosamine and chondroitin in patients with various types of osteoarthritis. These studies were evaluated in a meta-analysis in 2000. The authors of this review of 15 studies concluded that ‘trials of glucosamine and chondroitin
preparations for osteoarthritis symptoms demonstrate a moderate to large effect.
McAlindon TE, LaValley MP, Gulin JP, Felson DT. Glucosamineand chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. JAMA 2000;283:1469-75.

Clinical trials have now shown that the use of oral glucosamine sulphate 1.5 g daily in patients with osteoarthritis of the knee results in a significant reduction in joint pain and an improvement in joint function. In addition, glucosamine appears to reduce the loss of cartilage in the knee joint over at least a three-year period, particularly in those with milder radiological osteoarthritis. It would therefore seem reasonable to recommend a trial of glucosamine in patients with symptomatic osteoarthritis of the knee.
Geoff McColl, Associate Professor, Centre for Rheumatic Diseases and Department of Medicine, Royal Melbourne Hospital, Melbourne. Glucosamine for osteoarthritis of the knee Aust Prescr 2004;27:61-3

  • Weight loss (if applicable)
    Osteoarthritis is most common in weight-bearing joints, Knee, Hip, Ankle, Spine (lumbar & cervical), and end joints of fingers. A reduction in excess weight takes excess pressure off these joints.

There are no perfect measures of overweight and obesity. Body Mass Index (BMI), which is calculated by dividing weight in kilograms by height in meters squared, is used most often.
For example, a woman 1.67m in height and weighing 65kg would have a BMI of 23.3

A person’s waist circumference may be a better predictor of health risk than BMI. Having fat around the abdominal organs and enlarged waist circumference, regardless of your BMI, means you are more likely to develop certain obesity-related health conditions. Fat predominantly deposited around the hips and buttocks does not appear to have the same risk. Men and post menopausal women are at greater risk of excess fat in the waist region.

A waist circumference of 80cm for women and 94cm for men or greater indicates increased risk of obesity related health conditions.

  • Medications
    Always seek professional advice before taking any medications for your pain to
    make sure that the medicine is safe for you and the correct medication to help
    your symptoms.

    • Analgesics – like Paracetamol may help to reduce pain in acute episodes
    • Anti-inflammatories – are generally not useful unless there is an ‘acute
      flare up’ you should seek professional advice
  • Surgery
    • In severe cases surgery and joint replacement has been shown to be effective especially for hips and knees. In this case, I would recommend consulting a specialist surgeon for their opinion. To do this, you must go through your GP.
    • What if I have an Acute episode
    • Stop any activities that cause pain and rest
    • See the osteopath for specific assessment, advice and referral if necessary
    • Don’t use heat
    • Use Panadol etc only as prescribed

References

  • Australian Institute of Health and Welfare 2004, Australia’s Health, AIHW cat. no. AUS 44, AIHW, Canberra.
  • Australian Institute of Health and Welfare 2004b, AIHW Disease Expenditure Database, July 2004.
  • Kumar P. and Clark M. 2004, Clinical Medicine 5th ed. WB Saunders
  • Davidson’s Principles and Practice of Medicine 19th ed. 2002 Churchill Livingstone
  • Dorlands Medical Dictionary28th Ed 1994, WB Saunders
  • The Merck Manual 17th Ed 1999 Merck Research Laboratories
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