Osteoarthritis

Osteoarthritis is a slowly progressive chronic condition affecting joints. The most common symptoms are pain, swelling and stiffness leading to reduced function of the affected joints. It is thought that the underlying process is the degeneration of the hyaline cartilage covering the end of bones with in the joints which undergo constant wear-tear and repair. The body has a remarkable ability to repair the damage but with advancing age and also with other factors such as excessive body weight, family history, lack of physical activity and muscle weakness the rate of repair is slower than the degeneration, leading to progressive increase of symptoms.

Previous injury to a joint (e.g., meniscal tear, ACL rupture of the knee or shoulder dislocation) and inflammatory conditions (rheumatoid arthritis and gout) can also accelerate the development of secondary osteoarthritis.

Arthritis can affect any joint in the body. The most commonly affected joints are:

1. Knees

2. Hips

3. Shoulders

4. Small joints of the hands and wrists

5. Big toes

5. Ankle 

Diagnosis:

Osteoarthritis can be diagnosed based on symptoms and examination. Occasionally an X-ray or blood test will be needed to exclude inflammatory cause to differentiate between osteoarthritis and rheumatoid arthritis. 

On occasions the joint might need to be drained (aspirated) if there is a large effusion (swelling) and sent for analysis.

Treatment:

This is usually a step-wise approach 

1. Loosing weight

2. Rehabilitation to improve muscle function and strength

3. Appropriate orthotic usage (footwear, brace)

4. Anti-inflammatory medication and simple analgesia during exacerbation (short duration)

5. Injection therapy (Hyaluronic acid, steroid or PRP). The aim of injection therapy is to reduce pain levels to enable an active lifestyle and to adhere to physiotherapy. The choice of treatment would depend on the severity of the condition and suitability of the patient. For example, Hyaluronic acid will not be effective in the presence of an effusion in the joint and PRP injections would be more appropriate in the early stages of arthritis.

6. Surgery is most appropriate when all conservative measure have failed and in advanced cases.