Osteoarthritis-OA

• Osteoarthritis (OA) is by far the most common form of arthritis.
• Moreover, It is strongly associate with ageing and is a major cause of pain and disability in older people.
• Inflammation can occur but is not a prominent feature.
• Joint involvement in Osteoarthritis (OA) follows a characteristic distribution, mainly targeting the hips, knees, PIP (Proximal Interphalangeal Joint) & DIP (in other words, Distal Interphalangeal Joint) of the hands, neck and lumbar spine.
• The prevalence of osteoarthritis (OA) rises progressively with age and it has estimated that 45% of all people develop knee OA also 25% hip OA at some point during life.
• Although some of these patients are asymptomatic, the lifetime risk of having a total either hip or knee replacement for OA in someone aged 50 is about 11% in women and 8% in men.
• Symptoms attributable to osteoarthritis (OA) are more prevalent in women, except at the hip, where men are equally affected. [1]
• A joint is where two bones come together. Additionally; the ends of these bones are cover with protective tissue called cartilage. With OA, this cartilage breaks down, causing the bones within the joint to rub together. Besides this, This can cause pain, stiffness, and other symptoms.
• Osteoarthritis (OA) occurs most often in older people, although it can occur in adults of any age.
• All in all; Osteoarthritis (OA) is also call degenerative joint disease, degenerative arthritis, and wear-and-tear arthritis. [3]

Pain:

• Insidious onset over months or years
• Either Variable or intermittent over time (‘good days, bad days’)
• Mainly related to movement and weight-bearing, relieve especially by rest
• Only brief (< 15 mins) morning stiffness also brief (< 5 mins) ‘gelling’ after rest
• Usually only one or a few joints painful

Clinical signs in Osteoarthritis (OA):

• Restricted movement due to capsular thickening, or blocking by osteophyte
• Furthermore; Palpable, sometimes audible, coarse crepitus due to rough articular surfaces
• Bony swelling around joint margins
• Deformity, usually without instability
• Either Joint-line or periarticular tenderness
• Muscle weakness also wasting
• Synovitis mild or absent

Types:

Generalised nodal OA:

Characteristics of generalised nodal osteoarthritis i.e.:

• Polyarticular finger interphalangeal joint Osteoarthritis (OA)
• Heberden’s (± Bouchard’s) nodes
• Marked female preponderance
• Peak onset in middle age
• Good functional outcome for hands
• Predisposition to Osteoarthritis (OA) at other joints, especially knees
• Strong genetic predisposition

Some patients are asymptomatic whereas others develop pain, stiffness and swelling of one or more PIP joints of the hands from the age of about 40 years onward.

Gradually, these develop posterolateral swellings on each side of the extensor tendon that slowly enlarge and harden to become Heberden’s (DIP) and Bouchard’s (PIP) nodes.

Typically, each joint goes through a phase of episodic symptoms (1–5 years) while the node evolves and OA develops.

Once OA is fully establish, symptoms may subside and hand function often remains good.

Affected joints are enlarge as the result of osteophyte formation and often show characteristic lateral deviation, reflecting the asymmetric focal cartilage loss of Osteoarthritis (OA).

Involvement of the first carpometacarpal joint (CMC) is also common, leading to pain on trying to open bottles and jars and functional impairment.

Clinically, it may detect by the presence of crepitus on joint movement, and squaring of the thumb base.

Generalised nodal OA has a very strong genetic component: the daughter of an affected mother has a 1 in 3 chance of developing nodal OA herself. [1]

Knee OA:

Osteoarthritis Of Knee

Location i.e.:

OA principally targets the patello­femoral and medial tibio­femoral compartments at this site but eventually spreads to affect the whole of the joint.

It may isolate or occur as part of generalised nodal OA.

Most patients, particularly women, have bilateral and symmetrical involvement.

With men, trauma is a more important risk factor and may result in unilateral OA.

Pain i.e.:

The pain is usually localised to the anterior or medial aspect of the knee and upper tibia.

Patello­femoral pain is usually worse going up and down stairs or inclines.

Posterior knee pain suggests the presence of a complicating popliteal cyst (Baker’s cyst).

Prolonged walking, rising from a chair, getting in or out of a car, or bending to put on shoes and socks may be difficult.

Local examination findings may include i.e.:

• A jerky, asymmetric (antalgic) gait with less time weight bearing on the painful side
• A varus, less commonly valgus, and/or fixed flexion deformity
• Joint ­line and/or periarticular tenderness (secondary anserine bursitis and medial ligament enthesopathy, causing tenderness of the upper medial tibia)
• Weakness and wasting of the quadriceps muscle
• Restricted flexion/extension with coarse crepitus
• Bony swelling around the joint line

Calcium pyrophosphate dihydrate (CPPD) crystal deposition in association with OA is most common at the knee. [1]

Hip OA:

Location i.e.:

Hip OA most commonly targets the superior aspect of the joint.

This is often unilateral at presentation, frequently progresses with superolateral migration of the femoral head, and has a poor prognosis.

The less common central (medial) Osteoarthritis-OA shows more central cartilage loss and is largely confined to women.

It is often bilateral at presentation and may associate with generalised nodal OA.

It has a better prognosis than superior hip OA and progression to axial migration of the femoral head is uncommon.

Pain i.e.:

Hip pain is usually maximal deep in the anterior groin, with variable radiation to the buttock, anterolateral thigh, knee or shin.

Lateral hip pain, worse on lying on that side with tenderness over the greater trochanter, suggests secondary trochanteric bursitis.

Common functional difficulties are the same as for knee Osteoarthritis-OA; in addition, restricted hip abduction in women may cause pain on intercourse.

Examination may reveal i.e.:

• An antalgic gait
• Weakness and wasting of quadriceps and gluteal muscles
• Pain and restriction of internal rotation with the hip flexed the earliest and most sensitive sign of hip OA; other movements may subsequently restricted and painful
• Anterior groin tenderness just lateral to the femoral pulse
• Fixed flexion, external rotation deformity of the hip
• Ipsilateral leg shortening with severe joint attrition and superior femoral migration.

Although obesity is not a major risk factor for development of hip Osteoarthritis-OA, it is associated with more rapid progression.

Spine OA:

• The cervical and lumbar spine are predominantly targeted by OA, then referred to as cervical spondylosis and lumbar spondylosis, respectively.
• Spine OA may occur in isolation or as part of generalised OA.
• The typical presentation is with pain localised to the low back region or the neck, although radiation of pain to the arms, buttocks and legs may also occur due to nerve root compression.
• The pain is typically relieved by rest and worse on movement.
• On physical examination, the range of movement may be limited and loss of lumbar lordosis is typical.
• The straight leg raising test or femoral stretch test may be positive and neurological signs may be seen in the legs where there is complicating spinal stenosis or nerve root compression.

Early-onset OA:

• Unusually, typical symptoms and signs of Osteoarthritis-OA may present before the age of 45.
• In most cases, a single joint is affected and there is a clear history of previous trauma.
• However, specific causes of OA need to be considered in people with early onset disease affecting several joints, especially those not normally targeted by Osteoarthritis-OA, rare causes need to be considered.
• Kashin– Beck disease is a rare form of Osteoarthritis-OA that occurs in children, typically between the ages of 7 and 13, in some regions of China.
• The cause is unknown but suggested predisposing factors are selenium deficiency and contamination of cereals with mycotoxin­ producing fungi.

Causes of early-onset osteoarthritis:

Monoarticular e.g.:

• Previous trauma
• Localised instability

Pauciarticular or polyarticular e.g.:

• Juvenile idiopathic arthritis
• Metabolic or endocrine disease: for example Haemochromatosis, Ochronosis, Acromegaly
• Spondyloepiphyseal dysplasia
• Late avascular necrosis
• Neuropathic joint
• Kashin–Beck disease [1]

There are several factors that increase a person’s chances of developing osteoarthritis.

Causes of Osteoarthritis-OA:

Heredity i.e.:

• Some people have an inherited defect in one of the genes responsible for making cartilage.
• This causes defective cartilage, which leads to more rapid deterioration of joints.
• People born with joint abnormalities are more likely to develop osteoarthritis, and those born with an abnormality of the spine(such as scoliosis or curvature of the spine) are more likely to develop osteoarthritis of the spine.

Obesity i.e.:

• Obesity increases the risk for osteoarthritis of the knee, hip, and spine.
• Maintaining ideal weight or losing excess weight may help prevent osteoarthritis of these areas or decrease the rate of progression once Osteoarthritis-OA is established.

Injury i.e.:

• Injuries contribute to the development of osteoarthritis.
• For example, athletes who have knee-related injuries may be at higher risk of developing osteoarthritis of the knee.
• In addition, people who have had a severe back injury may predispose to develop osteoarthritis of the spine.
• People who have had a broken bone near a joint are prone to develop osteoarthritis in that joint.

Joint overuse i.e.:

• Overuse of certain joints increases the risk of developing osteoarthritis.
• For example, people in jobs requiring repeated bending of the knee are at increase risk for developing osteoarthritis of the knee.

Other diseases i.e.:

• People with rheumatoid arthritis, the second most common type of arthritis, are more likely to develop osteoarthritis.
• In addition, certain rare conditions, such as iron overload or excess growth hormone, increase the chance of developing Osteoarthritis-OA. [4]

There is no blood test for the diagnosis of osteoarthritis.

Blood tests are performed to exclude diseases that can cause secondary osteoarthritis, as well as to exclude other arthritis conditions that can mimic osteoarthritis.

X-rays:

• X-rays of the affected joints can use to diagnose osteoarthritis.
• The common X-ray findings of Osteoarthritis-OA include loss of joint cartilage, narrowing of the joint space between adjacent bones, and bone spur formation.
• Simple X-ray testing can also very helpful to exclude other causes of pain in a particular joint as well as assisting the decision-making as to when surgical intervention might consider.

Arthrocentesis:

• Arthrocentesis is a procedure to remove joint fluid that is often performed in a health care professional’s office.
• During arthrocentesis, a sterile needle is use to remove joint fluid for analysis.
• Joint fluid analysis is useful in excluding gout, infection, and other causes of arthritis.
• Removal of joint fluid and injection of corticosteroids into the joints during arthrocentesis can help relieve pain, swelling, and inflammation.

Arthroscopy:

• Arthroscopy is a surgical technique whereby a doctor inserts a viewing tube into the joint space.
• Abnormalities of and damage to the cartilage and ligaments can detect and sometimes repair through the arthroscope.
• If successful, patients can recover from the arthroscopic surgery much more quickly than from open joint surgery.

Finally, a careful analysis of the location, duration, and character of the joint symptoms and the appearance of the joints helps the doctor in diagnosing osteoarthritis.

Bony enlargement of the joints from spur formations is characteristic of osteoarthritis.

Therefore, the presence of Heberden’s nodes, Bouchard’s nodes, and bunions of the feet can indicate to the doctor a diagnosis of osteoarthritis. [5]

Management of Osteoarthritis (OA):

OA treatment is centered upon symptom management.

The type of treatment that will help you the most will largely be determined by the severity of your symptoms and their location.

Often, lifestyle changes, over-the-counter (OTC) medication, and home remedies will be enough to provide you with relief from pain, stiffness, and swelling.

At-home treatments and lifestyle changes for Osteoarthritis-OA include:

Exercise i.e.:

• Physical activity strengthens the muscles around your joints and may help relieve stiffness.
• Aim for at least 20 to 30 minutes of physical movement, at least every other day.
• Choose gentle, low-impact activities, such as walking or swimming.
• Tai chi and yoga can also improve joint flexibility and help with pain management.
• Gentle stretching exercises can be very helpful for people with Osteoarthritis-OA, especially if you have stiffness or pain in your knees, hips, or back.
• Stretching can help improve mobility and range of motion.

Weight loss i.e.:

• Being higher-weight person can put strain on your joints and cause pain.
• Shedding excess pounds helps relieve this pressure and reduces pain.
• A healthy weight can also lower your risk of other health problems, such as diabetes and heart disease.

Bryonia Alba:

• Excellent remedy which is useful in treatment of osteoarthritis, pain with inflammation which is aggravated by movement on the other hand relieved by moderate pressure and rest.
• There is inflammation of joints which are hot also swollen.

Rhus Toxicodendron:

• Recurring attacks due to getting chilled.
• Rheumatism caused by damp weather and worse in damp climate; there is restlessness and the pains are worse on first motion, better by continued motion.

Kali Carb:

• Pains stitching, stabbing and burning character relieved temporarily by cold application and not by rest or motion.
• The patient shrieks on account of pain.
• Backache accompanied by great weakness.

Arnica:

• Generally, Chronic arthritis with a feeling of bruised soreness can indicate a need for this remedy.
• Pain is worse specifically from touch, and may occur in joints that were injured in the past.

Ruta graveolens:

• Arthritis with a feeling of great stiffness and lameness, worse from cold and damp, and worse from exertion often is relieved by this remedy.
• Tendons and the capsules of the joints may be affected.
• Besides this; Arthritis may have developed after overuse, from repeated wear and tear.

Kalmia latifolia:

• Intense arthritic pain that appears quite suddenly may indicate this medicine especially when the problems start in higher joints and extend to lower ones.
• Pain and inflammation often start in the shoulder, moving to the elbow, wrist and hand.
• The knees are also frequently affected.
• Discomfort is worse from motion and often worse at night.

Apis mellifica:

• This remedy can be helpful in acute conditions with redness, tenderness, also swelling.
• Joints feel hot and have stinging pain.
• The hands and knees are often affected.
• Warmth can aggravate the symptoms and cool applications bring relief.

Calcarea fluorica:

• This medicine is often indicated for arthritic pains that are improved especially by heat and motion.
• Joints become enlarged also hard, and nodosities or bone spurs may develop.
• Arthritis after chronic injury to joints often responds to Calcarea fluorica.

Calcarea carbonica:

• This remedy is often useful for arthritis in a person who is flabby or higher-weight person , and easily tired by exertion.
• Inflammation and soreness are worse from cold and dampness, and weakness or cramping in the extremities are often seen.
• Problems often focus on the knees when Calcarea is needed.

Sticta Pulmonaria:

• Rheumatism of right shoulder blade or joint, wrist joint, ankle joint and knee joint.
• It also reduces fluid in the joints. [6]