Risk factors Age
• Normal ageing process causes increases progression
• 27% of those aged 63-70 had radiographic evidence of knee OA, increasing to 44% in over 80 age group Trauma
• Collateral ligament, meniscal tears and joint fractures lead to increased risk for OA
• Men with a history of known injury were at 5-6 fold increased risk of developing OA Occupation
• More common in those performing heavy physical work
• Dockers, miners and farmers found to have OA Exercise
• High impact sports present an increase for OA Gender and ethnicity
• Men under the age of 50 have a higher prevalence and incidence
• Women over 50 have a higher prevalence and incidence (menopause may be a trigger. However there is conflicting evidence if hormone replacement therapy protects against OA)
• Difference is less marked after the age of 80
• Generally more common in Europeans than in Asians Genetics
• There is genetic susceptibility to the disease • Children of parents with early onset OA are at a higher risk of developing OA themselves Obesity
• Strongest modifiable risk factor • Being overweight at an average age of 36-37 is a risk factor for developing knee OA Diet
• Threefold increase risk of progression of OA for people in the lower decile of vitamin C and D blood levels Bone density
• Increasing bone density may lead to increased loading through weight bearing joint cartilage
There are more than 100 different types of arthrthis. The most common type of arthritis is osteoarthritis (OA) or degenerative joint disease. It is a common chronic, progressive musculoskeletal disorder characterized by gradual loss of articular cartilage. The disease most commonly affects the middle-aged and elderly, although it may begin earlier as a result of injury or overuse. It is often more painful in weight bearing joints such as the knee, hip, and spine than in the wrist, elbow, and shoulder joints. All joints may be more affected if they are used extensively in work or sports, or if they have been damaged from fractures or other injuries.
• The current (2004) economic burden of arthritis in its various forms is approximately $82.4 billion.
• Direct costs are $34.6 billion (hospitals, doctors, transportation, nursing homes)
• Only 3% of the cost is for drugs.
• Indirect costs are $47.8 billion (primarily lost wages and lost productivity). Patients with OA suffer from pain and loss of function. Objectives of OA management are to reduce the level of pain, reduce inflammation, slow cartilage degradation, improve function and reduce disability. Non-pharmacological treatment
• Education (patient and spouse or family)
• Social support • Physiotherapy (physical therapy)
• Occupational therapy
• Weight loss
• Exercise-Exercise is considered the most important intervention in the management of OA. Exercise builds muscle strength and endurance, improves joint flexibility and motion.
• Orthotic devises
• Pulsed EMF (Electromagnetic field therapy)
• Transcutaneous electrical nerve stimulation (TENS)
• Herbal remedies
• Vitamins/minerals Pharmacological therapy review At present, there is no cure for OA. Pharmacological management of OA remains control of pain and improvement in function and quality of life while limiting drug toxicity. Surgical treatment Surgical treatment of osteoarthritis is usually considered after failure of nonsurgical therapies. There are four surgical procedures: osteotomy, arthroscopy, arthrodesis and arthroplasty. The four procedures have different indications and variable benefits. Total joint arthroplasty, the most surgically advanced in OA treatment, is the mainstay of surgical treatments.
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