Osteoarthritis

Osteoarthritis (OA) is a condition that affects the joints.

In a normal joint, a layer of cartilage covers the ends of the bones. Cartilage helps the joint move smoothly and cushions the ends of the bones. In OA, the cartilage breaks down and becomes thin. This leaves the ends of the bones unprotected, and the joint loses its ability to move smoothly.

There are three characteristics of OA:
1. Damaged cartilage - the strong, smooth surface that lines the bones and allows joints to move easily and without friction,
2. Bony growths developing around the edge of the joints, and
3. Mild inflammation of the tissues around the joints (synovitis).

Any joint in the body can be affected by OA. The joints most commonly affected are the knees, hips and small joints of the hands.
Who develops osteoarthritis?
OA usually develops in people who are over 50 years of age, and it is more common in women than in men. It is commonly thought that OA is an inevitable part of ageing, but this is untrue. Younger people can also be affected by OA, often as a result of an injury or another joint condition.

SIGNS AND SYMPTOMS
Osteoarthritis is most likely to occur in the joints of the knees, hips or hands. The main symptoms are:
Pain,
Stiffness (which is worst in the morning but improves movement, and
Difficulty moving the affected joints.

In some cases, Osteoarthritis does not produce symptoms. In most cases, symptoms occur in one joint or a few joints at any one time. Symptoms may develop slowly. Other symptoms of Osteoarthritis may include:
• Joint tenderness,
• Increased pain and stiffness after sitting or resting for a while,
• Joints appearing slightly larger,
• Grating or crackling sound or sensation in the joints,
• Limited range of movement in the joints,
• Weakness and muscle wasting (loss of muscle bulk), and
• Warm joints.

TREATMENT OPTIONS
As with all conditions, your Doctor should be consulted to diagnose and treat this condition. Osteoarthritis cannot be cured. Treatment for the condition can ease the symptoms and allow you to continue with normal activities. In mild cases, treatment strategies can include appropriate exercises and lifestyle changes such as weight loss.

Your Doctor can recommend analgesics (painkillers) to manage any pain. If pain persists, your GP may prescribe a non-steroidal anti-inflammatory drug (NSAID). Sometimes, NSAIDs may not be suitable for you if you have certain conditions, such as asthma or a peptic ulcer. If you are unsure about whether NSAIDs are suitable for you, you should speak to your GP. Children who are under 16 years of age should not take aspirin. Thermotherapy (warm and cold packs) can also help to relive pain and stiffness.

If your Osteoarthritis is causing you severe pain and discomfort, or affecting your mobility, your GP may refer you for treatment from a Physiotherapist or an Occupational therapist. An Occupational Therapist can recommend devices, which may help in performing everyday tasks.

In the past, the only way to detect Osteoarthritis was through an x-ray after the condition had progressed. Clinical research shows that an MRI (Magnetic Resonance Imaging) may be able to detect small changes in cartilage that indicate when a person is in the very early stages of developing the disease. Lifestyle changes such weight loss and appropriate exercise can then be implemented. This type of early intervention may reduce the future need for medication and surgery.

CURRENT TREATMENT OPTIONS
• Appropriate exercises can help maintain healthy cartilage, increase the range of motion of a joint and strengthen surrounding muscles. Exercises may include stretching, strengthening and postural exercises. Exercise should be balanced with rest of painful joints.
• The combination of weight loss and exercise is significantly better than either one of these Interventions alone in reducing pain and improving function in overweight patients with knee Osteoarthritis
• Very soft chairs, recliners, mattresses or car seats may worsen symptoms. Your Doctor may recommend using straight-backed chairs, firm mattresses and bed boards. Back supports or braces may be needed if the Osteoarthritis affects the spine.
• Physical therapy such as heat treatment, splints or supports and massage may be suitable for certain affected joints.
• Analgesics, NSAIDs, and injected steroids are drugs that may be prescribed for the treatment of pain and inflammation associated with Osteoarthritis.
• Surgery for Osteoarthritis is only needed in a small number of cases. There are a number of different types of surgery. You may have surgery to smooth the surfaces of your joints or restore cartilage (an arthroscopy), or you may have surgery to replace your whole joint, or to fuse it into position.

DIET HINTS
Osteoarthritis may, in some cases, respond to dietary changes.
• The diet generally should be rich in fish oils such as salmon, tuna, mackerel and mullet. Fish oils may help to regulate the inflammatory process.
• It is recommended that you include vitamin C rich foods in the diet.
• Foods rich in silicon may be beneficial for Arthritis sufferers. These include wholegrain cereals, nuts and apples.
• Weight control is important. This will help minimise the load on inflamed joints. (See the Weight Management Diet topic for more information).
• Certain food groups such as the "nightshade" vegetables (potato, tomato, eggplant, chilli and capsicum) and salicylate-rich foods (see examples in the Hives and Hyperactivity Diet topic) may aggravate Osteoarthritis. Check for food sensitivities, particularly dairy and wheat. This should be assessed on an individual basis with the help of a qualified Dietician.

VITAMINS/MINERALS/HERBS
Nutritional supplements are only to be used if the dietary vitamin intake is inadequate.
• Glucosamine can reduce joint pain and rebuild cartilage.
• Chondroitin is often combined with glucosamine for use in Osteoarthritis.
• MSM can act as a pain reliever and due to its anti-inflammatory actions can benefit osteoarthritis sufferers. Arthritic joints have been shown to be lower in sulphur than healthy joints. Sulphur is an integral component of cartilage. MSM contains sulphur, which can be delivered to the affected areas.
• Ginger has been found to inhibit inflammation in the body and reduce the pain of arthritis.
• Fish Oil supplementation can help to decrease the severity of Osteoarthritis and regulate the number of molecules in the body, which cause inflammation.
• Bromelain may assist symptoms of pain in osteoarthritis, as has a natural anti-inflammatory effect.
• S-adenosyl-L-methionine (SAMe) is an excellent supplement to assist in reducing the symptoms of osteoarthritis due to its anti-inflammatory effects. .
• Herbs such as devil's claw, feverfew, and white willow bark have traditionally been used to relieve the pain and inflammation associated with osteoarthritis.
• Boswelia may relieve swelling and inflammation in osteoarthritis.

PHARMACIST'S ADVICE
1. Follow the diet hints.
2. Paracetamol or NSAIDs (nonsteroidal anti-inflammatories) may be suggested for pain relief. Paracetamol is considered suitable to ease the pain of Osteoarthritis. Ask your Pharmacist for advice as there are possible side effects.
3. Paracetamol and codeine in combination may be recommended for Osteoarthritis pain, which does not respond to paracetamol. Codeine may cause constipation in some people.
4. A variety of over-the-counter topical analgesics are available. These are usually creams or gels, which may be rubbed into the painful area several times a day. Such creams should not be applied to broken or irritated skin, and hands must be washed well after application. If it is your hands that are being treated, wear a pair of light cotton gloves to prevent creams from getting into the eyes. Creams may interact with oral medications, so always ask your Doctor or Pharmacist before commencing a new treatment.
5. Ask your doctor about the most suitable exercise Programme for this condition.
6. Relief from Osteoarthritis may be obtained from heat treatment, splints and/or supports. Ask your Pharmacist for advice.
7. Functional aids such as walking sticks or forearm support crutches are available.
8. Lose weight if necessary. Excess weight increases the risk of Osteoarthritis of the knee. Weight loss can reduce the severity of pain in the knee and hip. Ask your Pharmacist for advice.
9. Consider taking the supplements recommended in this topic.

ORGANISATIONS & GROUPS
Arthritis Foundation of India (http://www.arthfound.org/)