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Oct 2016
Osteoarthritis by Imtayaz Ahmed

The most common form of arthritis is osteoarthritis (OA), the technical term is osteoarthrosis.

The characteristics include: the joint space reducing due to thinning of the cartilage, osteophytes (bony outgrowths), sclerosis (hardening of the bone next to the joint) and inflammation.

  • OA is the biggest cause of anti-inflammatory use.
  • Larger joints such as the knee and hip are mostly affected however smaller joints e.g. fingers can also be affected.
  • Swelling is caused by osteophytes and the thickening synovial fluid.
  • The condition is localised to the affected joint not widespread.

Risk factors as follows:

  1. Age - isn't a normal feature of the aging process however in the over 50s it is common. This may be due to the prolonged exposure to other risk factors over a lifespan.
  2. Weight bearing - "wear and tear” a continuous use of a joint can exacerbate OA for example lifting heavy loads can damage the knee and back joint and can increase the risk of OA by fivefold.
  3. Joint Surgery - it is thought that disruption of the joint capsule predisposes the treated joint to OA.
  4. Body Weight - this is thought to be a common risk factor but there isn't the direct link between obesity and OA as the ankle joint isn't affected in these patients however it is only logical to assume the risk factor to the knee joint increase as body weight increases.
  5. Genetics - there are familial tendencies, about half of OA patients have inherited this condition.

The main symptoms are pain, stiffness and joint swelling. In early OA the pain is only there when use of joint. There is a gradual progression from the pain being there at rest to at night, however this is a gradual process that can take decades.

The stiffness can be severe after a period of rest. "Morning stiffness" lasts for about 15 mins this symptom isn't to be confused with rheumatoid arthritis where it is more prolonged.

The swelling of the joint is both hard and soft, osteophytes are the cause of the hard swelling and increased synovial fluid in the joint capsule is the cause of the soft swelling.

After diagnosis and x-ray the aims of managing OA are firstly to relieve pain, secondly to maintain function of the affected joint and lastly to prevent further damage.

As mentioned earlier anti-inflammatories play a key role in the management of this condition, however they have to be used with caution. Side effects can include gastro-intestinal irritation and with prolonged use they can damage the kidneys.

This damage can lead to blood pressure issues and therefore an increased risk of stroke. Use of anti-inflammatory must be done with supervision of a medical practitioner where blood monitoring can occur. Simple steps can be taken to mitigate the gastroenteritis by taking the tablet with food.

Painkillers can be used for “breakthrough pain” and range in potency starting with paracetamol increasing to co-codamol, then co-dydrymol and then dihydyocodeine aside from paracetamol all of these can cause a patient to develop tolerance and dependency so often patients have to escalate their therapy to stronger opioid medicines e.g. morphine.

Lastly if there is severe deterioration then surgery can be effective.

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