OSTEOARTHRITIS (OA) is one of the oldest and most common forms of arthritis and it is caused by the wear-and-tear of daily living.
It is characterised by the breakdown of the joint’s cartilage resulting in bones rubbing against each other, causing stiffness, pain and loss of movement in the joints.
At the molecular level, OA is characterised by an imbalance between chondrocyte (cartilage cell) anabolism and catabolism.
A variety of other causes – hereditary, metabolic and mechanical – may initiate processes leading to loss of cartilage.
OA of the hip and knee represent two of the most significant causes of pain and physical disability in adults.
In many countries, OA is the second most common form of disability and has been declared an international health burden by the World Health Organisation.
The main risk factors consistently associated with knee OA are obesity, previous knee trauma, and hand OA, among others.
The influence of obesity stems from a complex interaction of genetic, metabolic, neuroendocrine and biomechanical factors.
Arthritis appears to be inevitable because of the mal-distribution of load that results from the age-related changes in joint shape and the joint requirement for stability.
Approximately 80-90% of individuals older than 65 years have evidence of primary osteoarthritis.
Earlier trauma or wear-and-tear from repetitive use of joints such as during bending and heavy labour promote OA. Patients with symptoms usually do not notice them until after they turn 50.
Secondary osteoarthritis, the causes of which are more specific, often occurs in relatively young individuals.
Acute knee joint injury appears to be a risk factor for the development of knee OA, which may also be linked to bone bruises.
In individuals aged above 55, the prevalence of OA is higher among women than men.
Moderate levels of physical activity do not appear to increase the incidence or progression of OA and may even have a weak protective effect.
Earlier perceptions and rationalisations held by older adults might alter their treatment outcome for OA pain.
They are likely to be non-adherent to their prescribed treatment if they hold low expectations of pain relief.
OA differs from rheumatoid arthritis, which is a chronic, systemic inflammatory disorder that affects many tissues and organs, but principally attacks synovial joints.
Complementary therapies
Current drug interventions focus primarily on improving symptoms. At higher or more frequent doses, the popular drug acetaminophen (paracetamol) can cause liver damage.
Studies showed that almost 50% of OA patients sought traditional/complementary (T&CM) medicines to achieve symptomatic relief.
Some patients benefit from heat and capsaicin cream applied locally over the affected joint, and some report relief with ice application.
According to Herman et al (2004), popular adjunct therapies include oral supplements, mind-body therapies, herbal topical ointments, vitamins/minerals, herbs, consulting a CAM therapist, using T&CM movement therapies, or going on specially tailored diets.
T&CM is commonly used to treat joint and arthritic pain in about 50% of people with radiographic-confirmed knee OA.
Consult only a MoH-licensed nutritional therapist to find out which supplements and diets are suited to your exact conditions. You need to be supervised while on supplements.
Considering its favourable safety records, acupuncture seems a useful option for knee OA since it can effectively treat acute pain with minimal side effects.
However, not everyone likes the idea of having needles on their forehead and arms.
Although tai chi may be effective for pain control in patients with knee OA, there is little evidence on its use for pain reduction.
Physical activity and diet programmes are beneficial for pain relief and improving functional status for adults with OA who are obese.
A pulsed electromagnetic field stimulation device may treat OA of knee and cervical spine or treat stiffness suffered by the elderly.
It acts on the articular cartilage by maintaining proteoglycan composition of chondrocytes via preventing its rapid turnover.
Transcutaneous electrical nerve stimulation using a frequency device may be another treatment option for pain relief.
http://www.thesundaily.my/news/429301
