Daily in our day today practice we r facing a lot of case of osteoarthritis so let’s have a little discussion on it.
What is osteoarthritis?
Osteoarthritis (OA) is the most common chronic (long-lasting) joint condition. A joint is where two bones come together. The ends of these bones are covered with protective tissue called cartilage. With OA, this cartilage breaks down, causing the bones within the joint to rub together. This can cause pain, stiffness, and other symptoms.
●All patients with knee osteoarthritis (OA) should be thoroughly assessed with regard to their knowledge about the disease and treatment alternatives, previous experiences with treatment, and expectations of current treatment. Patient education about OA and its treatment options can occur during the clinical encounter and can be complemented by provision of written materials. Monitoring of the patient's response to therapy should also be done on a regular basis.
●Patients with knee OA may fall into different categories that must be considered when making treatment decisions .
•Mild knee OA – Patients with mild knee OA have low levels of or intermittent knee pain with relatively well-preserved joint function and quality of life. Nonpharmacologic therapies alone or in combination with topical therapies or analgesics on an as-needed basis are likely to provide adequate control of symptoms
•Moderate/severe knee OA – Patients with moderate to severe OA have persistent pain which significantly impairs functionality, activity participation, and quality of life. Nonpharmacologic interventions are also first-line therapy, but other treatment alternatives are usually required, including oral nonsteroidal antiinflammatory drugs (NSAIDs), intraarticular steroids, duloxetine, and possibly surgery .
•Knee OA with one or more joints involved – The best approach for management patients with multijoint, symptomatic OA is to prioritize therapies that address the pain at the individual level and not the joint level.
•Patient with comorbidities – Knee OA is often comorbid with other conditions (eg, cardiovascular disease, diabetes); therapies should be chosen to minimize the potential for adverse events while optimizing function and quality of life.
●In all patients with knee OA, we recommend ongoing exercise for pain relief and joint protection .There is no strong evidence on the best prescription of exercise modalities and dosage (ie, intensity, duration, and frequency). We prefer a combination of low-impact aerobic fitness training (eg, walking, cycling, rowing, and deep-water running) and lower-limb strengthening exercises.
●In patients with knee OA who are overweight, we suggest a calorie-restricted diet and exercise program to preserve joint structures and improve symptoms .We encourage health care professionals to consult the available local community programs or refer patients to a dietitian to ensure that overweight and obese patients are offered optimal support to lose weight.
●In patients with mild OA localized to the knee or with concomitant hand involvement, we suggest initial treatment with a topical NSAID rather than an oral NSAID .The risk of gastrointestinal, renal, and cardiovascular toxicity is much lower with topical NSAIDs as compared with its oral formulation due to the reduced systemic absorption. The tolerability profile is also better with topical NSAIDs, with mild skin rashes being the most commonly reported side effect.
●In patients with mild OA localized to the knee or a few other joints in whom other treatments are ineffective or contraindicated, we suggest topical capsaicin .
●There are several approaches that have been used to treat patients with knee OA that we generally do not routinely use due to lack of data demonstrating efficacy. These include therapies for which the benefit remains uncertain; thus, some may be reasonable to try as adjunctive measures for patients who do not respond to the approach described above. These include:
•Insoles and footwear
•Glucosamine and chondroitin.
•nutritional supplements .
•Platelet-rich plasma (PRP) .
•Transcutaneous electrical nerve stimulation.
•Local heat .
DR Atul Chowdhury