Reducing the pain of osteoarthritis

  • Health
  • Thursday, 26 Jun 2014

Osteoarthritis is a common condition that usually affects us as we grow older.

Osteoarthritis (OA) is the most common form of arthritis. The term was coined by Dr John Kent Spender of England in 1889. It is also known as “degenerative joint disease”.

Over 60% of people over 65 have some form of arthritis. About 90% of adults are affected by the age of 40.

The commonest joints involved include the knees (41%), hands (30%) and hips (19%). It is currently understood to be a process rather than a disease that may be triggered by various constitutional and environmental factors.

The knee is one of the joints most prone to injury. The knee is the joint between the two longest bones of the body (the femur, which is the bone of the thigh, and the tibia, which is the bone of the lower leg).

It is more prone to injury because the entire weight of the body is transferred through the knee to the foot. About 13% of women and 10% of men aged 60 years and older have symptomatic knee OA.

Recent studies suggest that OA of the hand may predict the later development of OA in the hip or knee. It was found that those with hand OA were three times more likely to develop hip arthritis.

It was noted from the studies that OA of the hand also slightly increased the risk for knee OA.

The prevalence of knee OA in men is lower compared with women. This was shown in a meta-analysis of males and females in which the incidence of knee OA in males aged less than 55 years was lower than females.

Females, particularly those above 55 years, tended to have more severe OA in the knee, but not in other sites.

The results of this study demonstrated sex differences in the incidence of knee OA, particularly after menopausal age.

The incidence of knee OA is 1.7 times greater in women overall. Although multiple factors may contribute to this increased prevalence, it’s logical to consider the influence of hormones and oestrogen in postmenopausal women.

The articular cartilage of the knee has oestrogen receptors, and thus the decline in oestrogen with menopause may contribute to this upsurge in knee OA in older women.

Risk factor studies have shown that obesity precedes and increases the risk of knee OA, especially in women.

Other risk factors for knee OA include knee injury, chondrocalcinosis, knee bending, low bone density, lack of nutrients, particularly those that function as antioxidants, and genetic factors.

The treatment goals in OA include managing pain, preventing disability and improving joint function.

The motivation for most OA therapy is pain improvement and relief. Losing weight by monitoring the diet is potentially one of the best treatments for controlling pain associated with knee OA.

Obese people with OA experience a 25% reduction in symptoms just by losing 5% of body weight.

Although it has not been proven that glucosamine and chondroitin sulfate rebuild cartilage, there is evidence from a small number of patients that these compounds can reduce OA pain, usually within several weeks to months after initiating therapy.

Green lipped mussels contain omega-3 fatty acids, glycosaminoglycans and marine minerals. It can provide repair and relief to inflamed and joints.

Fish oil supplement and flaxseed oil also contain high amounts of omega-3 fatty acids.

Exercise should focus on local muscle strengthening and general aerobic fitness. “Land”-based therapeutic exercise have short-term benefit in terms of reduced knee pain and physical disability for people with knee OA.

Some of the exercises which are useful include standing hamstring stretch, straight leg raise, side leg raise, heel raise, seated hip lift and knee squeeze chair squats and quadriceps-strengthening exercise concentrating on the vastus medialis oblique muscle.

Swimming is an excellent non-impact exercise.

Regular “land” exercises can also be done underwater. The buoyancy of the water supports most of the body’s weight while the resistance of the water allows muscles to work harder to perform movements.

The following positions and activities place excessive pressure on the knee joints and must be limited until knee pain and swelling resolve – squatting, kneeling, twisting, pivoting, repetitive bending and cycling.

Supportive devices, such as finger splints or knee braces, can reduce stress on the joints and ease pain. If walking is difficult, canes, crutches, or walkers may be helpful.

Shock-absorbing shoes or insoles can be helpful.

Transcutaneous electrical nerve stimulation, ultrasound and laser can be used for pain relief.

Medications are an important strategy for breaking the pain cycle. There are no drugs that can reverse the progression of OA.

The main goal of drug therapy is to relieve pain and help patients exercise and keep the joints functioning.

There are a variety of treatments that can be applied to the affected joint that will relieve pain, such as heat, ice, lidocaine patches, topical NSAIDS and capsaicin.

Certain herbs such as St John’s Wort, Devil’s Claw, Skullcap, Angelica, black and white willows, bogbean, cayenne, dandelion, ginger, wintergreen, Boswellia, and Valerian Root can reduce pain and inflammation.

NSAIDs can be used to treat pain and reduce inflammation. Non-selective NSAIDs include ibuprofen, naproxen and indomethacin.

Selective COX-2 inhibitors are also an option.

Botulinum toxin type A injections may provide sustained pain relief for patients with knee OA.

Hyaluronic acid can be injected into the joints of patients with severe disease and has many advantages, but must also be used sparingly. It acts to replace lost fluid in the joint spaces and keep the joint working to cushion the bones in the joint.

Cartilage repair techniques include abrasion, drilling, microfracture and mosaicplasty.

Grafting techniques include osteochondral allograft transplantation, autologous chondrocyte implantation and autologous matrix-induced chondrogenesis.

Realignment osteotomy is an option in active patients with symptomatic unicompartmental OA of the knee with malalignment.

Arthroscopic lavage and debridement is done for mechanical locking.

Knee replacement can be unicompartmental, bicompartmental or total.

Stem cell usage is experimental as the results are not yet proven and consistently reproducible.

The theory behind the action of stem cells is good, and if this therapy works, it would reduce the number of total knee replacements.

Up until now, little attention has been given to OA due in part to the misconception that arthritis causes only mild aches and pains, is an inevitable part of ageing, and nothing that can be done to prevent or relieve it.

In some cases, OA can be prevented and its consequences can be minimised. Evidence shows that injury prevention and weight loss can prevent OA from occurring, and weight loss or maintenance, physical activity and self-management education can reduce the symptoms and progression of OA.

>> This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public. 

The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Datuk Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Datuk Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Prof Khoo Ee Ming, primary care physician; Dr Ng Soo Chin, consultant haematologist. 

For more information, e-mail The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. 

The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.

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Health , column , osteoarthritis


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