4 ways to prevent and 7 ways to treat osteoarthritis
Osteo-arthritis is inflammation of the joint. We know of over a hundred causes for the inflammation of the joint. Many are due to injury, infection, autoimmune disorders, due to accumulation of crystals in the joint etc. Osteoarthritis or Degenerative arthritis is the commonest form of arthritis where we have not been able to find a cause. Since it happens most often in the elderly we feel that in some way it is due to the aging process and or an accumulation of injury over the years.
The form of arthritis is most often seen in weight bearing joints i.e. the knees, hips and low back but may also be noted in joints of the hand especially the fingers which undergo high stress during our day to day activities.
All joints are composed of opposing bones held together by ligaments and muscles that bridge the joint. These tissues give stability to the joint while maintaining the ability of the joint to be mobile. The bones are separated by a cushion of a firm but compressible wedge of tissue we call the cartilage. The joint is enclosed by a thin but metabolically active membrane called the Synovia which secretes the turbid fluid called the Synovial fluid. This fluid keeps the joint lubricated and the cartilage healthy. In the knee cartilage is kept in place by a ring of very strong tissue called the Maniscus.
Degenerative arthritis involves all the components of the joint. Initially minimal inflammation is noted but with time, damage to the joint tissues result in misalignment and worsening tissue damage. Stiffness progressing to limitation of movement becomes prominent. Inflammation results in swelling and heat indicates inflammation has set in.
With time, quantity and quality of the synovial fluid decreases, resulting in the lack of suppleness and shock absorbing quality of the cartilage. In the early stages of the disease early morning stiffness is common. The dryness inside the joint causes the grinding noise in the joints. As the cartilage erodes and thins, bone comes in contact with bone. It is at this stage the pain becomes intense and activity like walking etc become severely restricted.
Prevention: Since no definite cause for this kind of arthritis is known or theorized the recommendations for prevention are based on association only.
1) Perhaps the single most important preventive measure by far is maintaining normal body weight. Various authorities have quoted that for every Ilb. Of weight the knee must bear stress four times that amount.
2) Maintaining good overall physical conditioning: As I have mentioned above the stability and integrity of the joint is for the most part due to the soft tissue surrounding it. If the muscles are strong and in good condition the joint will be protected.
3) Injury: Sport injuries at a younger age predisposes to degenerative arthritis later in life. Falls, accidents are other ways of injuring joints.
4) Alcohol: Some people feel that there is an increased risk of joint injury when a person is under the influence of alcohol although there is no direct or strong evidence to support this contention.
Therapy: The main goal of treatment is amelioration of symptoms. There is no known cure for this kind of arthritis. Maintenance of functions of the joint, lessening of discomfort and pain as well as slowing the degenerative process are the goals of therapy.
1) Range of motion both passive and active is essential part of the program. By passive range of motion we mean motion supported by another individual such as a physical therapist although this could be done by any competent individual with adequate training and precaution. Active range of motion is activity carried out by the individual using their own muscle power.
2) All range of motion activity is best done without weight bearing. Thus swimming becomes a wonderful way to achieve this end.
3) Exercise to assist in weight loss as well achieving muscle strength is important.
4) Keeping the joint warm with proper clothing helps with pain and stiffness. The use of hot and cold compresses is fine if they offer symptomatic relief.
5) The use of warm baths/salt water therapy etc has not proved of any value.
6) Wearing braces (well fitting) are helpful in maintaining alignment.
7) Use of crutches, walkers etc may help in maintaining ambulation and quality of life.
Medications: A vast number of medicines have come in vogue over the years. The most commonly used pain medication Acetaminophen is probably not the best one to use. Diclofenac and Cox2 inhibitors are to be preferred.
Written by Dr. Satish Chawla MD, FACP, AIIMS, who is a retired Geriatric Physician from the United States Navy. He is an expert in geriatric medicine, and on Samvedna’s panel of experts.
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