1. Introduction
- Definition: Osteoarthritis (OA) is a degenerative joint disease characterized by the breakdown of cartilage, bone remodeling, and inflammation, leading to pain and stiffness.
- Epidemiology: Affects over 500 million people globally, with prevalence increasing with age. Commonly impacts knees, hips, hands, and spine.
- Significance: Leading cause of disability and reduced quality of life, particularly in older adults.
2. Causes and Risk Factors
- Causes:
- Primary OA: Idiopathic, associated with aging and wear-and-tear.
- Secondary OA: Due to joint injury, obesity, or underlying conditions.
- Risk Factors:
- Age (≥50 years).
- Obesity (increased joint load).
- Joint overuse or trauma.
- Genetic predisposition.
- Female gender (higher prevalence post-menopause).
3. Pathophysiology
- Breakdown of articular cartilage → Joint space narrowing → Osteophyte formation → Synovial inflammation → Pain and functional limitations.
4. Symptoms and Features
- Common Symptoms:
- Joint pain (worsens with activity, relieved by rest).
- Morning stiffness lasting <30 minutes.
- Crepitus (grating sound) in joints.
- Swelling or tenderness around joints.
- Severe Cases:
- Significant deformity.
- Reduced range of motion.
5. Complications
- Functional disability.
- Chronic pain and reduced quality of life.
- Increased risk of falls and fractures due to reduced mobility.
6. Diagnosis
- Clinical Features: Pain, stiffness, and functional limitations in characteristic joints.
- Imaging:
- X-rays: Joint space narrowing, osteophytes, subchondral sclerosis.
- MRI: For early cartilage changes (rarely needed).
- Laboratory Tests:
- Rule out inflammatory arthritis (e.g., rheumatoid arthritis) via ESR, CRP, and rheumatoid factor.
7. Management Overview
- Multimodal Approach:
- Non-pharmacological interventions (e.g., physiotherapy).
- Pharmacological treatment for symptom control.
- Advanced therapies for severe cases.
8. Treatment Options with Cost (USD)
- Physical Therapy: $50–$150 per session.
- Medications:
- NSAIDs (e.g., ibuprofen): $5–$20/month.
- Topical agents (e.g., capsaicin): $10–$30/tube.
- Surgical Interventions:
- Joint replacement surgery (e.g., knee, hip): $15,000–$50,000.
9. Advanced Treatment Options with Cost (USD)
- Intra-articular injections:
- Corticosteroids: ~$100–$300/injection.
- Hyaluronic acid: ~$500–$1,000/injection.
- Platelet-rich plasma (PRP): ~$750–$1,500/session.
- Stem cell therapy (experimental): ~$5,000–$10,000/session.
10. Pharmacological Treatment
- First-line: Paracetamol (mild pain).
- Second-line: NSAIDs (moderate-to-severe pain).
- Adjuvants: Duloxetine, opioids (reserved for severe cases).
11. Medication Tables
Table 1: Doses and Side Effects
Drug | Indication | Dose | Common Side Effects |
---|---|---|---|
Paracetamol | Mild pain | 500–1,000 mg every 4–6 hours (max 4 g/day) | Liver toxicity (in overdose) |
Ibuprofen | Moderate pain | 200–400 mg every 6–8 hours | Stomach upset, GI ulcers |
Naproxen | Moderate-to-severe pain | 250–500 mg twice daily | GI upset, cardiovascular risks |
Capsaicin cream | Topical pain relief | Apply thinly 3–4 times daily | Skin irritation, burning sensation |
Duloxetine | Chronic pain | 30–60 mg once daily | Nausea, drowsiness, dry mouth |
Table 2: Brand Names and Approximate Costs (USD)
Drug | Brand Names | Approx. Cost |
---|---|---|
Paracetamol | Tylenol, Panadol | $5–$10 for a pack of 20 tablets |
Ibuprofen | Advil, Motrin | $5–$15 for a pack of 20 tablets |
Naproxen | Aleve, Naprosyn | $10–$25 for a pack of 20 tablets |
Capsaicin cream | Capzasin, Zostrix | $10–$30 per tube |
Duloxetine | Cymbalta | $30–$100 per month |
12. Lifestyle Interventions
- Weight loss: Reduces joint load.
- Low-impact exercises (e.g., swimming, walking, yoga).
- Assistive devices (e.g., braces, canes) to improve mobility.
13. Monitoring Parameters
- Pain levels and functional improvement.
- Adverse effects of medications (e.g., GI upset with NSAIDs).
- Imaging if symptoms progress despite treatment.
14. Patient Counseling Points
- Educate about the progressive nature of OA.
- Encourage adherence to weight loss and exercise plans.
- Explain proper medication use and potential side effects.
- Discuss realistic expectations for advanced treatments (e.g., surgery).
15. Special Populations
- In Children: Rare; consider juvenile idiopathic arthritis if suspected.
- In Pregnancy: Avoid NSAIDs in the third trimester; focus on physiotherapy and paracetamol.
- In Elderly: Increased risk of polypharmacy; cautious use of NSAIDs.
16. Prevention
- Maintain a healthy weight.
- Protect joints during physical activity to prevent injuries.
- Address joint instability or alignment issues early.
17. FAQs
- What is osteoarthritis?
Answer: A degenerative joint disease causing pain and stiffness. - What causes osteoarthritis?
Answer: Age, joint injury, obesity, or genetic factors. - How is it diagnosed?
Answer: Clinical symptoms, X-rays, and occasionally blood tests to rule out other conditions. - What are the treatment options?
Answer: Lifestyle changes, medications, physical therapy, and surgery for severe cases. - Can osteoarthritis be cured?
Answer: No, but symptoms can be effectively managed. - Does weight loss help?
Answer: Yes, reducing joint load significantly alleviates symptoms. - Are there alternative therapies?
Answer: Acupuncture, glucosamine supplements, and yoga may provide additional relief. - What are the risks of surgery?
Answer: Infection, blood clots, or implant failure. - Can I exercise with osteoarthritis?
Answer: Yes, low-impact exercises are encouraged. - How do topical agents work?
Answer: They reduce localized pain through anti-inflammatory or nerve desensitizing effects. - Is osteoarthritis hereditary?
Answer: It can run in families, but lifestyle factors also play a significant role. - What is the role of supplements?
Answer: Evidence for glucosamine and chondroitin is mixed, but some patients find them helpful. - Are injections safe?
Answer: Yes, but frequent corticosteroid injections may weaken joints. - What foods are good for joint health?
Answer: Anti-inflammatory foods like fatty fish, nuts, and leafy greens. - When should I see a doctor?
Answer: If pain persists, limits daily activities, or worsens despite home management.