Osteoarthritis

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

DrugIndicationDoseCommon Side Effects
ParacetamolMild pain500–1,000 mg every 4–6 hours (max 4 g/day)Liver toxicity (in overdose)
IbuprofenModerate pain200–400 mg every 6–8 hoursStomach upset, GI ulcers
NaproxenModerate-to-severe pain250–500 mg twice dailyGI upset, cardiovascular risks
Capsaicin creamTopical pain reliefApply thinly 3–4 times dailySkin irritation, burning sensation
DuloxetineChronic pain30–60 mg once dailyNausea, drowsiness, dry mouth

Table 2: Brand Names and Approximate Costs (USD)

DrugBrand NamesApprox. Cost
ParacetamolTylenol, Panadol$5–$10 for a pack of 20 tablets
IbuprofenAdvil, Motrin$5–$15 for a pack of 20 tablets
NaproxenAleve, Naprosyn$10–$25 for a pack of 20 tablets
Capsaicin creamCapzasin, Zostrix$10–$30 per tube
DuloxetineCymbalta$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

  1. What is osteoarthritis?
    Answer: A degenerative joint disease causing pain and stiffness.
  2. What causes osteoarthritis?
    Answer: Age, joint injury, obesity, or genetic factors.
  3. How is it diagnosed?
    Answer: Clinical symptoms, X-rays, and occasionally blood tests to rule out other conditions.
  4. What are the treatment options?
    Answer: Lifestyle changes, medications, physical therapy, and surgery for severe cases.
  5. Can osteoarthritis be cured?
    Answer: No, but symptoms can be effectively managed.
  6. Does weight loss help?
    Answer: Yes, reducing joint load significantly alleviates symptoms.
  7. Are there alternative therapies?
    Answer: Acupuncture, glucosamine supplements, and yoga may provide additional relief.
  8. What are the risks of surgery?
    Answer: Infection, blood clots, or implant failure.
  9. Can I exercise with osteoarthritis?
    Answer: Yes, low-impact exercises are encouraged.
  10. How do topical agents work?
    Answer: They reduce localized pain through anti-inflammatory or nerve desensitizing effects.
  11. Is osteoarthritis hereditary?
    Answer: It can run in families, but lifestyle factors also play a significant role.
  12. What is the role of supplements?
    Answer: Evidence for glucosamine and chondroitin is mixed, but some patients find them helpful.
  13. Are injections safe?
    Answer: Yes, but frequent corticosteroid injections may weaken joints.
  14. What foods are good for joint health?
    Answer: Anti-inflammatory foods like fatty fish, nuts, and leafy greens.
  15. When should I see a doctor?
    Answer: If pain persists, limits daily activities, or worsens despite home management.