Osteoarthritis - Knee & Hip Osteoarthritis

Introduction
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Osteoarthritis, sometimes called degenerative joint disease or osteoarthrosis, is the most common form of arthritis. Osteoarthritis occurs when cartilage in your joints wears down over time.

Osteoarthritis can affect any joint in your body, though it most commonly affects joints in your hands, hips, knees and spine. Osteoarthritis typically affects just one joint, though in some cases, such as with finger arthritis, several joints can be affected.

Osteoarthritis gradually worsens with time, and no cure exists. But osteoarthritis treatments can relieve pain and help you remain active. Taking steps to actively manage your osteoarthritis may help you gain control over your osteoarthritis pain.

Signs and symptoms
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Osteoarthritis symptoms often develop slowly and worsen over time. Signs and symptoms of osteoarthritis include:

* Pain in a joint during or after use, or after a period of inactivity
* Tenderness in the joint when you apply light pressure
* Stiffness in a joint, that may be most noticeable when you wake up in the morning or after a period of inactivity
* Loss of flexibility may make it difficult to use the joint
* Grating sensation when you use the joint
* Bone spurs, which appear as hard lumps, may form around the affected joint
* Swelling in some cases

Osteoarthritis symptoms most commonly affect the hands, hips, knees and spine. Unless you've been injured or placed unusual stress on a joint, it's uncommon for osteoarthritis symptoms to affect your jaw, shoulder, elbows, wrists or ankles.

Causes
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Osteoarthritis occurs when the cartilage that cushions the ends of bones in your joints deteriorates over time. The smooth surface of the cartilage becomes rough, causing irritation. Eventually, if the cartilage wears down completely, you may be left with bone rubbing on bone — causing the ends of your bones to become damaged and your joints to become painful.

It isn't clear what causes osteoarthritis in most cases. Researchers suspect that it's a combination of factors, including being overweight, the aging process, joint injury or stress, heredity, and muscle weakness.

Risk factors
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Factors that increase your risk of osteoarthritis include:

* Older age. Osteoarthritis typically occurs in older adults. People under 40 rarely experience osteoarthritis.
* Sex. Women are more likely to develop osteoarthritis, though it isn't clear why.
* Bone deformities. Some people are born with malformed joints or defective cartilage, which can increase the risk of osteoarthritis.
* Joint injuries. Injuries, such as those that occur when playing sports or from an accident, may increase the risk of osteoarthritis.
* Obesity. Carrying more body weight places more stress on your weight-bearing joints, such as your knees. But obesity has also been linked to an increased risk of osteoarthritis in the hands, as well.
* Other diseases that affect the bones and joints. Bone and joint diseases that increase the risk of osteoarthritis include gout, rheumatoid arthritis, Paget's disease of bone and septic arthritis.

When to seek medical advice
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If you have swelling or stiffness in your joints that lasts for more than two weeks, make an appointment with your doctor.

If you're already taking medication for osteoarthritis, contact your doctor if you're experiencing side effects from arthritis medications. Tell your doctor if you experience side effects such as nausea, abdominal discomfort, black or tarry stools, constipation, or drowsiness.

Screening and diagnosis
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If your doctor suspects you have osteoarthritis, he or she will examine your affected joint and ask you questions about your joint pain. To better understand the cause of your pain, he or she may also recommend:

* X-rays. X-ray images of your affected joint may reveal a narrowing space within a joint, which indicates that the cartilage is breaking down. An X-ray may also show bone spurs around a joint.
* Blood tests. Blood tests may help rule out other causes of joint pain, such as rheumatoid arthritis.
* Joint fluid analysis. Your doctor may use a long needle to draw fluid out of the affected joint. Examining and testing the fluid around your joint can determine if your pain is caused by gout or an infection.
* Examining the joint with a tiny camera (arthroscopy). In some cases, your doctor may recommend arthroscopy to see inside your joint in order to determine the cause of your pain. During arthroscopy, small incisions are made around your joint and a tiny camera is inserted to see inside your joint. Your doctor watches a video screen to look for abnormalities within your joint.

Complications
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Osteoarthritis is a degenerative disease that worsens over time. As many as a two-thirds of people with osteoarthritis will eventually experience significant disability. Joint pain and stiffness may become severe enough to make getting through the day difficult, if not impossible. Some people are no longer able to work. When joint pain is severe, or when routine activities like walking, going to work, climbing stairs, going to the toilet and other activities of daily living are affected, doctors typically suggest joint replacement surgery.

Treatment
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Initial treatment options for mild osteoarthritis
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For mild osteoarthritis pain that is bothersome, but not enough to have a great impact on your daily activities, your doctor may recommend that you:

* Rest. If you're experiencing pain or inflammation in your joint, rest it for 12 to 24 hours. Find activities that don't require you to use your joint repetitively. Try taking a 10-minute break every hour.
* Exercise. With your doctor's approval, get regular exercise when you feel up to it. Stick to gentle exercises, such as walking, biking or swimming. Exercise can increase your endurance and strengthen the muscles around your joint, making your joint more stable. Avoid exercising tender, injured or swollen joints. If you feel new joint pain, stop. New pain that lasts more than two hours after you exercise probably means you've overdone it.
* Lose weight. Being overweight or obese increases the stress on your weight-bearing joints, such as your knees and your hips. Even a small amount of weight loss can relieve some pressure and reduce your pain. Aim to lose 1 or 2 pounds a week, at most. Talk to your doctor about healthy ways to lose weight. Most people combine changes in their diet with increased exercise.
* Use heat and cold to manage pain. Both heat and cold can relieve pain in your joint. Heat also relieves stiffness and cold can relieve muscle spasms. Soothe your painful joint with heat using a heating pad, hot water bottle or warm bath. Heat should be warm, not hot. Apply heat for 20 minutes several times a day. Cool the pain in your joint with cold treatments, such as with ice packs. You can use cold treatments several times a day, but don't use cold treatments if you have poor circulation or numbness.
* Work with a physical therapist. Ask your doctor for a referral to a physical therapist. The physical therapist can work with you to create an individualized exercise plan that will strengthen the muscles around your joint, increase your range of motion in your joint and reduce your pain.
* Find ways to avoid stressing your joints. Find ways to go about your day without stressing your joints. An occupational therapist can help you discover ways to do everyday tasks or do your job without putting extra stress on your already painful joint. For instance, a toothbrush with a large grip could make brushing your teeth easier if you have finger osteoarthritis. A special seat in your shower could help relieve the pain of standing if you have knee osteoarthritis.
* Apply over-the-counter pain creams. Creams and gels available at the drugstore may provide temporary relief from osteoarthritis pain. Some creams numb the pain by creating a hot or cool sensation. Other creams contain medications, such as aspirin-like compounds, that are absorbed into your skin. Read the label so you know what you're using. Pain creams work best on joints that are close the surface of your skin, such as your knees and fingers.
* Try braces or shoe inserts. Consider trying special splints, braces, shoe inserts or other medical devices that can help reduce your pain. These devices can immobilize or support your joint to help you keep pressure off it.

Treatment options for moderate to severe osteoarthritis
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Osteoarthritis pain that persists despite initial treatment may require medications in addition to initial treatment options.
NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen and naproxen sodium stronger versions of these NSAIDs and others are available by prescription. NSAIDs have risks of side effects that increase when used at high dosages for long-term treatment. Side effects may include ringing in your ears, gastric ulcers, cardiovascular problems, gastrointestinal bleeding, and liver and kidney damage. Consuming alcohol or taking corticosteroids while using NSAIDs also increases your risk of gastrointestinal bleeding.
# Stronger painkillers. Prescription pain pills, such as codeine and propoxyphene , may provide relief from more severe osteoarthritis pain. These stronger medications carry a risk of dependence, though that risk is thought to be small in people who have severe pain. Side effects may include nausea, constipation and sleepiness.
# Cortisone shots. Injections of corticosteroid medications may relieve pain in your joint temporarily for a few weeks or months. During this procedure your doctor numbs the area around your joint and then inserts a needle into the space within your joint and injects medication. It isn't clear how or why corticosteroid injections work in people with osteoarthritis. Your doctor may limit the number of injections you can have each year, since too many corticosteroid injections may cause joint damage.
# Visco-supplementation. Injections of hyaluronic acid derivatives (Hyalgan, Synject) may offer pain relief temporarily by providing some cushioning in your knee. These treatments are made of rooster combs and are similar to a component normally found in your joint fluid.Injections are typically given weekly over several weeks. Pain relief is temporary usually & may last for a few weeks or months. Possible risks include infection, swelling and joint pain.
# Ayurveda. Though it is not prooven, it may help only if it is the very early stage of arthritis, effect may be very temporary or may last a few months or longer.

JOINT REPLACEMENT SURGERY:
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It is the only 100% permanent cure for osteoarthritis. Arthritis is a mechanical problem, where the mechanical joint axis of the knee is shifted towards one side of the knee & wear & tear occurs on that part of knee leading to asymmetric wear.& damage to the cartilage, and the only way to treat a mechanical problem is using a mechanical solution ie knee resurfacing.
Joint Replacement Surgery is actually only a resurfacing surgery, just like retreading of tyres & is the only 100% cure for Arthritis. Physio, ayurveda, injections, MSM, glucosamine, pain killers & other non- operative methods may help in the earliest stages & that also temporarily, and may result only in 10 -20% relief. Further more taking all the pain medications
can cause stomach ulcer, kidney & liver failure & serious organ damage.With the latest technology, joint replacement is a minor surgery done under epidural anaesthesia(tiny injection given in the back). The patient is fully conscious, during surgery. On the 2nd day, patient is made to walk & discharged on the 5th day. Patient becomes fully independent, & stops being
dependent on relatives or others.Patient is made, able to walk 3 to 4 km, do shopping, cooking, climb stairs & best is NO PAIN!!!

The objective is to use "CUTTING EDGE" highly successful & latest US technology in joint replacement surgery, for the arthritic patient, keeping International quality standards, at a very affordable cost to the common man.

The author has done his fellowship in joint replacement surgery in one of the largest orthopaedic hospitals in India, & trained in 4 of the most famous joint replacement centers in the USA, among them are the Mayo clinic & Harvard Medical School, USA.

For queries email: arthritisfreeworld@gmail.com

For best treatment 4 arthritis Email:arthritisfreeworld@gmail.com

Written by: Dr. Tejaz John on 15th Feb 2008

This page was last modified 18.50, 18-Febuary 2008.

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