Osteoarthritis is a major contributing factor to chronic disability due to its effect on the hips and /or knees. It is one of the most prevalent forms of arthritis which according to WHO is linked to disability in close to 10% of people over the age of 60 years (Arthritis Foundation, 2010). It is currently the second largest cause for disabilities within the labor force constituting of individuals of 50 years and above. OA is triggered by metabolic, genetic, traumatic and developmental factors and it involves all diathrodial joint tissues (Shelley, 2008).
Osteoarthritis is categorized into primary and secondary OA. The primary type is regarded as a ‘wear and tear’ type since it is involved with aging while the secondary type is associated with an apparent cause such as obesity and overuse of joints. Symptoms General symptoms Symptoms vary from patient to patient with some exhibiting fewer symptoms. OA is a joint disease and profound symptoms are observed on the hips, hands, spine and knees.
General OA symptoms include: Muscle spasms accompanied by tendon contraction; Stiffness in the morning lasting for less than thirty minutes; Mild joint pains in the morning which worsens as the day progresses due to increased activity; Stiffness following periods of rest which eases on resuming to activity; Weakening of joint muscles due to inactivity; Deteriorated coordination of walking and posture as a result of the stiffness and pain; Soreness of the joints following periods of inactivity or overuse (Nigel, et al.
2008). Imaging and hististopathological techniques and atomic analysis show evidence of structural alterations of the articular cartilage, i. e. there is progressive loss of the articular cartilage, new bone formations at the joint margins (osteophytes), and increased thickness of the subcondral plate. Subcondral bone cysts are observed as structural symptoms. Knee Osteoarthritis Symptoms are commonly evident on the knees’ weight-bearing joints. At an advanced stage, the knee becomes enlarged and swollen.
There is deformity of the knee joints leading to cases such as bowing of knees, stiffness, pain and swelling at the knees (Pelletier, et al. 2001). At the advanced stages still, these symptoms become disabling thus affecting an individual’s mobility or ability to move about independently as well the inability to perform normal day to day activities. Incase OA occur in fingers there is: joint enlargement and pain following pinching movements; bony growth at the finger’s end joint (Heberden’s node) or middle joint (Bouchard node) (Felson & Zhang, 1998).
Spine Osteoarthritis Pain and stiffness in the lower back and neck as well in the shoulder, legs and arms. Limited mobility and muscle spasms are also evident. Pinched nerves or in other words pressure in spinal cord nerves and a spinal disc breakdown and a bony overgrowth. Legs and arms exhibit numbness and weakness as a result of inflammation caused by pinched nerves Hips Osteoarthritis There is referred pain at the side of the thigh and in the knee. The weight-bearing joints of one or both hips show symptoms (Felson, 2006).
In some incidences, the pain spreads to the knee and this may affect diagnosis. A restricted motion range such as when rotating the hip is experienced. Limping when walking. Pain on the inner thigh, buttocks, and the groin. Prognosis Osteoarthritis significantly deteriorates or compromises the quality of life of a patient ranging form pain to mobility loss. Irrespective of gender or age, there is evidence of adverse negative impacts on both mental and physical health of an individual as well a compromise on ones ability to perform activities well (Arthritis Foundation, 2010).
OA limits an individual’s movement and the ability to work. Studies show that about five percent of individuals leave their work because of disability du to OA. At advanced stages (usually enhanced by lack of medical treatment or surgical correction), it results into the inability to perform relatively low-impact tasks like walking increasing dependency on help. Studies show that OA of the knee is the most common and when it occurs, it causes deformity of the joints which results into the inability to work, walk and enjoy a good quality of life.
The fact that OA is a chronic disease impacts negatively on an individual’s psychology since in some societies, such individuals are stereotyped rather tan being supported especially following functional impairment (Felson, 2006). This affects adversely one’s social life and quality of life. At the advanced stages for instance, deterioration of the knee articular cartilage causes disability making one to be dependent on the help of others for day to day activities such as climbing stairs, boarding or alighting a vehicle, walking and enjoying other routine activities.
Individuals used ton high impact activities or sports like running often face a difficulty when they develop OA. This not only affects enjoyment of sports and healthy living but also could ruin careers. Loss of mobility makes physical therapy and self management strategies ineffective and this leads to secondary effects such as obesity which apart from worsening the OA, is linked to other chronic diseases such as coronary heart disease. This compromises an individual’s quality of life adversely. At some stage, OA is associated with severe pain even when resting.
This pain causes discomfort; sleep impairment and stress exact a low quality of life. Other symptoms such as stiffness, swelling and deformity of the joints such as in the case of ‘knock-knees’ are a cause of discomfort as well. These also affect one normal body physique let alone inflicting pain and fatigue (Felson & Zhang, 1998). Although diet has not been proved to treat or cure OA, it is an important control therapy resulting into a restricted diet so as to avoid accelerating OA. Managing effects of OA could cause depression and mental disturbance due to subjection to unanticipated restrictions.
Some medication prescribed to patients of osteoarthritis has adverse side effects such as infertility and pregnancies. Disease factors that are a challenge to daily therapeutic treatment Osteoarthritis causes a disabling effect due to joint swelling and pain when resuming activity such as walking after a period of rest. This makes it difficult to introduce physical therapy such as exercise due to fear of the ‘start up’ or disability especially at advanced stages. This cold make physical therapy ineffective since it is estimated to have worked 3 to 6 weeks following it introduction.
The fact that prognosis indicates possibility of limited movement also makes it hard for daily self management techniques to be effective. Although the ‘wear and tear’ factor due to age does not imply that OA is inevitable, it does pose a challenge to the daily efforts for managing the severity of the disease. This is because age is a risk factor for OA development and that the condition gets worse with age (Shelley, 2008). Thus age compromises the impact of therapy since it is difficult to halt the effect of ageing on joints.
Genetic factors do play a key role in the development of OA sometimes. This is specifically so with the OA in the hands. Individuals could inherit bone abnormalities which later affect joint stability and shape thus becoming a risk factor. This makes day to day management strategies ineffective since there lacks therapy to alter or control genetic influence. Other arthritis types and disease makes it difficult for OA patients with such diseases to manage OA through daily physical or self management therapy (Pelletier, et al. 2001). This is because these could be disabling.
Hemochromotosis or generally having excess iron is a contributing factor to the severity of OA and a challenge to daily therapy since it plays part in the deterioration of the cartilage. Occurrence of growth hormones in excess or Acromegaly adversely affects the joints and bones making day to day treatment strategies ineffective. Physical therapy for managing and treating OA Treatment therapy helps in relieving pain, improving and/or maintaining movement at the joints, increasing joint strength and alleviating the disabling effect of OA.
Physical activity that predisposes individuals to joint injuries such as rough sports ought to be changed for moderate ones. Assistive devices such as those that help in reaching for items, getting up, walking or sitting down help reduce pain associated with activity or stiffness (Carrington, 2005). Braces are also introduced in some incidences to redistribute weight, limit motion, allowing healing after a joint surgery and also help in stabilizing the affected joint. At severe stages, devices such as stationary bikes and other stationary activities are introduced to cope with the loss of mobility and reduce arthritic pain.
Lifestyle changes This involves aspects of day to day activities aimed at reducing arthritic pain. Appropriate management of weight through diet restriction or low impact activities is paramount in reducing the excess pressure exacted on joints by the weight thus controlling arthritic pain in hip and knee OA. A change form high impact activities such as athletics and heavy manual jobs to low impact or moderate activities is essential in alleviating the symptoms of the condition and pain (Arthritis Foundation, 2010).
A change of lifestyle from sedentary to daily and appropriately designed programs for exercise and self management significantly reduces knee osteoarthritis pain and joint overuse during the earlier stages of the illness. Good work organization, body mechanics such as use of palms rather than fingers and pacing one self helps in reducing joint stress, stiffness and arthritic pain. Treatment and coping strategies The most common treatment approaches include medication, physical and occupational therapy, surgery, splint and braces and self management techniques.
Drugs most commonly prescribed include Analgesics, Cox-2 drugs, Topical Analgesics, Viscosupplements, Non-steroidal anti-inflammatory drugs (NSAIDs) or Injectabale glucocorticoids (Carrington, 2005). At severe stages, a joint surgery is carried out and the most common surgeries include Osteotomy, Arthroscopic surgery and Arthroplasty or Joint replacement surgery. Self management approaches range form weight control, pacing oneself, avoiding joint injuries or damage, exercise, keeping active, use of good body mechanics, simplifying and organizing tasks and use of assistive devices.
Bracing encompasses the use of assistive devices. There are alternative therapies such as the use of Chondroitin Sulfate and Glucosamine, Chiropractic care and Vitamins to reduce symptoms such as stiffness and pain. References Arthritis Foundation. (2010). Osteoarthritis. Retrieved 25 May 2010 from http://www. arthritis. org/disease-center. php? disease_id=32&df=treatments. Carrington, J. L. (2005). Aging bone and cartilage: cross-cutting issues. Biochem Biophy Res Commun, 328, (1), pp. 700-708 Felson, D. T. (2006). Clinical practice. Osteoarthritis of the knee. New England Journal of
Medicine, 354 (7), pp. 841-848. Felson, D. T. , & Zhang, Y. (1998). An update on the epidemiology of knee and hip osteoarthritis with a view to prevention. Arthritis Rheum, 41 (4), pp. 1343-1355 Nigel, A. , Elizabeth, A. , & David, H. (2008). Osteoarthritis. (6th Edn. ). Oxford, England: Oxford University Press. Pelletier, J. P, Martel-Pelletier J. , & Abramson, S. B. (2001). Osteoarthritis, an inflammatory disease: potential implication for the selection of new therapeutic targets. Arthritis Rheum, 44 (2), pp. 1237-1247 Shelley, E. T. (2008). Health Psychology. (7th Int. Edn. ). McGraw-Hill