Osteoarthritis

Osteoarthritis embraces a broad spectrum of clinical conditions with the common feature being that of primary joint failure.
Prevention is the ideal goal, however opportunities to achieve this are limited by our incomplete understanding of the aetiopathology.

The principles of Preventive Intervention are education about the condition, modification of lifestyle, and judicious exercise and joint protection, together with adequate pain relief. Optimum management involves a team approach that includes orthopaedic surgical expertise, as surgery can provide an alternative to continuing discomfort and limited mobility.

Osteoarthritis (OA) is the most common joint disorder in humans and increases with increasing age. It affects up to 70% of the world population over 65 years of age as well as a significant proportion of younger people. Osteoarthritis is multifactorial in causation and may be defined as primary failure of the joint with degeneration of articular cartilage.

The pathophysiology of the condition has been well reviewed.

Physical, Genetic, Chemical and Immunological factors are involved. The disorder may be primary or the almost inevitable sequel to previous joint damage.

Clinical Presentation:

There are 3 broad groups:

a. symmetrical peripheral arthritis
Heberden's nodes

Primary generalised osteoarthritis (PGOA) in females
Non-nodal OA in males

b. Oligoarticular large joint disease

c. Spinal arthritis
Spondylosis
Apophyseal OA

While OA is generally accepted as non-inflammatory in nature, localised inflammation can be demonstrated and may be prominent in certain forms such as 'erosive OA' of the fingers. However, in most instances, the precise aetiology cannot be defined and changes in articular cartilage are present long before clinical manifestations become apparent.

Preventive intervention:

Osteoarthritis is aggravated by several factors including obesity, occupation, and the nature of any previous joint damage and the presence of underlying joint disease. Recognition of these factors provides an opportunity for primary, secondary and tertiary preventive interventions, which include:

1. Weight reduction
2. Occupational modification (Posture/Occupational Assessments)
3. Joint protection
4. Team management approach (GP, Osteopath, Chiropractic, Surgeon, and Physiotherapist)
5. Analgesic techniques
6. Education groups for patients and relatives

Conclusion:

There are many approaches to the management of patients with osteoarthritis. It is my belief that Preventive Intervention has an important role in the total care of the patient and is often undervalued and under-utilised.

T. O'Brien (Back Trouble UK)