Degenerative Joint Disease.

Alternative Names: Hypertrophic osteoarthritis; Osteoarthrosis; Degenerative joint disease; DJD; OA; Arthritis-Osteoarthritis.

Causes
Unfortunately most of the time, the cause of OA is unknown. It is mainly related to aging, but metabolic, genetic, chemical, and mechanical factors can also lead to OA.
The symptoms of osteoarthritis usually appear in middle age and almost everyone has them by age 70. Before age 55, the condition occurs equally in both sexes. However, after 55 it is more common in women.

The disease causes the cushioning (cartilage) between the bone joints to wear away, leading to pain and stiffness. As the disease gets worse, the cartilage disappears and the bone rubs on bone. Bony spurs usually form around the joint.

OA can be primary or secondary.
Primary OA occurs without any type of injury or obvious cause.
Secondary OA is osteoarthritis due to another disease or condition. The most common causes of secondary OA are metabolic conditions, such as acromegaly, problems with anatomy (for example, being bow-legged), injury, or inflammatory disorders such as septic arthritis.

Symptoms
The symptoms of osteoarthritis include:
Deep aching joint pain that gets worse after exercise or putting weight on it and is relieved by rest
Grating of the joint with motion
Joint pain in rainy weather
Joint swelling
Limited movement
Morning stiffness
Of course some people might not have symptoms.
Examination and Tests
A physical exam can show limited range of motion, grating of a joint with motion, joint swelling, and tenderness.
An x-ray of affected joints will show loss of the joint space, and in advanced cases, wearing down of the ends of the bone and bone spurs.

Treatment
The goals of treatment are to relieve pain, maintain or improve joint movement, increase the strength of the joints, and reduce the disabling affects of the disease. The treatment depends on which joints are involved.

MEDICATIONS
The most common medications used to treat osteoarthritis are nonsteroidal anti-inflammatory drugs (NSAIDs). They are pain relievers that reduce pain and swelling. Types include aspirin, ibuprofen, and naproxen.
Although NSAIDs work well, long-term use of these drugs can cause stomach problems, such as ulcers and bleeding. Manufacturers of NSAIDs include a warning label on their products that alerts users to an increased risk for cardiovascular events (heart attacks and strokes) and gastrointestinal bleeding.

Other medications used to treat OA include:
COX-2 inhibitors (coxibs). Coxibs block a substance called COX-2 that causes swelling. This class of drugs was first thought to work as well as other NSAIDs, but with fewer stomach problems. However, reports of heart attacks and stroke have led the Drug Licensing Authorities to re-evaluate the risks and benefits of the COX-2s. Ask your doctor whether the drug is 1. Still available and if so 2. Right and safe for you.
Steroids. These medications are injected right into the joint. They can also be used to reduce inflammation and pain.

Supplements. Many people are helped by over-the-counter remedies such as glucosamine and chondroitin sulfate. There is some evidence that these supplements can help control pain, although they do not seem to grow new cartilage.
Artificial joint fluid (Synvisc, Hyalgan). These medications can be injected into the knee. They may relieve pain for up to 6 months.

LIFESTYLE CHANGES
Exercise helps maintain joint and overall movement. Ask your health care provider to recommend an appropriate home exercise routine. Water exercises, such as swimming, are especially helpful.
Applying heat and cold, protecting the joints, using self-help devices, and rest are all recommended.
Good nutrition and careful weight control are also important. If you're overweight, losing weight will reduce the strain on the knee and ankle joints.

PHYSICAL THERAPY
Physical therapy can help improve muscle strength and the motion at stiff joints. Therapists have many techniques for treating osteoarthritis. If therapy does not make you feel better after 3-6 weeks, then it likely will not work at all.

BRACES
Splints and braces can sometimes support weakened joints. Some prevent the joint from moving; others allow some movement. You should use a brace only when your doctor or therapist recommends one. Using a brace the wrong way can cause joint damage, stiffness, and pain.

SURGERY
Severe cases of osteoarthritis might need surgery to replace or repair damaged joints. Surgical options include:
Total or partial replacement of the damaged joint with an artificial joint (knee arthroplasty, hip arthroplasty )
Arthroscopic surgery to trim torn and damaged cartilage and wash out the joint
Cartilage restoration to replace the damaged or missing cartilage in some younger patents with arthritis
Change in the alignment of a bone to relieve stress on the bone or joint (osteotomy)
Surgical fusion of bones, usually in the spine (arthodesis)

Outlook (Prognosis)
Your movement may become very limited. However Treatment generally improves function.
Possible Complications
Decreased ability to walk
Decreased ability to perform everyday activities, such as personal hygiene, household chores, or cooking
Adverse reactions to drugs used for treatment
Surgical complications
When to Contact a Medical Professional
Do contact your health care provider if you have symptoms of osteoarthritis.

Prevention
*Weight loss can certainly help in the management of DJD and reduce the risk of knee osteoarthritis in overweight women.

Degenerative Joint Disease

Alternative Names: Hypertrophic osteoarthritis; Osteoarthrosis; Degenerative joint disease; DJD; OA; Arthritis-Osteoarthritis.
Causes
Unfortunately most of the time, the cause of OA is unknown. It is mainly related to aging, but metabolic, genetic, chemical, and mechanical factors can also lead to OA.
The symptoms of osteoarthritis usually appear in middle age and almost everyone has them by age 70. Before age 55, the condition occurs equally in both sexes. However, after 55 it is more common in women.


The disease causes the cushioning (cartilage) between the bone joints to wear away, leading to pain and stiffness. As the disease gets worse, the cartilage disappears and the bone rubs on bone. Bony spurs usually form around the joint.


OA can be primary or secondary.
Primary OA occurs without any type of injury or obvious cause.
Secondary OA is osteoarthritis due to another disease or condition. The most common causes of secondary OA are metabolic conditions, such as acromegaly, problems with anatomy (for example, being bow-legged), injury, or inflammatory disorders such as septic arthritis.
Symptoms
The symptoms of osteoarthritis include:
Deep aching joint pain that gets worse after exercise or putting weight on it and is relieved by rest.
Grating of the joint with motion.
Joint pain in rainy weather.
Joint swelling.
Limited movement.
Morning stiffness.
Of course some people might not have symptoms.

Examination and Tests
A physical exam can show limited range of motion, grating of a joint with motion, joint swelling, and tenderness.
An x-ray of affected joints will show loss of the joint space, and in advanced cases, wearing down of the ends of the bone and bone spurs.

Treatment
The goals of treatment are to relieve pain, maintain or improve joint movement, increase the strength of the joints, and reduce the disabling affects of the disease. The treatment depends on which joints are involved.

MEDICATIONS
The most common medications used to treat osteoarthritis are nonsteroidal anti-inflammatory drugs (NSAIDs). They are pain relievers that reduce pain and swelling. Types include aspirin, ibuprofen, and naproxen.

Although NSAIDs work well, long-term use of these drugs can cause stomach problems, such as ulcers and bleeding. Manufacturers of NSAIDs include a warning label on their products that alerts users to an increased risk for cardiovascular events (heart attacks and strokes) and gastrointestinal bleeding.
Other medications used to treat OA include:
COX-2 inhibitors (coxibs). Coxibs block a substance called COX-2 that causes swelling. This class of drugs was first thought to work as well as other NSAIDs, but with fewer stomach problems. However, reports of heart attacks and stroke have led the Drug Licensing Authorities to re-evaluate the risks and benefits of the COX-2s. Ask your doctor whether the drug is 1. Still available and if so 2. Right and safe for you.


Steroids. These medications are injected right into the joint. They can also be used to reduce inflammation and pain.
Supplements. Many people are helped by over-the-counter remedies such as glucosamine and chondroitin sulfate. There is some evidence that these supplements can help control pain, although they do not seem to grow new cartilage.
Artificial joint fluid (Synvisc, Hyalgan). These medications can be injected into the knee. They may relieve pain for up to 6 months.


LIFESTYLE CHANGES
Exercise helps maintain joint and overall movement. Ask your health care provider to recommend an appropriate home exercise routine. Water exercises, such as swimming, are especially helpful.
Applying heat and cold, protecting the joints, using self-help devices, and rest are all recommended.
Good nutrition and careful weight control are also important. If you're overweight, losing weight will reduce the strain on the knee and ankle joints.


PHYSICAL THERAPY
Physical therapy can help improve muscle strength and the motion at stiff joints. Therapists have many techniques for treating osteoarthritis. If therapy does not make you feel better after 3-6 weeks, then it likely will not work at all.

BRACES
Splints and braces can sometimes support weakened joints. Some prevent the joint from moving; others allow some movement. You should use a brace only when your doctor or therapist recommends one. Using a brace the wrong way can cause joint damage, stiffness, and pain.
SURGERY
Severe cases of osteoarthritis might need surgery to replace or repair damaged joints. Surgical options include:
Total or partial replacement of the damaged joint with an artificial joint (knee arthroplasty, hip arthroplasty )
Arthroscopic surgery to trim torn and damaged cartilage and wash out the joint
Cartilage restoration to replace the damaged or missing cartilage in some younger patents with arthritis
Change in the alignment of a bone to relieve stress on the bone or joint (osteotomy)
Surgical fusion of bones, usually in the spine (arthodesis)

Outlook (Prognosis)
Your movement may become very limited. However Treatment generally improves function.
Possible Complications.
Decreased ability to walk.
Decreased ability to perform everyday activities, such as personal hygiene, household chores, or cooking.
Adverse reactions to drugs used for treatment.
Surgical complications.

When to Contact a Medical Professional
Do contact your health care provider if you have symptoms of osteoarthritis.

Prevention
*Weight loss can considerably help in the management DJD and ceratainly reduce the risk of knee osteoarthritis in overweight women.

The Silent Disease

The Silent Disease is the name that is often given to Osteoporosis, as most people don't know they have osteoporosis until it has progressed often to the point of fracture, usually in the hip, wrist or spine. Even when undiagnosed osteoporosis results in a vertebral fracture, the pain is frequently dismissed as general back pain. This lack of awareness can lead to serious illness, deformity, even death.

Osteoporosis alone does not cause back pain. It can, however, weaken the spine to where it is no longer able to withstand normal stress or minor trauma, resulting in vertebral fracture. It is the ensuing fracture that causes pain.

Osteopenia is a condition where bone mineral density is lower than normal, but not low enough to be classified as osteoporosis. While often a precursor to osteoporosis, not everyone with osteopenia will develop osteoporosis. Since a diagnosis of osteopenia puts one at greater risk for osteoporosis, patients are encouraged to seek the advice of their physicians about implementing preventive measures.

Osteoporosis Causes and Risk Factors
Bones are made of complex, constantly changing, living tissue. They are able to grow and heal, and are also susceptible to changes in diet, body chemistry, and exercise levels.
Early in life, more bone is laid down than is removed by the body. People typically achieve peak bone mass by around age 30, after which more bone is lost than is replaced. Too much bone loss leads to osteoporosis.

Both of the two primary types of osteoporosis are far more common in women than men:

Type I osteoporosis (postmenopausal osteoporosis) —generally develops after menopause, when estrogen levels drop precipitously, leading to bone loss — usually in the trabecular (spongy) bone inside the hard cortical bone.


Type II osteoporosis (senile osteoporosis) — typically happens after age 70 and involves a thinning of both the trabecular (spongy) and cortical (hard) bone.

In addition, certain medications and medical conditions can damage bone and lead to what is known as “secondary osteoporosis”. Patients being treated for any of the following conditions should discuss the risk of osteoporosis with their physicians:

Endocrine disorders

Marrow disorders

Collagen disorders

Gastrointestinal disorders

Seizure disorders

Eating disorders (such as anorexia or bulimia)

It is important to distinguish between primary and secondary causes of osteoporosis because treatment is often different. To determine the cause, a thorough medical history, physical examination, and appropriate diagnostic tests need to be conducted (see Diagnosing Osteoporosis).

Key risk factors for developing osteoporosis include:

Advanced = age over age 65.

Gender = Women are four times more likely to develop osteoporosis than men.

Heredity = Family history of osteoporosis or fracture on the mother’s side.

Personal history = any type of fracture after age 45.

Race = Caucasian and Asian women are at greater risk.

Body type= small-boned women weighing less than 127 pounds.

Menstrual history = Normal menopause increases the risk of osteoporosis and early menopause can exacerbate this risk.

Lifestyle = calcium and/or vitamin D deficiency; little or no exercise (especially weight-bearing exercise); alcohol abuse; smoking; too much cola/soda.

Testosterone deficiency (hypgonadism) = in men.

Why women are at greater risk for developing osteoporosis

Estrogen plays an important part in maintaining bone strength. Starting at about age 30 through onset of menopause, women lose a small amount of bone every year as a natural part of the aging process. When women reach menopause and estrogen levels decrease, the rate of bone loss increases for approximately 8 to 10 years before returning to premenopausal rates.

Osteoporosis Symptoms

Osteoporosis can go undetected for years and fracture is typically the first outward sign. Advanced osteoporosis is potentially disabling, often leading to one or more of the following:
fractures of the spine, wrist or hip

spinal deformity (e.g., lost height, hunched back)

chronic or severe pain

limited function and reduced mobility

loss of independence

decreased lung capacity

difficulty sleeping

Osteoporosis is the leading cause of spine fractures, especially in women over age 50, but only about one third of all spine fractures are diagnosed.

Most osteoporotic spine fractures (vertebral compression fractures) start with sudden back pain, usually after routine activity (lifting or bending) that slightly strains or jars the back. After a month or two, this acute pain is usually replaced by an achy pain (see Diagnosing vertebral compression fractures).

Osteoporosis Prevention

Postmenopausal (Type I) osteoporosis can be significantly influenced by preventive measures. Most of these behaviors are up to the individual and should be started as early in life as possible. For those genetically predisposed to osteoporosis, the following practices are even more important:
Exercise regularly weight-bearing exercises (activities that work one’s bones and muscles against gravity) are essential to maintaining bone health.

Ensure adequate calcium intake, Calcium plays a key role in keeping bones strong. Vitamin D is also essential, as it helps ensure absorption and retention of calcium in bones. Calcium and vitamin D requirements vary depending on age and gender.

Eat a balanced, healthy diet Certain foods provide excellent sources of calcium, while diets high in protein and/or sodium increase calcium loss.

Quit smoking - Smoking has a detrimental effect on bone density, leading to greater risk of injury and longer recovery times.

Limit alcohol consumption - While the exact way alcohol affects bone isn’t entirely understood, excessive alcohol use has been proven to accelerate bone loss.

Limit intake of colas/sodas - recent research indicates that too much cola or soda can increase the risk of osteoporosis.

Undergo bone density testing - every 1-2 years if you are postmenopausal, over age 65, or have other risk factors. Bone mineral density (BMD) tests indicate normal, low or osteoporotic bone density levels, as well as any increased risk of fracture.

For more information, see How to prevent osteoporosis.

Osteoporosis Treatment

Once osteoporosis has been diagnosed, patient and physician should work together to develop a treatment plan where the goal is to slow bone loss and prevent fractures. Treatment may include:
Education on diet/nutrition - see Food for Thought: Diet and Nutrition for a Healthy Back.

Exercise (if no fracture) - to help maintain bone density and reduce the risk of falls.

Medication - to slow bone loss and prevent fractures. Osteoporosis medications fall into two categories:

medications that slow or stop bone resorption (loss);

medications that increase bone formation.

Treatment for vertebral fractures, which may include:

rest, though long-term rest accelerates bone loss;

rigid back braces to support the spine;

ice/heat and pain medications;

surgery (kyphoplasty or vertebroplasty), which may be necessary in certain situations where the fracture is causing severe pain and/or deformity, or has failed to respond to three months of non-surgical treatment.

Do be positive because even once osteoporosis has been diagnosed, it is possible to slow bone loss, build bone density and prevent fractures. Continually advancing osteoporosis and related fractures are not an inevitable outcome of being diagnosed with osteoporosis.



Terry O’Brien
Back Trouble UK.

Arthritis

Spinal arthritis is a very painful condition, worse than other forms of arthritis due to the high amount of nerves present in and around the spinal structures, especially those concerning the facet joints and intervertebral discs.
Spinal osteoarthritis, otherwise known as spondylosis, can affect any region of the spine and is caused by the degenerative process.

More common in the over 55s and with women more than men, spinal arthritis can be triggered by an accident, injury or from a weakened immune system.
People who have a family history of spinal arthritis are more likely to develop the condition themselves.

Symptoms
Apart from suffering with high levels of pain, there is the likelihood of having an increased stiffness, especially in the spine, particularly after long periods of rest. Pain can be intermittent and worse on movement.
As part of the human body’s natural response to arthritis, an excess of bony growth may occur, resulting in ‘spurs’ being formed। They can cause additional pain and can restrict movement further. Some sufferers report a crunching sound, like bone on bone, possibly due to the growth of the spurs.

Spinal arthritis occurring in the lower back can affect the lower extremities with additional pain in the legs and buttocks. Cervical spine arthritis can cause pain to radiate to the shoulders and arms.
There is no known cure for arthritis but there are a number of treatments available for the relief of symptoms.

Treatment
The treating GP may refer you to an x-ray department in order to confirm diagnosis by a series of images। These pictures will also show any inflammation and if there is any deterioration in the cartilage.

Along with this a blood sample can be gained and sent for analysis to determine the type of arthritis. Medications include anti-inflammatory drugs, pain relief, arthritic drugs or steroids.
Spinal spondylosis can cause the intervertebral discs to degenerate which increases the risk of them herniating, a condition that would require further treatment.

Facet joints of the spine can be affected by the deterioration of cartilage or the formation of bony overgrowths and can limit movement significantly. Surgery may be an option to remove the bony growths.
Treatments that can be performed by the patient, without input from a medical professional include giving-up smoking; this will increase the levels of oxygen to the affected area and prevent further deterioration of the discs. Maintaining a healthy weight for your frame will prevent putting excessive pressure and strain on the ligaments and joints of the spine. Applying regular heat or ice therapy, whichever is preferred, will help with pain relief and reduce inflammation. Exercise is a good way of help alleviate symptoms, as arthritis can affect mobility, it may be best to seek advice from a physiotherapist who will work with you and devise an appropriate and manageable programme of exercise.

Spinal arthritis is a painful and restrictive condition. Though there is no cure, it may be prevented or onset delayed by eating a healthy diet, rich in nutrients and calcium (to keep bones strong and healthy), and by ensuring flexibility, strength and suppleness by keeping to a regular exercise regime.

The Pain of it all!

Lower back pain is one of the most common ailments people suffer from and approximately 8 out of 10 people will deal with back pain at some point in their life. That's a lot of people… are you one of them? I am.


I have bulging, herniated discs and have had low back spasms (that knock me to my knees) and sciatica. I have been on all kinds of pain killers, including narcotics which only mask the problem and is by no means a permanent solution.

I have avoided back surgery like the plague as there are so many with horror stories.

The only relief I have found is with the proper exercise and stretching. I can assure you will find back pain relief if you do this regimen the correct way, do it the wrong way and you might up under the knife! Out of all of the various forms of back pain, lower back pain is by far the most common and there's a good explanation for this.


Any idea why? It's not car accidents, it's not work-related injuries, and it's not a lack of prescription medications either. Lack of movement and use is the number one cause of lower back pain! It's the lack of movement in various muscles over years that leads to muscle imbalances and uneven wear and tear on your body, especially the spine. For example, how many times a day are you bending, leaning, or twisting?

Here's what the typical person's day is like:

Wake up - Eat breakfast (hopefully) - Drive or ride to work - Sit at desk - Eat lunch - Sit at desk some more - Drive or ride home - Eat dinner - Sit on couch and watch television - Go to bed
Notice the trend here?

That's an awful lot of sitting and not moving. Well, this is what leads to serious muscle imbalances and so what do we do, we go to the gym and perform exercises that only make the imbalances worse! The key to eliminating lower back pain (nearly any ache, pain, or injury for that matter) is to identify the muscle imbalances that are pulling the spine, bones, and joints out of place and then stretch the tight muscles while strengthening the weak muscles.


Many people who seek professional help are often mis-diagnosed and end up following a treatment plan that fails to eliminate the cause of their back pain. ( Seek out Physical Therapy)
Nearly all of the individuals I worked with were able to eliminate their back pain, or significantly improve their condition even though all of the traditional treatments failed them , cortisone injections, anti-inflammatory medications, back surgery, etc). Even more amasing is the fact that most of these individuals were able to eliminate their back pain in a matter or days or weeks simply by performing a handful of exercises and stretches!

These weren't your basic exercises or the standard back stretches and stomach exercises most "experts" recommend - these were specific exercises and stretches prescribed based on the individual. Many of these people had suffered for years and years with aches, pains, and stiffness and lived inactive lives because of their back pain.


Most back pain treatments offered for lower back pain only address the symptoms and don't address the cause, which usually delivers just temporary relief for the individual. In addition to helping hundreds of others eliminate lower back pain, I also have had personal experiences with back pain and other various conditions such as sciatic pain, tendonitis, muscle strains and sprains, and more.

In every single situation the traditional treatments did nothing but treat the symptoms (often times not successfully) and the only approach that gave lasting improvements and relief was targeted stretches and exercises.


Have you tried traditional treatments and found little relief? I am not saying these treatments are not effective at temporarily reducing the pain or inflammation, but I am saying nearly all fail to get rid of the underlying cause of the problem.
I wish you the best and remember, the key to a healthy back is movement!


About the Author:

Terry O’Brien served 15 years in the Army (Medicine) (Airborne Forces).
He then embarked on Air Crew Emergency Medical Training for Global Airlines and has been actively involved in Sports Medicine, Rehabilitation and Community Care.
www.backtrouble.co.uk/

Sex

Back pain can be an intruder into your sex life and even ruin your relationship, if you are not careful. This article presents six things you can do to keep the love in your life when you suffer from back pain. The tips and insights here are provided by Terry O'Brien. Back Trouble (UK)

1. Try to Talk to Your Doctor About Your Sexual Functioning - or Turn Elsewhere
Patients tend to be uncomfortable about discussing sex and sexual positions with their doctors. According to Terry , a big part of the responsibility for the lack of communication between doctor and patient lies with the medical professionals. "Health care providers should be actively seeking the subject," he says. Sex is on par with returning to work and daily activities in diagnosing and treating back pain.

If your health care provider will not address your questions about sex, Terry suggests researching the information on the internet.

2. Address Your Attitude

Address your attitude about your condition and the effect it will have on your relationship. Terry says that quite often relationships break up when one partner experiences back pain. This is because, he says, reaction to pain is a learned behavior. "As you decide to be, that's how you are." Often people in pain will exaggerate it by avoiding sex. "This is what ruins the relationship," he says.

3. Accept that you may not be able to be as vigorous as you were prior to the onset of your pain. You can turn to your creativity and sense of discovery to help you adapt your sex life to the level your back can handle.

4. Know your condition and which positions bring on symptoms, as well as which alleviate them. Back injuries and conditions can be categorized by what kinds of movements make symptoms worse, and this information can be used to guide the selection of sexual positions.

5. With your partner, plan out which positions to try. Often you can modify your favorite positions with just a pillow or towel. Other times, you need to communicate and work it out with your partner. Talk about it up front, then expect, at times, that you will need to modify the plan. Planning your positions is a valuable strategy, Terry says, because relationships which accommodate back pain with a "we can adapt" attitude fare better than those in which the problem belongs only to the partner with the pain.

6. Get your pelvic floor muscles in shape. Strong flexible pelvic floor muscles can greatly enhance sexual function. The good news is that they can also do wonders for your back. The reason for this is that they are a part of the core support system that balances out muscle usage and stabilizes body posture. Terry says that along with their role in sex, the pelvic floor muscles are as important as the abdominals and low back muscles in back health.

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)