What is osteoarthritis?
Osteoarthritis is a joint disease that affects most middle-aged and older people. It is also known as ‘wear of the joints’ or ‘calcification’ among the people. Although it is more common in the elderly; In some sports injuries or occupational traumas, osteoarthritis may develop at an earlier age, along with wear on the joints. Generally, the incidence increases from middle age to the elderly.
How does osteoarthritis occur?
It has a slow course. The cartilage structure of the joint changes due to aging. Being overweight causes cartilage fragmentation due to falls or some other mechanical traumas, followed by damage to the meniscus and ligaments, narrowing of the joint space and new bone formation. Osteoarthritis develops more easily in diseases that involve and erode the joint, such as gout or rheumatoid arthritis. Osteoarthritis most commonly involves the spine (lower back and neck), knee, hip and hand joints; shoulder and ankle are involved less frequently. Osteoarthritis causes complaints such as joint pain, stiffness, hard swelling on the joint (due to the growth of the bone structure), a feeling of mass or stuckness with the movement of the joint, and a decrease in the range of motion of the joint.
Who affects osteoarthritis?
Osteoarthritis is the most common joint disease in the elderly and is the most common cause of disability. In direct X-ray films, 70% of those over 70 years of age have osteoarthritis findings. According to one study, a person’s lifetime risk of developing knee osteoarthritis is approximately 46%; The risk of developing hip osteoarthritis is 25%.
Osteoarthritis in the elderly
Those with a family history of osteoarthritis (especially in first-degree relatives-mother, father and siblings)
Obese
Joint injury or repetitive overuse of joints injury
Joint deformity (unequal leg length, removal of meniscus at an early age, etc.)
How is the diagnosis of osteoarthritis made?
In the patient’s history; Joint pain not at rest but with movement, feeling of sticking in the joint and short-term stiffness in the joint when starting movement after rest; The diagnosis is made by examination findings (such as limitation of movement without signs of inflammation in the joint, growth in the bone structure) and imaging methods. Direct X-rays or sometimes magnetic resonance imaging (MRI) are used for further imaging.
How is osteoarthritis treated?
Once osteoarthritis-related joint damage has developed, there is no treatment to reverse it. The goal of treatment is to reduce pain and improve movement of the involved joint. Physical therapy and drug therapy are often used together; Sometimes surgical treatment is done.
Physical Therapies:
Avoiding movements that will tire the joint should be the most important step. For example, a person with joint calcification in their knees; such as crouching down by putting a load on the knees while standing, praying (it is recommended to sit down), going up and down hills and stairs (it is recommended to use an elevator), getting up from the chair he is sitting in (it is recommended to use a sofa or chair with arms and to get up from there without putting too much weight on the knee). . For patients with calcification in hand joints; it is recommended not to force it by opening the bottle cap, jar lid, and not to force it when using scissors and knives. There are ergonomic tools that can be developed for this purpose and you can design them yourself. Pizza cutter roll knives can be recommended instead of knives. If you are holding a pencil or brush for a long time, you can relax the joint by wrapping soft sponges on them.
Weight loss and exercise are the two most important words. Getting rid of excess weight; Sometimes it also provides relief on its own, as it reduces the load on the knees, hips and waist. Do not forget that with every 10 kg you lose, you will reduce the 40 kilos on your knees.
Exercise increases muscle strength, reduces joint pain and stiffness.
In addition, using a walker or cane called a ‘wolker’ for daily activities will reduce the load on that joint and help maintain balance. Application of heat or cold (only when there is inflammation) can relieve osteoarthritis symptoms for a short time.
Some alternative treatments such as spa (hot tub), massage, acupuncture help relieve pain for a short time. However, it may require expensive and repetitive treatments. Also, alternative therapies (sometimes called complementary or integrative) may provide temporary relief for patients, although long-term benefits have not been proven.
Drug Treatments:
There are topical, oral (by mouth) and injection forms of drug therapy. Topical medications are applied directly to the skin over the affected joints. These drugs are like capsaicin cream, lidocaine and diclofenac gel. Oral pain relievers such as acetaminophen (paracetamol) are the most commonly recommended pain relievers. It does not touch the stomach, does not harm the kidneys. It also does not touch the liver unless it exceeds 4 tablets (ie 2000mg) per day. In the presence of inflammation (in the presence of warmth, blistering and swelling), non-steroidal anti-inflammatory drugs (usually called NSAIDs: naprosyn, diclofenac, ibuprofen, indomethacin) are used. However, unlike paracetamol, these drugs touch the stomach, reduce blood flow from the kidneys, cause water and salt retention, increase blood pressure, and increase the risk of diseases such as stroke and paralysis. Long-term use also causes deterioration in liver and kidney tests. These drugs (nonsteroidal anti-inflammatory drugs) are not used in the elderly, those with underlying heart, liver and kidney disease.
Intra-articular injections; corticosteroids (cortisone) can be used in those with signs of intense inflammation. It can be made with a form of lubricant called hyaluronic acid. A few years may help delay knee replacement in some patients.
Surgery:
Surgery is a treatment option for severe cases. It is preferred when there is severe damage to the joint, or when medical treatment cannot relieve pain, or if there is severe loss of function. Surgery may require knee or hip joint replacement (prosthesis) or interventions to relieve nerve compression in the narrowed spinal canal.
Supportive Therapies:
Many nutritional supplements are used for the treatment of osteoarthritis. Most of them lack data on efficacy and safety. Among the most widely used is Glucosamine / Chondroitin sulfate. The effectiveness of oral use in osteoarthritis is indistinguishable from placebo (false drug). Please consult your doctor before using any of these supplements to ensure safe use and avoid drug interactions. These drugs have undesirable side effects such as water and salt retention, edema and increased blood pressure. Other applications such as PRP or ozone treatments are not yet among the recommendations of the ACR (American Society of Rheumatology) or EULAR (European Society of Rheumatology).
Tips for Patients with Osteoarthritis:
Osteoarthritis has no cure, but you can manage how it will affect your life. Here are some tips:
Properly positioning and supporting the neck and back while sitting or sleeping.
Also take approaches that are not straining the joints on a daily basis, such as using a chair or using a toilet seat while lying down.
Avoid repetitive movements that strain the joint, such as twisting.
Lose weight if you are overweight. It can reduce pain and slow the progression of osteoarthritis. In fact, weight loss surgery is recommended by ACR for those with a body mass index of 35 and above with joint calcification (waist, hip and especially knee).
Exercise every day.
Use assistive devices in your daily activities.
You can work with a physical therapist or occupational therapist to learn the exercises and select assistive devices that work best for you.
The Role of the Rheumatologist in the Treatment of Osteoarthritis:
Rheumatology doctor has an important role in the diagnosis and treatment of osteoarthritis; It is a disease that usually requires multidisciplinary (jointly with other departments) work. Therefore, doctors of physical therapy, orthopedics or neurosurgery also have important duties in the treatment of this disease.
