E30: Joint Disease- Osteoarthritis Medication and Lifestyle Management

What is osteoarthritis?

Osteoarthritis, also known as degenerative joint disease (DJD), is the most common type of arthritis. Osteoarthritis is more likely to develop as people age. Inflammation and injury to the joint cause bony changes, deterioration of tendons and ligaments and a breakdown of cartilage, resulting in pain, swelling, and deformity of the joint.

Some people call it degenerative joint disease or “wear and tear” arthritis. It occurs most frequently in the hands, hips, and knees. With OA, the cartilage within a joint begins to break down and the underlying bone begins to change. These changes usually develop slowly and get worse over time. In some cases it also causes reduced function and disability; some people are no longer able to do daily tasks or work.

There are two main types of osteoarthritis:

• Primary: Most common, generalized, primarily affects the fingers, thumbs, spine, hips, knees, and the great (big) toes.
• Secondary: Occurs with a pre-existing joint abnormality, including injury or trauma, such as repetitive or sports-related; inflammatory arthritis, such as rheumatoid, psoriatic, or gout; infectious arthritis; genetic joint disorders, such as Ehlers-Danlos (also known as hypermobility or “double-jointed; congenital joint disorders; or metabolic joint disorders.

What is cartilage?

Cartilage is a firm, rubbery, flexible connective tissue covering the ends of bones in normal joints. It is primarily made up of water and proteins whose primary function is to reduce friction in the joints and serve as a “shock absorber.” The shock-absorbing quality of normal cartilage comes from its ability to change shape when compressed, because of its high water content. Although cartilage may undergo some repair when damaged, the body does not grow new cartilage after injury. Cartilage is avascular, meaning there are no blood vessels in it. Therefore, healing is a slow process.

What are the risk factors for osteoarthritis?

In addition to age and secondary causes such as inflammatory arthritis and prior injury/ trauma, several other risk factors increase the chance of developing osteoarthritis including obesity, diabetes, elevated cholesterol, sex, and genetics.

• Obesity is a risk factor for osteoarthritis, particularly of the knee. In addition to overloading the weight-bearing mechanisms of the body, the metabolic and pro-inflammatory effects of obesity have been studied as contributory to osteoarthritis. Maintaining ideal body weight or losing extra weight is important for those at risk.
• Both diabetes and hyperlipidemia (elevated lipids/cholesterol) contribute to the inflammatory response within the body, increasing the risk of osteoarthritis. Oxidation of lipids can also create deposits in cartilage which affects affecting blood flow of subchondral bone in the same way that blood vessels are affected by atherosclerosis. Elevated blood sugars, as well as elevated cholesterol/lipids, increase free radicals within the body, this oxidative stress exceeds the resilience of cartilage on the cellular level. Controlling diabetes and hyperlipidemia is important for bone health in addition to general health.

• Decreased estrogen as experienced by post-menopausal women increases the risk of knee osteoarthritis as estrogen is protective of bone health specifically reducing oxidative stress to the cartilage.
• Heredity can play a role in osteoarthritis, as individuals born with other bone diseases or genetic traits may be more likely to develop osteoarthritis. For example, Ehlers-Danlos, which is characterized by joint laxity or hypermobility, can contribute to osteoarthritis.

MANAGEMENT AND TREATMENT

How is osteoarthritis treated?

There is no cure for osteoarthritis. Mild to moderate symptoms are usually well managed by a combination of pharmacologic and non-pharmacologic treatments. Medical treatments and recommendations include:

• Medications (topical pain medicines and oral analgesics including nonsteroidal anti-inflammatory medications, NSAIDs).
• Exercise (land- and water-based).
• Intermittent hot and cold packs (local modalities).
• Physical, occupational, and exercise therapy.
• Weight loss (if overweight).
• Healthy eating, managing diabetes and cholesterol.
• Supportive devices such as braces, orthotics, shoe inserts, cane, or walker.
• Intra-articular injection therapies (steroid, hyaluronic acid “gel”).
• Complementary and alternative medicine strategies, including vitamins and supplements.

Surgery may be helpful to relieve pain and restore function when other medical treatments are ineffective or have been exhausted, especially with advanced OA.

E5: Sickle Cell Anemia: 5 Cases and Probability of A Parent Siring a Sickle Anemic Child. HB Electro – AfyaTalk Podcast

HIV is a common test, just as VDRL for couples settling down. But what of HB Electrophoresis? My keen interest is sickle cell disease because it is inherited and you can be actually a carrier without knowing. You have a probability of passing that to your child. Sickle cell disease is the first molecular disease to be identified (Pauling et al 1949).  Frank B. Livingstone and Antony C. Allison studied sickle cell and its distribution in period 1950-1980. Up to now, Africa has the highest burden of sickle cell disease while Arabian Peninsula has the highest variety in terms of sickle cell disease genotype and phenotype. Sickle cell anemia topics has featured into my AfyaStoryline Weekly Edition blogs  for health, lifestyle and mental awareness and sensitization.

The goals of treatment are to:

• Decrease joint pain and stiffness and delay further progression.
• Improve mobility and function.
• Increase patients’ quality of life.

The type of treatment regimen prescribed depends on many factors, including the patient’s age, overall health, activities, occupation, and severity of the condition.