Good Morning

Current Trends in treatment

Osteoarthritis
 What is It?
How Do I get it?
Risk Factors.
Presentation.
When Do I need To see a Doctor?
Complications.
Treatment.
Breakthroughs.
Self-care.
 The word "arthrits" is a blend of the Greek words
What does it mean?
"arthron" for joint, and "itis," for infammation.
 Cartilage is the slippery tissue that
covers the ends of bones in a joint.
Healthy cartilage allows bones to glide
over each other.
In osteoarthritis, the top layer of
cartilage breaks down and wears away.
 Second

First
 The rubbing causes pain, swelling, and
loss of motion of the joint. Over time,
the joint may lose its normal shape.
Also, bone spurs may grow on the
edges of the joint.
Bits of bone or cartilage can break off
and float inside the joint space, which
causes more pain and damage.
No more cartilage
How do I get it??
 Risk Factors

The exact causes of osteoarthritis are unclear, but these factors

increase your risk:
Being 45 years old or older
Being female
Having certain hereditary conditions, including defective
cartilage and malformed joints
Having joint injuries caused by physical activity or sports
Being obese
Having diseases that change the normal structure and
function of cartilage, such as rheumatoid arthritis,
hemochromatosis or gout.
 Presentation:

Osteoarthritis ofen develops slowly, and some

people may not experience any signs or
symptoms, however there might be:
Pain in a joint during or afer use, or afer a period
of inactivity.
Discomfort in a joint before or during a change in
the weather.
Swelling and stiffness in a joint, particularly afer
using it.
Areas osteoarthritis typically affects include:
Spine. Slow deterioration of disks between the
bones along your spine can lead to back and neck
pain and stiffness.

Weight-bearing joints. The parts of your body

that bear the majority of your weight your hips,
knees and feet are more susceptible to
osteoarthritis. As cartilage slowly deteriorates
over the years, you can develop chronic pain or
varying amounts of discomfort when you stand
and walk. Swelling also may occur, especially in
your knees.
 When Do I see the doctor?

Warning signs of osteoarthritis are:

Stiffness in a joint afer getting out of bed or
sitting for a long time
Swelling or tenderness in one or more joints
A crunching feeling or the sound of bone
rubbing on bone.
 The main Symptom of osteoarthritis is
pain!!.
The degree of pain can vary greatly, from
being a mild inconvenience to being
debilitating.
Imaging Studies: Investigations:
X-rays, Ct scans, MRI
 Treatment
Doctors often combine
treatment to fit patients
needs, lifestyle, and
health.
Improve joint function
Keep a healthy body
weight
Control pain
Achieve a healthy
lifestyle.
 Medicatons
Medications are used to:
Treat pain and mild infammation.
Improve your joints' functioning.

They include both topical medications , oral

medications and local Intra-articular Injections.
 Gels.
Creams.
Topical pain relievers:
Pain Reliever.
Counter Irritant.
Glucoasmine sulphate,
Chondroitin.
 NSAIDs:Inhibitors:
Cox-2
work in two ways. They relieve pain and they fght infammation
Oral Medications

Considered as effective for managing pain and

They range from OTC aspirin, ibuprofen (Advil, Motrin IB, others) and
 NSAIDs have risks of side effects that increase when
NSAIDs:
used at high dosages for long-term treatment. Side
 Side effects may include fuid retention and causing
Cox-2:
or exacerbating high blood pressure.
To give or not to give??
Doctors Dilemma!!!
That is the question
All forms of Glucosamine sulphate originated from Shellfsh.
They have been shown since the early clinical studies in the 80s to be
Glucosamine Sulphate
effective in easing the pain and discomfort of Arthritis.
 Mechanism Of Action
Glucosamine inhibits the recombinant Interlukin I
 new cartilage growth?
get to the right place in the joint to stimulate
Yes it does. In FEBRUARY 2000, An article published in the Journal of the
Does oral Glucosamine supplementation really
American Medical association, revealed a trial study where
Most Orthopedic surgeons prescribe it for early
Who will beneft from it?!!!
arthritis.
 A 6 week study was conducted to determine if glucosamine sulfate
was efectve in treatng the pain associated with cervical and/or
Does it work for my back?
lumbar spondylarthrosis.
The pain and limited mobility lasted at least 6 months in all patents.
 Forms:
Oral Tablets with or without MSM.

Oral Liquid form (not available in the local

Market).

Topical (for compliant patients).

Capsule Form The most effective, Dorofen

 Local Therapy

-Corticosteroid
Injections:
Notorious
Doctor please do not
give me Cortisone
Steroids are synthetic Drugs which act like
the natural hormone Cortisol.

The goal of Intra-articular injection is to

improve joint function by reducing
infammation and synovitis.
 Aoouch!!!!!!

Cortisone
 Dose: Doses of 50 mg equivalent of prednisone may
be needed to obtain benefts at 16 to 24 weeks.
 Hyalouronic Acid (Viscosupplementation)

Viscosupplementation for the treatment of osteoarthritis has been studied since

1970.
Hyalgan was FDA approved on 28/05/1997.
Injections are typically given once a week, one week apart for a total of fve.
It supplements the viscous properties of synovial fuid.
Now being studied for joint use other than the knee etc.. Shoulder and facet
joints.
Highly irritant..do not do it if u are not and
Points to remember:
Orthopedic surgeon or rheumatologist.
 Types Of Surgery

Arthroscopy.
Corrective Osteotomy.
Unicompartmental Knee replacement.
Total Knee replacement.
Do I need it or not:
Joint replacement :
1)Intractable umanagble everyday pain.
 Prepare your patient well
This is a one way ticket.
Alternate Methods Acupuncture.
 Lifestyle Modificatons
Modifcation of work and sporting activities.