“After a particular age, if you do not get up aching in every joint, you are probably dead.”
Definition
A degenerative joint condition with loss of articular cartilage leading to pain and deformity.
Prognosis
Many show phasic symptoms. Tends to be progressive with pain occurring even at rest, crepitus on movement, effusions, and full thickness loss of cartilage, and much disability especially when weight bearing joints are involved. No mortality due to disease per se but drugs like NSAIDs could cause major problems.
General Measures
Adequate rest a sdictated by severity of symptoms. Graded proper exercises. Heat and other Physical therapy. Local Rjubefacent creams. Capsaicin cream for smaller and joint NSAID ointments. Corrective shoes, collars, supports, and straps as suitable, with physiatrist’s advice. Protection of joint from overuse-with crutches, elastic knee support, walkers, crutches. Elderly might need calcium supplements/Anabolic steroids. Surgical measures – Total Hip/Knee replacement in gross impairment with constant pain. Any associated Lumbar spinal stenosis may need extensive decompression laminectomy for relief of symptoms. Good results in expert surgical hands. Arthroscopic surgery in trained hands for – Osteotomy, debridement, removal of loose bodies Laminectomy snad spinal fusion for spinal Osteo Arthritis
Advice to Patient
Reassurance on absence of any systemic background illness. Impress on possibility of much disability by neglecting non-pharmacologic measures like exercise, weight reduction, use of corrective gadgets, walking stick, etc. Hazards of NSAIDs abuse (often resorted to, as an alternative ‘easy way out’) To learn to avoid drugs for minimal degrees of pain or discomfort like a ‘little stiffness in the mornings’
Follow Up
At regular intervals to ensure compliance on physical measures, non-abuse of NSAIDs. To assess range of movement of joints, and functional status at every visit. To watch out for GI blood loss (stool for occult blood), renal and cardiac side-effects after NSAIDs, especially in elderly patients.
Inadequate Response
Consider local steroids, more active support with heat, physical measures. Arthroscopic surgical measures, joint replacement to be considered for knee and hip involvement
Prevention
Weight reduction. Regular exercises/walking/Yoga/Corrective gadgets for congenital or acquired deformities.
