Re­duce the pain

Os­teoarthri­tis is a com­mon con­di­tion that usu­ally af­fects us as we grow older.

The Star Malaysia - Star2 - - HEALTH - By Dr EU­GENE WONG

OS­TEOARTHRI­TIS (OA) is the most com­mon form of arthri­tis. The term was coined by Dr John Kent Spen­der of Eng­land in 1889. It is also known as “de­gen­er­a­tive joint dis­ease”.

Over 60% of people over 65 have some form of arthri­tis. About 90% of adults are af­fected by the age of 40.

The com­mon­est joints in­volved in­clude the knees (41%), hands (30%) and hips (19%). It is cur­rently un­der­stood to be a process rather than a dis­ease that may be trig­gered by var­i­ous con­sti­tu­tional and en­vi­ron­men­tal fac­tors.

The knee is one of the joints most prone to in­jury. The knee is the joint be­tween the two long­est bones of the body (the fe­mur, which is the bone of the thigh, and the tibia, which is the bone of the lower leg).

It is more prone to in­jury be­cause the en­tire weight of the body is trans­ferred through the knee to the foot. About 13% of women and 10% of men aged 60 years and older have symp­to­matic knee OA.

Re­cent stud­ies sug­gest that OA of the hand may pre­dict the later de­vel­op­ment of OA in the hip or knee. It was found that those with hand OA were three times more likely to de­velop hip arthri­tis.

It was noted from the stud­ies that OA of the hand also slightly in­creased the risk for knee OA.

The preva­lence of knee OA in men is lower com­pared with women. This was shown in a meta-anal­y­sis of males and fe­males in which the in­ci­dence of knee OA in males aged less than 55 years was lower than fe­males.

Fe­males, par­tic­u­larly those above 55 years, tended to have more se­vere OA in the knee, but not in other sites.

The re­sults of this study demon­strated sex dif­fer­ences in the in­ci­dence of knee OA, par­tic­u­larly af­ter menopausal age.

The in­ci­dence of knee OA is 1.7 times greater in women over­all. Al­though mul­ti­ple fac­tors may con­trib­ute to this in­creased preva­lence, it’s log­i­cal to con­sider the in­flu­ence of hor­mones and oe­stro­gen in post­menopausal women.

The ar­tic­u­lar car­ti­lage of the knee has oe­stro­gen re­cep­tors, and thus the de­cline in oe­stro­gen with menopause may con­trib­ute to this up­surge in knee OA in older women.

Risk fac­tor stud­ies have shown that obe­sity pre­cedes and in­creases the risk of knee OA, es­pe­cially in women.

Other risk fac­tors for knee OA in­clude knee in­jury, chon­dro-cal­ci­nosis, knee bend­ing, low bone den­sity, lack of nu­tri­ents, par­tic­u­larly those that func­tion as an­tiox­i­dants, and ge­netic fac­tors.

The treat­ment goals in OA in­clude man­ag­ing pain, pre­vent­ing disability and im­prov­ing joint func­tion.

The mo­ti­va­tion for most OA ther­apy is pain im­prove­ment and re­lief. Los­ing weight by mon­i­tor­ing the diet is po­ten­tially one of the best treat­ments for con­trol­ling pain as­so­ci­ated with knee OA.

Obese people with OA ex­pe­ri­ence a 25% re­duc­tion in symp­toms just by los­ing 5% of body weight.

Al­though it has not been proven that glu­cosamine and chon­droitin sul­fate rebuild car­ti­lage, there is ev­i­dence from a small num­ber of pa­tients that these com­pounds can re­duce OA pain, usu­ally within sev­eral weeks to months af­ter ini­ti­at­ing ther­apy.

Green lipped mus­sels con­tain omega-3 fatty acids, gly­cosamino­gly­cans and ma­rine min­er­als. It can pro­vide re­pair and re­lief to in­flamed and joints.

Fish oil sup­ple­ment and flaxseed oil also con­tain high amounts of omega-3 fatty acids.

Ex­er­cise should fo­cus on lo­cal mus­cle strength­en­ing and gen­eral aer­o­bic fit­ness. “Land” - based ther­a­peu­tic ex­er­cise have short­term ben­e­fit in terms of re­duced knee pain and phys­i­cal disability for people with knee OA.

Some of the ex­er­cises which are use­ful in­clude stand­ing ham­string stretch, straight leg raise, side leg raise, heel raise, seated hip lift and knee squeeze chair squats and quadri­ceps-strength­en­ing ex­er­cise con­cen­trat­ing on the vas­tus me­di­alis oblique mus­cle.

Swim­ming is an ex­cel­lent non-im­pact ex­er­cise.

Reg­u­lar “land” ex­er­cises can also be done un­der­wa­ter. The buoy­ancy of the wa­ter sup­ports most of the body’s weight while the re­sis­tance of the wa­ter al­lows mus­cles to work harder to per­form move­ments.

The fol­low­ing po­si­tions and ac­tiv­i­ties place ex­ces­sive pres­sure on the knee joints and must be limited un­til knee pain and swelling re­solve – squat­ting, kneel­ing, twist­ing, piv­ot­ing, repet­i­tive bend­ing and cy­cling.

Sup­port­ive de­vices, such as fin­ger splints or knee braces, can re­duce stress on the joints and ease pain. If walk­ing is dif­fi­cult, canes, crutches, or walk­ers may be help­ful.

Shock-ab­sorb­ing shoes or in­soles can be help­ful.

Tran­scu­ta­neous elec­tri­cal nerve stim­u­la­tion, ul­tra­sound and laser can be used for pain re­lief.

Med­i­ca­tions are an im­por­tant strat­egy for break­ing the pain cy­cle. There are no drugs that can re­verse the pro­gres­sion of OA.

The main goal of drug ther­apy is to re­lieve pain and help pa­tients ex­er­cise and keep the joints func­tion­ing.

There are a va­ri­ety of treat­ments that can be ap­plied to the af­fected joint that will re­lieve pain, such as heat, ice, li­do­caine patches, top­i­cal NSAIDS and cap­saicin.

Cer­tain herbs such as St John’s Wort, Devil’s Claw, Skull­cap, An­gel­ica, black and white wil­lows, bog­bean, cayenne, dan­de­lion, gin­ger, win­ter­green, Boswellia, and Va­le­rian Root can re­duce pain and in­flam­ma­tion.

NSAIDs can be used to treat pain and re­duce in­flam­ma­tion. Non-se­lec­tive NSAIDs in­clude ibupro­fen, naproxen and in­domethacin.

Se­lec­tive COX-2 in­hibitors are also an op­tion.

Bo­tulinum toxin type A in­jec­tions may pro- vide sus­tained pain re­lief for pa­tients with knee OA.

Hyaluronic acid can be in­jected into the joints of pa­tients with se­vere dis­ease and has many ad­van­tages, but must also be used spar­ingly. It acts to re­place lost fluid in the joint spa­ces and keep the joint work­ing to cush­ion the bones in the joint.

Car­ti­lage re­pair tech­niques in­clude abra­sion, drilling, mi­crofrac­ture and mo­saic plasty.

Graft­ing tech­niques in­clude os­teo­chon­dral al­lo­graft trans­plan­ta­tion, au­tol­o­gous chon­dro­cyte im­plan­ta­tion and au­tol­o­gous ma­trix-in­duced chon­dro gen­e­sis.

Re­align­ment os­teotomy is an op­tion in ac­tive pa­tients with symp­to­matic uni­com­part­men­tal OA of the knee with malalign­ment.

Arthro­scopic lavage and de­bride­ment is done for me­chan­i­cal lock­ing.

Knee re­place­ment can be uni­com­part­men­tal, bi-com­part­men­tal or to­tal.

Stem cell us­age is ex­per­i­men­tal as the re­sults are not yet proven and con­sis­tently re­pro­ducible.

The the­ory be­hind the ac­tion of stem cells is good, and if this ther­apy works, it would re­duce the num­ber of to­tal knee re­place­ments.

Up un­til now, lit­tle at­ten­tion has been given to OA due in part to the mis­con­cep­tion that arthri­tis causes only mild aches and pains, is an in­evitable part of age­ing, and noth­ing that can be done to pre­vent or re­lieve it.

In some cases, OA can be pre­vented and its con­se­quences can be min­imised. Ev­i­dence shows that in­jury preven­tion and weight loss can pre­vent OA from oc­cur­ring, and weight loss or main­te­nance, phys­i­cal ac­tiv­ity and self-man­age­ment ed­u­ca­tion can re­duce the symp­toms and pro­gres­sion of OA.

This ar­ti­cle is con­trib­uted by The Star Health & Age­ing Panel, which com­prises a group of pan­el­lists who are not just opin­ion lead­ers in their re­spec­tive fields of med­i­cal ex­per­tise, but have wide ex­pe­ri­ence in med­i­cal health ed­u­ca­tion for the pub­lic. The mem­bers of the panel in­clude: Datuk Prof Dr Tan Hui Meng, con­sul­tant urol­o­gist; Dr Yap Piang Kian, con­sul­tant en­docri­nol­o­gist; Datuk Dr Azhari Rosman, con­sul­tant car­di­ol­o­gist; A/Prof Dr Philip Poi, con­sul­tant geri­a­tri­cian; Dr Hew Fen Lee, con­sul­tant en­docri­nol­o­gist; Prof Dr Low Wah Yun, psy­chol­o­gist; Datuk Dr Nor Ashikin Mokhtar, con­sul­tant ob­ste­tri­cian and gy­nae­col­o­gist; Dr Lee Moon Keen, con­sul­tant neu­rol­o­gist; Dr Ting Hoon Chin, con­sul­tant der­ma­tol­o­gist; Prof Khoo Ee Ming, pri­mary care physi­cian; Dr Ng Soo Chin, con­sul­tant haema­tol­o­gist. For more in­for­ma­tion, e-mail starhealth@thes­tar.com.my. The Star Health & Age­ing Ad­vi­sory Panel pro­vides this in­for­ma­tion for ed­u­ca­tional and com­mu­ni­ca­tion pur­poses only and it should not be con­strued as per­sonal med­i­cal ad­vice. In­for­ma­tion pub­lished in this ar­ti­cle is not in­tended to re­place, sup­plant or aug­ment a con­sul­ta­tion with a health pro­fes­sional re­gard­ing the reader’s own med­i­cal care. The Star Health & Age­ing Ad­vi­sory Panel dis­claims any and all li­a­bil­ity for in­jury or other dam­ages that could re­sult from use of the in­for­ma­tion ob­tained from this ar­ti­cle.

Tak­ing the first step: Obese people with Oa ex­pe­ri­ence a 25% re­duc­tion in symp­toms just by los­ing 5% of body weight. — aFP (In­set) Swim­ming is an ex­cel­lent non-im­pact ex­er­cise for os­teoarthri­tis sufferers.

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