Medical Insider
Dr. Cora Lim
For APRIL 30 2023
Applied Rheumatology Made Simple (A.R.M.S.)
(Part 5)
Let us now discuss the topic on OSTEOARTHRITIS. This is a
common subject matter being tackled by many.
Osteoarthritis Generalities:
We have listed below some generalities about osteoarthritis. The
list includes:
- Cartilage degradation: loss of matrix integrity
- Role of cytokines, enzymes, nitric oxide
- Age as the strongest risk factor
- Other risk factors: obesity, injury, muscle weakness
- Knees and hips are most commonly affected
- Heberden’s and Bouchard’s nodes;
- Mechanical pain, no systemic features
Please take note of the following: the typical stance of a patient
with knee OA – elderly female; often overweight; with genu varum
deformity; they usually complain of a “mechanical” knee pain;
characteristically felt on initial standing from a prolonged sitting
position; unlike RA, these patients do not have any systemic
manifestations.
Osteoarthritis of the hands typically present as Heberden’s and
Bouchard’s nodes. These are more likely to cause cosmetic
rather than functional impairment.
Management of Osteoarthritis:
The non-pharmacologic management of osteoarthritis includes
the following:
Heat and cold treatments
Jooint protection (e.g. weight reduction, orthotics, assistive
devices
Exercises e.g. isometrics. Stationary cycling
The pharmacologic management of osteoarthritis includes the
following:
Analgesic
systemic and topical
Nonsteroidal anti-inflammatory drugs (especially specific
COX-2 inhibitors)
Intra-articular steroid
Intra-articular hyaluronate
Disease-modifying drugs
Management of Knee OA
The management of Knee OA includes the following:
Non-pharmacologic modalities
Considering aspiration of Pee joint & intra-articular steroids
Acetaminophen; if necessary, add capsaicin cream
If inadequate. use low-dose ibuprofen or non-acetylated
salicylates
If inadequate, use full-dose NSAID with gastric protectants
If inadequate, joint lavage. or PY licker) st debridement
If inadequate, surgery
Some of the exercise considerations of Hip or Knee
Osteoarthritis-1
Maintain proper weight
Maintain range of motion and flexibility
Exercise in water, on a bicycle or a rowing machine
Alternate weight-bearing and non-weight-bearing activities
Use cane on contralateral side
Some of the exercise considerations in Hip or Knee
osteoarthritis-II
Do not carry loads more than 10% body weight
Minimize use of stairs, one-legged stance, low seating
Walking speed should not exacerbate joint symptoms
Select shoes and insoles for shock attenuation
Warm-up prior to walking exercise
In our next issue, we will discuss the following topics: spectrum
gout, gouty arthritis generalities, gout associated factors,
treatment of gout, gout and diet, heperuricemia, monoarthritis, the
septic joint, and the arthritis-rash syndromes,