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Osteoarthritis of the knee

Osteoarthritis is a disease distinguished by degeneration of cartilage and its underlying skeletal part within a joint as well as bony overgrowth.

The breakdown of these tissues finally directs to pain and joint stiffness. The joints most commonly influenced are the knees, hips, and those in the hands and spine. The exact determinants of osteoarthritis are unidentified, but are accepted to be a outcome of both mechanical and molecular events in the influenced junction.

Disease onset is stepwise and generally begins after the age of 40. There is actually no cure for OA. Treatment for OA focuses on reassuring symptoms and advancing function, and can encompass a blend of persevering education, personal treatment, heaviness command, and use of medications.

Overview of Osteoarthritis

Osteoarthritis is the most common type of arthritis and is seen especially among older people. It is sometimes called degenerative joint disease.

People with osteoarthritis usually have joint pain and stiffness. The most commonly affected joints are in the hands (ends of the fingers and thumbs), neck, lower back, knees, and hips. Unlike some other forms of arthritis, osteoarthritis does not affect the skin, lungs, eyes, or blood vessels. It can also occur in only one joint or can affect a joint on one side of the body much more severely.

Osteoarthritis affects each person differently. For some people, osteoarthritis is relatively mild and interferes little with day-to-day life. For others, it causes significant pain and disability. Joint damage usually develops gradually over years, although it could worsen quickly in some people.

What happens in osteoarthritis?

Osteoarthritis damages cartilage, the tissue that covers the ends where two bones meet to form a joint. This allows the bones to rub together, causing pain, swelling, and loss of joint motion. Over time, the joint may lose its normal shape. Also, small bone growths, called osteophytes or bone spurs, may grow on the edges of the joint. Bits of bone or cartilage can also break off and float inside the joint space. This causes more pain and damage.

Hip osteoarthritis

Prevalence of Osteoarthritis

General OA affects 13.9% of adults elderly 25 and older and 33.6% (12.4 million) of those 65+; an approximated 26.9 million US mature persons in 2005 up from 21 million in 1990 (believed to be conservative approximate).

Radiographic OA (moderate to severe)—prevalence per 100 (knee and hip may be underestimated)

  • Hand = 7.3 (9.5 female; 4.8 male)
  • Feet = 2.3 (2.7 feminine; 1.5 male)
  • Knee = 0.9 (1.2 feminine; 0.4 male)
  • Hip = 1.5 (1.4 feminine; 1.4 male)

Who Gets Osteoarthritis?

Osteoarthritis becomes more common with age. However, younger people can also develop it, usually as the result of a joint injury, an abnormal joint structure, or a genetic defect in joint cartilage.

Before age 45, more men than women have osteoarthritis. After age 45, it is more common in women. It is also more likely to occur in people who are overweight and in those with jobs that stress particular joints.

Incidence of Osteoarthritis

Age and sex-standardized incidence rates of symptomatic OA

  • Hand OA = 100 per 100,000 person years
  • Hip OA = 88 per 100,000 person years
  • Knee OA = 240 per 100,000 individual years

Osteoarthritis Among women

  • occurrence radiographic knee OA 2% per year
  • occurrence symptomatic knee OA 1% per year
  • Progressive knee OA 4% per year
  • Incidence rates bigger with age, and grade off round age 80.
  • Women had higher rates than men, particularly after age 50.
  • Men have 45% smaller occurrence risk of knee OA and 36% decreased risk of hip OA than women.
  • Prevalent knee OA, but not hip or hand OA, is significantly more critical in women contrasted to men.

Mortality and Morbidity of Osteoarthritis

About 0.2 to 0.3 killings per 100,000 community due to OA (1979–1988).

OA anecdotes for ~6% of all arthritis-related killings.

~ 500 killings per year attributed to OA; numbers bigger throughout the past 10 years.

OA killings are expected highly underestimated. For demonstration, gastrointestinal bleeding due to remedy with NSAIDs is not counted.

Osteoarthritis and Hospitalizations

  • OA accounts for 55% of all arthritis-related hospitalizations; 409,000 hospitalizations for OA as principal diagnosis in 1997.
  • Knee and hip joint replacement procedures accounted for 35% of total arthritis-related methods throughout hospitalization.
  • From 1990 to 2000 the age-adjusted rate of total knee replacements in Wisconsin bigger 81.5% (162 to 294 per 100,000).
  • Rates increased most amidst least old age group (45–49 years).
  • charges bigger from 69.4 million to 148 million dollars.
  • Blacks and individuals with reduced earnings have reduced rates of total knee replacement but higher complications and death than whites.

Ambulatory care visits and Osteoarthritis

OA accounted for 7.1 million (19.5%) of all arthritis-related ambulatory health care visits in 1997.

  • 7.1 million total ambulatory care visits for OA as prime diagnosis.
  • SEX: Males = 2.2 million; Females = 4.9 million.
  • AGE: 0–18 = 35,000; 19–44 = 355,000; 45–64 = 2.5 million; 65+ = 4.1 million.
  • About 39% of persons with OA report inability to access needed health care rehabilitative services.

Cost of Osteoarthritis

  • $7.9 billion approximated charges of knee and hip replacements in 1997.
  • Average direct charges of OA ~$2,600 per year out-of-pocket expenses.
  • Total annual disease charges = $5700 (US dollars FY2000).
  • Job-related OA costs $3.4 to $13.2 billion per year.

Osteoathritis Impact on health-related quality of life

  • OA of the knee is 1 of 5 premier causes of disability amidst non-institutionalized mature persons.
  • About 80% of patients with OA have some degree of action limitation
  • and 25% will not perform foremost activities of every day dwelling (ADL’s), 11% of adults with knee OA need help with personal care and 14% require help with usual needs.
  • About 40% of adults with knee OA described their wellbeing “poor” or “fair”.
  • In 1999, mature persons with knee OA described more than 13 days of lost work due to wellbeing difficulties.
  • Hip/knee OA ranked high in disability modified life years (DALYs) (20) and years dwelled with disability (YLDs).

Modifiable risk factors for osteoathritis

Obesity overweight or high body mass index (especially knee OA).

Joint injury (sports, work, trauma).

Occupation (due to unwarranted mechanical stress: hard work, heavy lifting, knee angling, repetitive motion).

Men — Often due work that includes construction/mechanics, agriculture, azure collar laborers, and engineers.

Women — Often due work that encompasses cleaning, building, agriculture, and little business/retail.

Non-modifiable risk factors for osteoathritis

  • Gender (women higher risk).
  • Age (increases with age and levels round age 75).
  • Race (some Asian populations have lower risk).

Genetic predisposition and Osteoarthritis

NOTE: present fuming has been shown to be shielding for osteoarthritis whereas it is unknown if this is due to the physiological consequences of smoking on collagen, skeletal part and cartilage tissue or if it is due to some unmeasured surrogate factor.

Other likely risk factors for Osteoarthritis

  • Estrogen deficiency (ERT may reduce risk of knee/hip OA).
  • Osteoporosis (inversely related to OA).
  • Vitamins C, E and D – equivocal reports.
  • C-reactive protein (increased risk with higher levels).

Symptoms of Osteoarthritis

Early in the disease, your joints may ache after physical work or exercise. Later on, joint pain may become more persistent. You may also experience joint stiffness, especially when you first wake up in the morning or have been in one position for a long time.

Joints often affected by osteoarthritis include:

  • Hands: If your mother or grandmother has or had osteoarthritis in their hands, you’re at an increased risk of having it too. Women are more likely than men to have osteoarthritis in the hands. For most women, it develops after menopause.
  • Knees: Stiffness, swelling, and pain in the knees can make it hard to walk, climb, and get in and out of chairs and bathtubs. Osteoarthritis in the knees can lead to disability.
  • Hips: You might feel pain and stiffness in the hip joint or in the groin, inner thigh, buttocks, or even knees. Moving and bending may be limited, making daily activities such as dressing and putting on shoes a challenge.
  • Spine: You may feel stiffness and pain in the neck or lower back. In some cases, arthritis-related changes in the spine can cause pressure on the nerves where they exit the spinal column, resulting in weakness, tingling, or numbness of the arms and legs. In severe cases, this can even affect bladder and bowel function.

Tests for Osteoarthritis

Although there is no single test for osteoarthritis, your doctor may do the following to diagnosis you with the condition:

  • Medical history to learn about your symptoms, any other medical problems you and your close family members have, and about any medications you are taking.
  • Physical exam to check your general health, reflexes, and problem joints.
  • Take pictures of your joint.
    • X-rays can show things such as cartilage loss, bone damage, and bone spurs. Early damage may not show on x-rays.
    • Magnetic resonance imaging (MRI) can show damage to connective tissues.
  • Blood tests to rule out other causes for symptoms.
  • Joint fluid samples to look for other causes of joint pain, such as infection or gout.

Treatment of Osteoarthritis

Treatment for osteoarthritis can include medications or surgery to reduce pain and improve functioning.

  • Medications commonly used in treating osteoarthritis include:
    • Over-the-counter pain relievers such as acetaminophen.
    • Nonsteroidal anti-inflammatory drugs (NSAIDs) to treat pain and inflammation. Ibuprofen and naproxen sodium, are available over the counter, whereas other NSAIDS are available by prescription only.
    • Creams, rubs or sprays that are applied to the skin over sore joints to relieve pain.
    • Other prescription pain relievers are sometimes prescribed when over-the-counter medications don't work or a person may not be able to take NSAIDs.
    • Corticosteroids are strong inflammation-fighting drugs that can be injected into the joint to temporarily relive pain. This type of treatment is usually not recommended for more than two to four treatments per year. These types of drugs are not typically given by mouth to treat osteoarthritis, unless treating inflammatory flares.
    • Hyaluronic acid substitutes (viscosupplements) are injected into the knee to replace a normal component of the joint involved in lubrication and nutrition.
  • Surgery may be a factor after considering a variety of factors, including your age, occupation, level of disability, pain intensity, and the degree to which arthritis interferes with your lifestyle. Surgeries can include one or more of the following:
    • Arthroscopic debridement: Removal of loose pieces of bone and cartilage from the joint.
    • Osteotomy: Repositioning of bones.
    • Joint resurfacing: Smoothing out bones.
    • Prostheses are artificial joints that replace affected joints. The artificial joints can be made from metals, high-density plastic, or ceramic material. Artificial joints can last 10 to 15 years or longer. In some cases, your surgeon may replace only the damaged part of the knee joint, leaving undamaged parts of the joint in place.
  • Transcutaneous electrical nerve stimulation (TENS) directs mild electric pulses to nerve endings that lie beneath the skin in the painful area. It seems to work by blocking pain messages to the brain and by changing pain perception.
  • Alternative therapies for osteoarthritis can include:
    • Massage can increase blood flow and bring warmth to a stressed area. However, arthritis-stressed joints are sensitive, so the therapist must be familiar with the problems of the disease.
    • Acupuncture uses thin needles to relieve pain and restore health. Scientists think the needles stimulate the release of natural, pain-relieving chemicals produced by the nervous system.== Rheumatologic diseases ==

Arthritis is often used to refer to any disorder that affects the joints. Rheumatic diseases usually affect joints, tendons, ligaments, bones, and muscles. Arthritis is often used to refer to any disorder that affects the joints. Rheumatologic diseases usually affect joints, tendons, ligaments, bones, and muscles.

Connective Tissue Diseases
Rheumatology and Connective Tissue Diseases
* Ankylosing spondylitis * Arthritis
* Arthritis and Rheumatic diseases * Autoimmune diseases
* Autoinflammatory diseases * Behçet’s disease
* Bursitis * Giant cell arteritis
* Gout * Juvenile arthritis
* Knee problems * Lupus
* Osteoarthritis * Polymyalgia rheumatica
* Psoriatic arthritis * Reactive arthritis
* Rheumatoid arthritis * Scleroderma
* Sjögren’s syndrome * Systemic lupus erythematosus (Lupus)
* Tendinitis * Rheumatologic diseases
* Glossary of rheumatology terms

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