Osteoarthritis (OA) affects more then 2 million Australians and 1 in 4 people with OA report poor health as a result of the condition. Osteoarthritis is a chronic and degenerative synovial joint condition which is characterized by the loss articular cartilage and the over growth of the underlying bone. It affects women twice as commonly as men.
Whilst osteoarthritis can effect any joint in the body with synovial fluid, it is most common in the finger and thumb joints of the hands, hips, knees, big toe joints and joints in the lower back. Most commonly, the initial symptom of OA is pain which is made worse by activity and settles with rest. As OA progresses, joint tenderness, swelling, crepitus and restriction is seen.
The goal of management is to improve tolerance of functional activities and maintenance of joint function. These goals can be attained by non-pharmacological, pharmacological and surgical measures.
One of the non-pharmacological first line of treatments is exercise, which allows for the maintenance of range of motion and assists with strengthening muscles and tendons allowing them to absorb more stress during active movement. In some cases keeping active has been show to stop or even reverse hip and knee osteo arthritis. In addition to changing some activities under taken daily such as implementing ergonomic chairs and work stations, wearing supportive footwear and continuing hobbies and working can assist with treatment. In addition to this, modest weight loss also reduces OA pain and may reduce progression especially knee osteoarthritis.
Pharmacologically the first line treatment often used is paracetamol due to its safe nature however NSAIDS have been seen to have superior efficiency of assisting with pain relief. NSAIDS do however have major adverse effects on gastro intestinal, renal and cardiovascular systems. Opioids have also been shown to have short term improvements in pain however also have significant adverse effect. Finally, corticosteroid injections have also been shown to give short term pain relief however are limited to how frequently they are able to be used. There is also some limited research on hyaluronic acid injections and antidepressants to have some pain relieving mechanisms.
Surgically, in severe osteoarthritic, where non-pharmacological and pharmacological management has failed, joint replacement surgery may be indicated.