Osteoarthritis(OA)

Symptoms

• Joint Pain: Pain is usually worse with movement or after prolonged activity, and improves with rest.
• Stiffness: Especially after inactivity, such as in the morning or after sitting for long periods.
• Swelling: Mild swelling or warmth may be present in the affected joint.
• Decreased Range of Motion: As the disease progresses, joints may become less mobile.
• Crepitus: A sensation or sound of crunching or popping when moving the affected joint due to roughened cartilage surfaces.

How is the diagnosis done ?

• Medical History and Physical Exam: The doctor will assess the symptoms, review the patient's history, and examine the affected joints.
• X-rays: X-rays are the primary diagnostic tool for OA. They can show joint space narrowing, bone spurs (osteophytes), and cartilage loss.
• MRI or Ultrasound: These imaging techniques may be used to assess soft tissue damage and cartilage loss, especially in more complex cases.
• Joint Fluid Analysis: In some cases, joint fluid may be analyzed to rule out other conditions like infection or gout.
• Blood Tests: While blood tests can't diagnose OA, they may be used to rule out other inflammatory forms of arthritis (like rheumatoid arthritis).

Why is Early Diagnosis Important?

• Preventing Joint Damage: Early detection of OA helps manage the disease before significant cartilage damage occurs.
• Slowing Disease Progression: Early treatment can help prevent the worsening of symptoms and preserve joint function.
• Improving Pain Management: Early diagnosis allows for timely interventions, reducing pain and improving quality of life.
• Avoiding Complications: Delayed treatment can lead to worsening joint deformities and disability, limiting mobility and independence.
• Optimizing Treatment: Starting appropriate treatments early can prevent the need for more invasive procedures, such as joint replacement surgery.

Treatment

• Lifestyle Modifications: Weight management and avoiding joint overuse can reduce stress on affected joints, especially the knees and hips.
• Physical Therapy: Tailored exercises can improve strength, flexibility, and range of motion.
• Medications:
  • Pain Relievers: Painkillers/ NSAIDs are used to relieve inflammation and pain. These do not modify the disease itself and are given on SOS basis (used only when required).
  • Topical Treatments: Creams and gels containing capsaicin or menthol can provide localized pain relief.
  • Corticosteroid Injections: For short-term relief of inflammation and pain.
  • Hyaluronic Acid Injections: Lubricant injections can help improve joint movement and reduce pain.
  • Platelet-Rich Plasma (PRP) injection: is a regenerative therapy that uses a concentration of a patient's own platelets to promote healing and reduce inflammation. It involves drawing a small amount of blood, processing it to concentrate the platelets, and injecting the PRP into the affected area, such as a joint or tendon, aiming to accelerate recovery and improve function.
• Surgery: In severe cases, procedures like arthroscopy (joint cleaning), osteotomy (bone realignment), or joint replacement (especially in the knee or hip) may be required.
• Assistive Devices: Braces, orthotic shoe inserts, or canes can help improve function and reduce joint stress.

Prognosis

• Variable Progression: OA progresses at different rates in different individuals. It may remain mild and manageable for many years in some, while others may experience significant functional decline.
• Chronic Pain and Disability: For some, OA leads to chronic pain, stiffness, and reduced mobility, which can interfere with daily activities and quality of life.
• Joint Deformity: As cartilage continues to deteriorate, joints may become misaligned or deformed, leading to additional pain and disability.
• Long-Term Management: Although OA is a lifelong condition, proper treatment can help manage symptoms, maintain joint function, and improve overall quality of life.
• Surgical Outcomes: Joint replacement surgery can significantly improve pain and function, especially in the knees and hips, providing long-term relief for severe OA.

Scoring

There are a few scoring systems used to assess the severity of OA, focusing on symptoms, function, and joint damage:

• WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index):
  This is a widely used questionnaire to assess pain, stiffness, and physical function in people with OA. It consists of 24 questions divided into three subscales: pain, stiffness, and physical function.
  • Pain: Rated from 0 (none) to 4 (extreme)
  • Stiffness: Rated from 0 (none) to 4 (extreme)
  • Physical Function: Rated from 0 (none) to 4 (extreme difficulty)
    The scores are combined to assess overall disease severity.
• Kellgren-Lawrence Grading Scale:
  This is a radiographic scoring system used to assess the severity of OA based on X-ray findings. The scale ranges from 0 (no radiographic features of OA) to 4 (severe OA with large joint deformities and bone spurs).
  • Grade 0: No OA
  • Grade 1: Doubtful narrowing of joint space
  • Grade 2: Mild OA with definite joint space narrowing and small osteophytes
  • Grade 3: Moderate OA with moderate joint space narrowing, osteophytes, and possible deformities
  • Grade 4: Severe OA with large osteophytes, severe joint space narrowing, and joint deformities

These scoring systems are helpful for monitoring disease progression and assessing the effectiveness of treatments over time.