Osteoarthritis – Cause For Disability

Osteoarthritis is a chronic, non-inflammatory type of arthritis, which usually affects the movable and weight bearing joints of the body. It is the most common joint disease in human beings and commoner in elderly subjects and in females. It is not a single disease entity but an end result of variety of joint disorders. OA is an important cause of disability in the elderly people.

OA was earlier considered as ‘wear and tear’ of bones and cartilages, but it is now recognized as a metabolic process that involves the whole of the joint including bone, cartilage, muscles, synovium as well as the capsule. Commonly affected joints are hip, knee, hands, spine and the base of the thumb.

This joint disorder is commonly seen in people with history of obesity, poor muscle function, sports stress, genetic predisposition, joint trauma and certain occupations like farming.

There are no systemic symptoms in this illness. However, deterioration of cartilage and osteophyte formation occurs at the affected joints. Bony ridges are easily felt at the margins of the joints. Wrist joint is spared characteristically.

Initial complaints start with pain, stiffness and swelling. Pain is felt on exercise or at night, which is relieved by rest. Crepitus and decreased motion of joints is usually seen. Other symptoms include joint enlargement and tenderness along the joint margin. Deformities and effusion may also occur in severe cases.

On examination, Heberden and Bouchard’s nodules are found in interphalangeal joints. ‘Squared appearance’ of the thumb occurs due to the deposition of osteophytes.

Lab investigations are not helpful in the diagnosis of primary OA. Abnormal lab results are only found in secondary osteoarthritis. Visible changes like fibrillation of cartilage are seen on radiography.

Treatment aims to relieve pain, improve mobility and correct deformity. Conservative treatment includes analgesics, weight loss and physiotherapy. Surgery is advised in severe cases.