Osteoarthritis is a progressive degenerative disorder of advancing age. However nowadays the term 'osteoarthrosis a degenerative joint disease is used because it is not associated with inflammation.

It may be:

1)              Primary, which occurs in old age

2)              Secondary to some preexisting disease in joint which can occur at any age It can involve many joints in the body, but the most common involved sites are

i.                             Knee

ii.                        Spine

iii.                     Hip

iv.                      Shoulder

Depending upon the stage of the disease, it may be:

·                 Mild

·                 Moderate or

·                 Severe

Diagnosis is made on the basis of history, examination and x-ray. Very rarely MRI or CT may be needed.

History:

Pain :-             To start with it is mild and gradually increases in severity.

Difficulty in squatting, climbing stairs, sitting cross legged, etc Examination:

Crepitus is most common finding. Varying degree of deformity may be seen. Painful restriction of movements..

X-  ray will show decreased joint space with marginal osteophytes.

Treatment:

It varies with region involved, but there are certain common modes of non- surgical treatment which are applicable to every part of the body.

NON SURGICAL TREATMENT

1.                Muscle strengthening exercises: This is applicable to every part of body because strong muscles reduce the stress on the joint.

2.                Lifestyle modification. Patient should be advised to modify routine habits such squatting etc.

3.                Education to the patient regarding decrease in weight.

4.                Physical means in the form of

i.                          Braces/orthosis / ambulatory aids

ii.                        Heat and cold therapy

iii.                     LASER therapy. This helps in improving the morning stiffness and it acts at both cellular and systemic level activating variety of mechanisms including cartilage regeneration

5.                Pharmacological treatment in the form of NSAIDS: Any NSAID can be used such as diclofenac 50 mg tds, brufen 400 mg tds, etc. But for prolonged use paracetamol 1 5mg/kg tds and Etoricoxib 60- 120 mg in single or divided doses can be used.

6.                Steroids (5-15 mg/kg) have been shown to help in relieving the symptoms but they are not recommended because of increase in the degenerative process

7.                Diacerin : A new anti-inflammatory analgesic has modifying effect and is used very commonly. 50 mg OD to start then BD after 1 month and can be used minimum for 3 months or longer time depending upon the requirement.

8.                Narcotic analgesics are usually reserved for patients with severe joint disease and intolerable suffering who are not candidate for other therapeutic interventions or in those where other therapeutic interventions have failed

9.                Nutritional supplements such as glucosamine (1 gm daily) and chondroitin sulfate (750 mg daily) which are constituents of articular cartilage are also helpful.

10.            Collagen peptides: They are also used because they increase the production of aggrecan, a special proteoglycan which is of central importance to cartilage function. Available in sachet 10.2 gm to be given once a day.

11.            Rose hip extract: This extract is developed from blossoms of white rose and is a popular natural remedy. This has also been found to be useful in reducing the suffering of osteoarthrosis.   -

12.            Antidepressants because of continuous disabling pain, these patients usually go into depression so antidepressants help in decreasing pain but every patient should be evaluated before starting these drugs.

13.            Viscosupplements : Hyaluronic acid given by intraarticular injection appear to provide some relief.

SURGICAL TREATMENT

Multiple surgical options are available and the patient should be referred to higher centre.

SUMMARY

Among all these option listed above, the following are most commonly used:

1.                Muscle strengthening exercises.

2.                Change in occupation and lifestyle

3.                Analgesics.

4.                Diacerin and nutritional substitutes such as glucosamine and chondroitin sulfate.

5.                Surgery

SPINE

In addition to the above treatment sometimes these patients needs decompression when there is evidence of compressive myelopathy.

HIP

Routine treatment is same as described above, but refractory patients need arthroplasty.

SHOULDER

•           In addition to the common schedule, intraarticular steroid injections can be used to relieve the symptoms.

•           Local intraarticular injections : Hydrocortisone acetate 25 mg every week (3-5 injections)

•           Methylprednisolone 80 mg biweekly (3-5 injections)

•           Triamcinolone acetate 40 mg biweekly (3-5 injections)

•           Patient not responding needs arthroplasty.