Need of patient education about osteoarthritis.

Helping the patient to understand about osteoarthritis is important. It is a progressive wear and tear disease of old age. Poor understanding of the disease will lead to negative attitude in patients. For example ignorance about the disease may lead to lack of activity which further aggravate the disease. Patient education is an essential component of  treatment due to the following reasons.

Psychological and social factors will alter the effect of disease, proper education of the patient regarding the disease and effect will reduce the pain, distress, disability and it will improve the treatment compliance.

To protect the affected joint from excessive loading

1. Reduce the weight.

2. Patient should consume low fat, carbohydrate rich low calorie food for weight reduction.

3. Avoid inappropriate daily and occupational activities example knee lifts.

4. Use walking sticks.

5. Wear shock absorbing footwear.

6. Correct the disparity in leg length with shoe rise.

7. Tubular loose knee support may reduce the pain.

8. Use wedge insoles.

9. Proper advice should be given to maintain the normal joint function.

10.Advice aerobic fitness such as walking and swimming to maintain the joint motion and stability.

11. Do muscle strengthening exercise.

12. Regular physical activity.

13. Avoid over activity on good days because that may increase the pain and reduction of activities on subsequent days.

Proper modification of work place and home activities are required.

Advice regarding sexual activities should be given to the patient and the partner with hip osteoarthritis.

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What are the risk factors for osteoarthritis

Osteoarthritis is very common in the community and there are certain factors that place the patient at high risk for osteoarthritis. These factors act in two ways

1. They may increase the joint susceptibility to development of  osteoarthritis.

2. They increase the load on the joint

3. Combination of above mechanism

Following are the risk factors for osteoarthritis.

1. Age is the most potent risk factor for osteoarthritis,as age advances the risk also increases.

2. Gender, females are at increased risk for osteoarthritis. The role of sex hormone is indicated by increased risk after menopause.

3. Heritability, osteoarthritis is a heritable disease. Heretability varies depending on the joint. This is high in hip osteoarthritis.

4. Local factors in the joint. This will lead to uneven distribution of weight and increased focal stress example malalignment across the joint, increased mobility of joints, congenital joint abnormality.

5. Obesity increases the load across the joint.

6. Repeated use of joints and injury will cause osteoarthritis especially in sportsmen.

7. Fracture and trauma increases the risk.

8. Cigarette smoking.

9. Occupation - Certain occupation is at risk for this condition. 

   (a) Miners - osteoarthritis of hip, knee, shoulder.

   (b) Cotton workers - hand osteoarthritis.

   (c) Farmer - hip osteoarthritis

10. Osteo arthritis can  also develop secondary to certain disease.

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Exercise in knee joint osteoarthritis

Osteoarthritis pain occur during activity in weight bearing joints such as hip and knee. This will lead to physical inactivity. As osteoarthritis is very common this will lead to significant public health concern. Physical inactivity lead to increased risk for heart disease and for obesity.Exercise capacity is poor in  those with osteoarthritis of knee joint.

There is weakness of muscles over the knee joint in osteoarthritis. Since adequate muscle power is needed for joint protection muscle weakness results in further damage to the joint and decreases the exercise capability. Degree of weakness correlate with severity of joint disease and degree of limitation of mobility of joint.

Causes of muscle weakness

1.Decrease strength with age

2.As pain occur during activity ,there is tendency for physical inactivity this will lead to disuse atrophy

3.Alteration in gait as a protective mechanism decreases the load on affected joint and further decreases the muscle power.

Exercise program in osteoarthritis

For knee and hip joint osteoarthritis exercise improves the power and reduces the pain.

Effective exercise program are

1.Aerobic exercise 

2.Resistance training

Resistance training is aimed at strengthening of muscle power. Exercise is maximum effective if the affected people are trained for their daily activities. Certain exercise increases the pain in joints they should be avoided. Strengthening of muscle by repeated bending of knee against resistance. It is done by flexing and extending the knee joint. Low impact exercise such as water aerobics and water resistance training is also found to be useful. This is better tolerated than loading exercise such as running. For getting maximum benefit from exercise patient should be referred to an exercise class or to a therapist to plan individual home based exercise regimen.

Major challenge in exercise program is lack of compliance. Trial showed 30 to 50 percentage of people stopped exercise after 6 months and less than 50 percentage continued after one year. Previous history of successful exercise is the strongest predictor for continued exercise in a given patient.

Role of physician

1.At each visit he should reinforce the exercise prescription.

2.Help the patient to identify obstacles in continuing exercise.

3.Identify convenient time for exercise daily.

It is also observed that calorie restriction along with exercise is very effective in decreasing pain. It is shown that early exercise and muscle strengthening help to improve the cartilage function on joint by MRI study.

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