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OSTEOARTHRITIS - A Public Health Burden (PART 1)

15-May-2014.By: Gideon Dashe


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Osteoarthritis (OA) is the most common form of arthritis; it often affects hands, hips, and knees. There are over 100 different types of arthritis conditions. OA affects as many people as all other types of arthritis combined.   Arthritis is the leading cause of disability among older adults.   Joint diseases account for half of all chronic conditions in persons aged 65 years and over.

The prevalence of Osteoarthritis is high and will get even higher as the number of older people increases.   Because of its prevalence it is recognized as a significant public health problem.

Women have a higher prevalence of OA, and the risk of developing OA increases with age, obesity, and joint mal-alignment.

OA typically presents with pain and reduced joint function. Therapeutic programs are often multimodal and must take into account pharmaceutical toxicities and patient comorbidities. For example, nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with cardiovascular, gastrointestinal, and renal adverse events. Topical NSAIDs offer efficacy with reduced systemic drug exposure. The consensus across US and European OA guidelines is that topical NSAIDs are a safe and effective treatment for OA. Because the research base on topical NSAIDs for OA is small, guidelines will continue to evolve.

Osteoarthritis is a type of arthritis that is caused by inflammation, breakdown, and eventual loss of the cartilage of the joints. Cartilage is a protein substance that serves as a "cushion" between the bones of the joints. Osteoarthritis is also known as degenerative arthritis. Most cases of osteoarthritis have no known cause, and are called primary osteoarthritis.   When the cause of the osteoarthritis is known, the condition is called secondary osteoarthritis.

Primary osteoarthritis is mostly related to aging. After prolonged use of joints, the cartilage begins to degenerate by flaking or forming tiny crevasses.   In advanced cases, there is a total loss of the cartilage cushion between the bones of the joints.   Loss of cartilage cushion causes friction between the bones, leading to pain and minimized movement of the joint(s). Inflammation of the cartilage can also stimulate new bone outgrowths (spurs or osteophytes) to form around the joints. These spurs may cause the joint to enlarge and press on other nearby structures such as nerves or tendons. This can lead to significant pain, further limitations in joint motion, tendonitis and other problems.  

Secondary osteoarthritis is caused by another disease or condition. Conditions that can lead to secondary osteoarthritis include obesity, repeated trauma or surgery to the joint structures, abnormal joints at birth (congenital deformities).

Osteoarthritis (OA) of the knee is a common problem throughout the world. As estimated by the World Health Organization, it is one of the major causes of impaired function that reduces quality of life worldwide and estimated to be the fourth leading cause of disability by the year 2020 (Kraus et al., 2006 and Wluka, 2006).

Knee osteoarthritis (OA) is a leading cause of chronic disability worldwide including Malaysia (Zakaria et al., 2009). As defined by Jette et al., 2002 disability is the impaired performance of expected socially defined life tasks, in a typical socio-cultural and physical environment. Physical function limitation, or difficulty with physical tasks and activities, is fundamental to the development of disability in OA. Pain is likely to be a central factor in the physical function limitation of knee OA, both due to its direct effects on function and as a route through which other factors operate. However, measuring only the pain is not enough. Physiotherapy must know exactly what functional limitation experienced by the patient and help them to handle those instead of treating just the pain. In the study by Izal et al., 2010 they discovered that there was discrepancy between levels of disability and quality of life (QOL) of Spanish elderly people with OA knee. They found this disparity possible due to active coping strategies practiced by the patient such as positive self-statements, re-interpreting pain sensations, distraction, ignoring sensations, prayer and joint protection strategies.

Knee Osteoarthritis prevalence is expected to rise significantly in the upcoming decades due to increasing life expectancy and decreasing physical activity, leading to a constant increase in body weight. Facing this situation, the WHO and the United Nations have declared the years 2000 to 2010 to be the "Bone and Joint Decade" (Rosemann et al., 2007). The exact prevalence of OA is difficult to determine because of the lack of use of standardized criteria. In epidemiological studies OA is often described by radiological criteria, however radiological disease especially when mild has poor correlation with the presence of pain. Studies found that in all populations, so far the prevalence of knee OA is higher than that of hip OA but this is more marked in Asian populations. In Malaysia, knee becomes the most common site for OA (Zakaria et al, 2009). Regarding prevalence, it is a frequently replicated result that women have a higher probability for developing OA, especially OA of the knee (Felson et al., 1987). Epidemiological studies have estimated that symptomatic radiographic knee osteoarthritis (OA) affects 10% of adults more than 55 years of age (Bedson et al., 2005). That shows that OA in an age increasing related process. In Nigeria, studies & anecdotal evidence suggest that prevalence of OA is increasing. About 8 million Nigerians presently have Knee OA these estimates portend a mounting public health burden. (Adekanla B. A. et al).

OA knee is currently understood to be a process rather than a disease which may be triggered by environmental factors and physiological factors. The factors influencing the prevalence and distribution of OA in populations are complex and interactive. Race, genetics, body build, obesity, gender, occupational use, repetitive use of joint, previous injury, and free radicals (Reactive Oxygen Species) have all been shown to have an influence (Escamilla, 2001; Kizawa et al., 2005; Braidot et al., 2007, Divya Sanghi et al. and Roos et al., 2011).

Last Updated: 30-Jun-2016 07:39 PM





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