Osteoarthritis in India: Causes, Signs, Symptoms, Diagnosis and Treatment in Indian Hospital

The chance of developing osteoarthritis increases with age. It is estimated that 33.6% (12.4 million) of individuals age 65 and older are affected by the disease.

Osteoarthritis affects different people differently. It may progress quickly, but for most people, joint damage develops gradually over years. In some people, osteoarthritis is relatively mild and interferes little with day-to-day life. In others, it causes significant pain and disability.

Osteoarthritis is one of the most frequent causes of physical disability among older adults. Many people with osteoarthritis find their movements or activities limited to some degree because of stiffness, limited range of motion, and pain.

Here are ways to decrease your chances of developing osteoarthritis.

• Maintain a healthy weight- If you are overweight or obese, you should try to lose weight. Weight loss can reduce stress on weight-bearing joints, limit further injury, increase mobility, and reduce the risk of associated health problems. A dietitian can help you develop healthy eating habits. A healthy diet and regular exercise can help reduce weight.
• Avoid injury- Putting too much stress on a joint that has been repeatedly injured may lead to the development of osteoarthritis.

Warning signs of osteoarthritis include:

• Joint pain
• Swelling or tenderness in one or more joints
• Stiffness after getting out of bed or sitting for a long time
• A crunching feeling or sound of bone rubbing on bone.

Not everyone with osteoarthritis develops symptoms. In fact, only a third of people with x-ray evidence of osteoarthritis report pain or other symptoms.

Treating arthritis often requires a multidisciplinary or team approach. Many types of health professionals care for people with arthritis. You may choose a few or more of the following professionals to be part of your health care team.

• Primary care physicians – Doctors who treat patients before they are referred to other specialists in the health care system. Often a primary care physician will be the main doctor to treat your arthritis. Primary care physicians also handle other medical problems and coordinate the care you receive from other physicians and health care providers.
• Rheumatologists – Doctors who specialize in treating arthritis and related conditions that affect joints, muscles, and bones.
• Orthopaedists – Surgeons who specialize in the treatment of, and surgery for, bone and joint diseases.
• Physical therapists – Health professionals who work with patients to improve joint function.
• Occupational therapists – Health professionals who teach ways to protect joints, minimize pain, perform activities of daily living, and conserve energy.
• Dietitians – Health professionals who teach ways to use a good diet to improve health and maintain a healthy weight.
• Nurse educators – Nurses who specialize in helping patients understand their overall condition and implement their treatment plans.
• Physiatrists (rehabilitation specialists) – Medical doctors who help patients make the most of their physical potential.
• Licensed acupuncture therapists – Health professionals who reduce pain and improve physical functioning by inserting fine needles into the skin at specific points on the body.
• Psychologists – Health professionals who seek to help patients cope with difficulties in the home and workplace resulting from their medical conditions.
• Social workers – Professionals who assist patients with social challenges caused by disability, unemployment, financial hardships, home health care, and other needs resulting from their medical conditions.
• Chiropractors – Health professionals who focus treatment on the relationship between the body’s structure — mainly the spine — and its functioning.
• Massage therapists – Health professionals who press, rub, and otherwise manipulate the muscles and other soft tissues of the body. They most often use their hands and fingers, but may use their forearms, elbows, or feet.

No single test can diagnose osteoarthritis. When a person feels pain in his or her joints, it may or may not be osteoarthritis.

The doctor will use a combination of tests to try to determine if osteoarthritis is causing the symptoms. These may include a medical history, a physical examination, x-rays, and laboratory tests. A patient’s attitudes, daily activities, and levels of anxiety or depression have a lot to do with how much the symptoms of osteoarthritis affect day-to-day living.

There is no cure for osteoarthritis and no way to reverse the joint damage once it occurs. However, current treatments can relieve symptoms.

Exercise is one of the best treatments. Exercise can improve mood and outlook, decrease pain, and assist in maintaining a healthy weight. Warm towels, hot packs, or a warm bath or shower can provide temporary pain relief. Medications such as non-steroidal anti-inflammatory drugs, or NSAIDs, help reduce pain and inflammation that result from osteoarthritis.

Yes, exercise is one of the best treatments. Exercise can improve mood and outlook, decrease pain, and assist in maintaining a healthy weight. The amount and form of exercise will depend on which joints are involved, how stable the joints are, whether or not the joint is swollen, and whether a joint replacement has already been done. Ask your doctor or physical therapist what exercises are best for you. The following types of exercise are part of a well-rounded arthritis treatment plan.

• Strengthening exercises. These exercises strengthen muscles that support joints affected by arthritis. They can be performed with weights or with exercise bands, inexpensive devices that add resistance.
• Aerobic activities. These are exercises, such as brisk walking or low-impact aerobics, that get your heart pumping and can keep your lungs and circulatory system in shape.
• Range-of-motion activities. These keep your joints limber.
• Balance and agility exercises. These help you maintain your balance and reduce your risk of falling.

Warm towels, hot packs, or a warm bath or shower can provide temporary pain relief. Medications such as non-steroidal anti-inflammatory drugs, or NSAIDs, help reduce pain and inflammation that result from osteoarthritis. A doctor or physical therapist can recommend if heat or cold is the best treatment. For osteoarthritis in the knee, wearing insoles or cushioned shoes may reduce joint stress.

People with osteoarthritis may find many non-drug ways to relieve pain, they include:

• Heat and Cold
• Transcutaneous electrical nerve stimulation (TENS)
• Massage
• Acupuncture

Nutritional supplements such as glucosamine and chondroitin sulfate

Doctors consider a number of factors when choosing medicines for their patients. In particular, they look at the type of pain the patient may be having and any possible side effects from the drugs. For pain relief, doctors usually start with acetaminophen because the side effects are minimal. If acetaminophen does not relieve pain, then non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen may be used. Some NSAIDs are available over the counter, while more than a dozen others, including a subclass called COX-2 inhibitors, are available only with a prescription.

Corticosteroids, hyaluronic acid, and topical creams are also used. Most medicines used to treat osteoarthritis have side effects, so it is important for people to learn about the medicines they take. For example, people over age 65 and those with any history of ulcers or stomach bleeding should use non-steroidal anti-inflammatory drugs, or NSAIDs, with caution.

There are measures you can take to help reduce the risk of side effects associated with NSAIDs. These include taking medications with food and avoiding stomach irritants such as alcohol, tobacco, and caffeine. In some cases, it may help to take another medication along with an NSAID to coat the stomach or block stomach acids. Although these measures may help, they are not always completely effective.

Protecting and supporting the affected joint or joints is important. Some people may use splints or braces to provide extra support for joints and/ or keep them in proper position during sleep or activity. Splints should be used only for limited periods of time because joints and muscles need to be exercised to prevent stiffness and weakness. If you need a splint, an occupational therapist or a doctor can help you get a properly fitted one. Some people find relief from special footwear and insoles that can reduce pain and improve walking or from using canes to take pressure off painful joints.

For many people, surgery helps relieve the pain and disability of osteoarthritis. Surgery may be performed to achieve one or more of the following.

• Removal of loose pieces of bone and cartilage from the joint if they are causing symptoms of buckling or locking (arthroscopic debridement).
• Repositioning of bones (osteotomy).
• Resurfacing (smoothing out) bones (joint resurfacing).

The decision to use surgery depends on several factors, including the patient’s age, occupation, level of disability, pain intensity, and the degree to which arthritis interferes with his or her lifestyle. After surgery and rehabilitation, the patient usually feels less pain and swelling and can move more easily.

Surgeons may replace affected joints with artificial joints called prostheses. These joints can be made from metal alloys, high-density plastic, and ceramic material. Some prostheses are joined to bone surfaces with special cements. Others have porous surfaces and rely on the growth of bone into that surface (a process called biologic fixation) to hold them in place. The artificial joints can last 10 to 15 years or longer. Surgeons choose the design and components of prostheses according to their patient’s weight, sex, age, activity level, and other medical conditions. Joint replacement advances in recent years have included the ability, in some cases, to replace only the damaged part of the knee joint, leaving undamaged parts of the joint intact, and the ability to perform hip replacement through much smaller incisions than previously possible.