داء الفصال العظمي Osteoarthritis

What is Osteoarthritis?

Osteoarthritis (OA) is also known as "degenerative joint disease". It is thought to be mainly a
problem of "wear and tear" and hence affects the elderly more than the young. When it occurs in
the younger age groups, it is usually associated with injury or previous damage to the joint.
Certain occupations may also make a person more prone to osteoarthritis in certain joints. There
is new evidence that osteoarthritis occurs also as a result of abnormal cartilage metabolism.

Types of Osteoarthritis

Almost any joint can be involved in osteoarthritis. However the pattern of joint involvement, Xray
changes and the absence of certain features on blood tests can help to distinguish it from
other forms of arthritis.
The small joints of the hands are commonly involved in "generalized osteoarthritis". This form
of OA tends to occur in females, can run in families and there is no underlying cause. OA of the
hands rarely causes severe symptoms and the function of the hand remains good for many years.
The spine is also commonly involved in OA. When this is severe, the surrounding nerve roots
may be pinched and cause tingling, numbness or weakness. Other names for spinal OA are
"cervical spondylosis" when the neck is involved and "lumbar spondylosis" when the lower back
is involved.
Large joints can also be affected, especially the hip and the knee. Other joints include the ankle,
the shoulder and the elbow. When only one joint is involved, it is likely to be "secondary OA"
where there is an underlying cause such as previous trauma.

What are the Symptoms?

Joint pains tend to occur after prolonged use. As such, symptoms are usually worse towards the
evening. This is in contrast to inflammatory forms of arthritis where symptoms are generally
worse in the early morning.
There may also be periods where the joint can become red, warm and swollen. Arthritis due to
deposition of crystals in the joint can mimic osteoarthritis.

Treatment

Weight Control
Weight control is especially important for the large weight bearing joints such as the hip and the
knee. There is no need for specific dietary adjustments except for a weight reducing diet in those
who are overweight.

Physiotherapy and Exercise
Physiotherapy is important to maintain strength in the surrounding muscles. The affected joint
will then be subjected to less stress and strain. Walking aids are also prescribed for this purpose.
In general, swimming is an exercise that is beneficial to almost any form of arthritis. Some sports
which place severe demands on the joints may not be suitable but the patient should aim to keep
as fit as possible. This includes stopping cigarette smoking.

Appropriate Footwear
Shoes should be comfortable and of a good fit. They should provide good support and even
weight distribution. High heels are generally not helpful. Sports shoes usually fulfil most
requirements of a good shoe.

Medications
Many medications are prescribed for control of symptoms only. Simple painkillers can be very
helpful unless the joint is inflamed. When this happens, non-steroidal anti-inflammatory drugs or
injection of steroids into the joint can provide relief. At present, research is still going on to see if
any treatment can stop the disease from progressing. Some natural supplements such as
glucosamine and chondroitin may be helpful in certain patients. Some patients may respond to
injections of a lubricant substance called Synvisc into joints.

Joint Replacement
In advanced stages, replacement of a severely damaged joint can produce very good results
especially for the hip.

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Conclusion

Osteoarthritis is a common condition. Much can be done for patients to enable them to live as