Osteoarthritis (OA) Theme Week!

• OA is the most common joint disorder worldwide; it affects 1 in 10 Canadians.

• OA affects men and women equally.

• It can occur at any age (average age of diagnosis is 65)

• 7 years = typical time from symptom onset to diagnosis

• OA is a degenerative disease, characterized by joint pain, tenderness, local inflammation, muscles weakness, movement limitation or compensatory functional movements

• X-ray changes unrelated to symptoms

• In a healthy joint, there is a balance between the regeneration and degeneration of the joint. When the degeneration surpasses the regeneration, OA occurs.

• Weak muscles, or living a sedentary life, can lead to OA because muscles help absorb shock and protect joints.

• OA has previously been described as “wear and tear” of the joint. This statement is misleading, as cartilage requires ongoing movement and healthy loads to regenerate.

• Cartilage can be thought of as a sponge. When load is applied, for instance when walking, fluid gets squeezed out into the joint capsule. When loads are removed, the cartilage absorbs the fluid back in from the surrounding area.

• Motion is lotion! (Weight-bearing is good for cartilage repair!)

Diagnosis

• In the past, radiographic imaging has been the primary diagnostic criteria for OA.

• Health practitioners are moving in a new direction and taking a more holistic approach… there is now more emphasis on the individual’s functional status and symptoms.

• Diagnosis for OA now: risk factors (previous injury, abnormal loading, weak muscles), clinical examination (range of motion/strength), report of pain and symptoms (stiff, pain at night, careful with joint, feels better after exercise). NOT: imaging.

Thoughts about Prevention

• Living an overall healthy lifestyle is the best approach- the way we eat, sleep, drink, exercise, whether we smoke and how we manage stress levels all impact our joint health.

• One strategy is maintaining a healthy weight. Carrying additional weight can increase the chances of developing OA as there is more stress on the joints during weight-bearing. Every pound of weight loss is equivalent to four pounds of decreased joint stress per step!

• Maintaining healthy levels of glucose in the body is another strategy. High glucose levels can trigger inflammatory reactions which can accelerate cartilage loss.

• Joint replacement is an effective means of treatment for end-stage OA; however, functional limitations can accompany this procedure.

• The focus in care is shifting to disease prevention, recognizing early symptoms, and the appropriate treatment of early stage OA with therapeutic exercise.

Exercise and OA

• Physiopilates exercises include proper joint loading, alignment, and muscular strengthening

• Exercise therapy can improve walking tolerance (distance walked) and walking speed in persons with knee OA. The most effective exercise programs include lower extremity strengthening, low-impact aerobic exercise (walking and/or bicycling), and flexibility training. Positive effects, such as decreased pain, have been observed in less than 24 weeks of training.

• Aquatic Exercise is a comfortable and effective means of therapy for knee and hip OA. The buoyancy of the water allows for more fluid movements with less joint stress. Sessions can include water walking, balance training, and general lower extremity strengthening.

• Exercise is also beneficial for hand OA. Regular range of motion exercises, hand strengthening exercises and functional hand exercises for a minimum of 8 weeks has been shown to decrease pain and stiffness and improve grip and pinch strength.

Knee OA

• The knee is a susceptible site for OA as it is prone to injury, and OA can subsequently follow.

• Common symptoms of knee OA include pain with weight-bearing, a stiff and unstable leg, clicking in the joint or feeling as though the knee will give out.

• In the later stages of knee OA, the legs can take on a “bow legged” or “knocked knee” appearance.

Hip OA

• Hip OA can present as pain outside the joint, deep in the groin, or along the inside or outside of the thigh muscles.

• It often results in decreased range of motion which can greatly impact activities of daily living, such as getting in and out of a car or putting on socks.

Hand OA

• Hand OA is responsible for the highest prevalence (43%) of radiographic OA

• (shows up on imaging) when compared to the hip (24%) and the knee (11%).

• It is more commonly found in women over the age of 50 (peri/post-menopausal) compared to age-matched men (exact reasons are unknown - genetics, hormones and environment all play a role).

• Hand OA most commonly affects the end of fingers, and the base of the thumb.

• The fingers may feel stiff, tender, or present with minor changes in finger/thumb shape.

• It is common for the muscles in the hand to become weak, and make tasks that require gripping or carrying difficult.