Current Management in Osteoarthritis

Abstract

Osteoarthritis (OA) is a process of destruction of joint cartilage, subchondral bone and other joint structures, leading to anatomical damage to the joint, impaired movement and pain. Secondary changes may be accompanied by synovitis, caused by degradation products of cartilage and bone. There is a disturbance in balance between the synthesis of articular cartilage components and their degradation. Osteoarthritis is the most common chronic disease of the joints. It causes joint pain, stiffness, distortion and impairment of function, leading to disability. The disease occurs in the elderly, but it is not a consequence of aging. Optimal treatment requires early diagnosis and removal of risk factors. Early diagnosis may be treatment non-pharmacologically, according to NICE’s treatment in chronological order, and may still benefit from physical therapy. Late diagnosis requires more invasive treatments, including alloplasty, and prognosis is poorer. Diagnosis must be based on clinical examination and supported by imaging. Obesity is the main modifiable risk factor for OA. Other factors are hyperglycemia, diabetes, and hypercholesterolemia, injuries of knees and hips and meniscus damage. Unmodifiable risk factors are female gender, age, joint malformations, trauma. Pain and stiffness are symptoms of OA. Joint pain occurs after joint movement and disappears after rest. As the disease progresses, the pain appears already after small joint movements and finally during sleep. The main goals of treatment are patient education, pain reduction, function optimization, and the degenerative process modification. The current treatments OA are non-pharmacological methods, topically capsaicin and topically NSAIDs, paracetamol, then oral NSAIDs and, finally, arthroplasty.