Osteoarthritis

INTRODUCTION

Osteoarthritis/arthrosis is a degenerative joint disease; affecting articulations, especially weight-bearing joints which are subjected to maximum 'wear and tear', it is the result of a variety of patterns of joint failure. It can be characterized by both degenerations of articular cartilage and simultaneous proliferation of new bones, cartilage, and connective tissue.

EPIDEMIOLOGY

AGE: There is a steady rise in degenerative changes in joints from the age of 30. By age of 65, 85% of people have some radiographic evidence of Osteoarthritis although only 25% may have symptoms.

SEX: More generalized and more severe in older women.

GENETIC: It is genetically linked. Obesity and body mass index are particularly associated with knee Osteoarthritis. Cold and damp climates are also associated with more symptoms.

AETIOLOGY AND PATHOGENESIS: (Cause and Disease Process)

PRIMARY OSTEOARTHRITIS: If cause is unknown.

SECONDRY OSTEOARTHRITIS: When degenerative joint changes occur in response to a recognizable local/systemic factor.

CLINICAL FEATURES

Synovial fluid is viscous and has a low cell count.

Symptoms are gradual in onset.

Pain is at first intermittent and aching and is provoked by the use of the joint. And relieved by rest.

As disease progresses movement of the joint becomes increasingly limited initially as a result of pain and muscular spasm but later because of capsular fibrosis, osteophyte formation and remodeling of bone.

There may be repeated effusions into joints especially after minor twists/injuries. Crepitus may be felt/even heard.

Associated muscle wasting is an important factor in the progress of the disease.

INESTIGATIONS

Blood count and ESR are characteristically normal.

Synovial fluid is viscous and has a low cell count.

Radiological specific features

Joint space narrowing seen due to cartilage destruction.

Joint space remodeling follows destruction of the cartilage. The joint alignment is altered with formation of new bone and cartilage in the non stressed area resulting in peripheral osteophytosis.

Cyst or geode formation may be seen along with subchondral sclerosis.

Detached osteophytes / ossification of cartilaginous debris form loose bodies.

MANAGEMENT

Treatment is directed towards relieving symptoms, maintaining and improving joint function and minimizing handicap.

For overweight weight reduction will benefit.

Muscle exercises to increase muscle tone and aerobic fitness benefit pain reduction and function even in the orderly.

Aids such as splints, walking sticks etc can help in reducing the condition in weight bearing joints and also in post-surgerical rehabilitation.

Occupational therapy services.

HOMOEOPATHIC APPROACH IN TREATEMENT OF OSTEOARTHITIS

A. Grading of disease / symptoms

Acute

Sub acute

Chronic

Acute exacerbation of chronic disease

Proper use of anti miasmatic remedies

Only under the guidance of qualified homoeopath

B. Grading of disease / symptoms

Serous Membrane

Ligaments

Circulation - Artery or venous

Nerves

Bones and Articular surface

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