Osteoarthritis

 

Osteoarthritis (OA) is a common joint disease that most often affects middle-age to elderly people. OA (arthrosis) is a disease of the entire joint, involving the cartilage, joint lining, ligaments and bone in which damage to the joints and loss of articular cartilage is the most characteristic. The cartilage (a protective layer on the ends of the bones) slowly becomes thinner and softer and eventually disappears. The ends of the bones then start to rub against each other when moving. This can cause considerable pain and problems can also arise with the underlying bone.
This process is often slow, but can also proceed very quickly (progressive loss of cartilage). In addition, changes occur in the quality of the bone under the cartilage (sclerosis) and outgrowth (osteophytes) develops at the edges of the bone. In response to the reducing cartilage protection, the bone will increase its bearing surface. This is to reduce the pressure on the joint (for example knee and hip). This allows protrusions (osteophytes) to grow on the bones and because of this the bone can become thicker and eventually become deformed.

A joint inflammation can occur due to the breakdown of the cartilage and irritation from the bone. We also often see reduced muscle strength and weakening of the ligaments. Some people suffer more from the cartilage damage, others from the changes in the bone and others from the inflammation or different combinations of these.

Osteoarthritis can occur in all joints as they age and mainly occurs in the neck, lower back, knees, hips, thumb, fingers and big toe. The condition progresses slowly progressively. Though some of the joint changes are irreversible, most patients will not need joint replacement surgery.

Osteoarthritis should not be confused with bone loss (osteoporosis).
In bone decalcification (osteoporosis), the bone becomes more fragile and therefore breaks faster. In osteoarthritis, the density of the bone under the cartilage often increases in response to the deformation of the bone due to cartilage loss and the outgrowth of osteophytes.

Cause of osteoarthritis

Osteoarthritis (OA) is a common joint disease that most often affects middle-age to elderly people. It is commonly referred to as ‘wear and tear’ of the joints, but it is not really accurate to say that the joints are just ‘wearing out’. Osteoarthritis is a condition of the entire joint, where damage to and loss of cartilage is the most characteristic feature, in addition to worsening of the tendons and ligaments, deformation of the affected bone and different degrees of inflammation of the synovium.

Loss of cartilage layer and joint inflammation
Osteoarthritis is characterized by the breakdown of the cartilage (the tissue that cushions the ends of the bones between joints), bony changes of the joints, damage to the joints, deterioration of tendons and ligaments and various degrees of inflammation of the joint lining (synovium).
Cartilage. The cartilage (a protective layer on the ends of the bones) slowly becomes thinner and softer and eventually disappears. The joint cartilage often breaks down because of mechanical stress or biochemical changes within the body, causing the bone underneath to fail. The loss of the cartilage layer often goes slowly, but can also proceed very quickly (progressive loss of cartilage). The ends of the bones then start to rub against each other when moving. You can get considerable pain and problems arise with the underlying affected bone, causing it to get slowly bigger.
Osteophytes and sclerosis. Changes occur in the quality of the bone under the cartilage (sclerosis) and the development of bone outgrowth at the edges of the bone (osteophytes). In response to the reduced cartilage protection, the bone will increase its bearing surface. This to reduce the pressure on the joint (for example knee, spine and hip). This allows osteophytes (protrusions) to grow on the bones. The bone can become thicker and eventually become deformed.
A joint inflammation joint inflammation can occur due to the breakdown of the cartilage and irritation from the bone. Often there is a reduced muscle strength and a weakening of the ligaments.

In some people the cartilage damage predominates, in others the changes to the bone or the inflammation or different combinations of these.

Risk factors
Osteoarthritis (OA) affects people of all races and both sexes. Most often, it occurs in patients age 40 and older, but younger people can also be affected by OA. Risk factors for the development of osteoarthritis can be:
• your age.
• your sex (osteoarthritis is more common in women).
heredity (having family members with OA).
obesity, which is a big overload for the joints.
• long-term overloading of joints (by hard physical work or top sports). A previous traumatic joint injury or repetitive use (overuse) of joints.
ruptured tendons caused by a sports or another injury.
certain sports that put maximum weight on the joints, such as intensive ball-, fighting and wintertime sports.
damage of the joint by a joint inflammation, bone fracture, a damaged meniscus or weak ligaments.
• having a joint deformity such as unequal leg length, bowlegs or knocked knees.
• the occurrence of osteoarthritis together with other joint disorders, such as rheumatoid arthritis (RA), gout and Calcium Pyrophosphate Deposition (CPPD).

Age
Osteoarthritis (OA) can occur in all joints as they age, but mainly occurs in the neck, lower back, knees, hips, thumb, fingers and big toe. The condition progresses slowly progressively. The lifetime risk of developing OA of the knee is about 46%, and the lifetime risk of developing OA of the hip is 25%, this according to the Johnston County Osteoarthritis Project, a long-term study from the University of North Carolina.

Hereditary predisposition
Hereditary predisposition can play a role in the development and worsening of osteoarthritis. With a genetic predisposition, osteoarthritis often occurs at a younger age and in several joints. In one family, osteoarthritis can occur more often than in another family.

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Forms of osteoarthritis

We distinguish two forms of osteoarthritis: primary osteoarthritis and secondary osteoarthritis.

Characteristic of primary osteoarthritis is:
• it is age-related.
• it is a chronic condition with an insidious onset.
• the joint cartilage becomes thinner and softer and disappears.
• it occurs mainly in the spine, hip or knee, but also in the fingers and other small joints.
• there are no systemic symptoms (no fever, no abnormalities measurable in laboratory).

Characteristic of secondary osteoarthritis is:
• an underlying illness/disorder or accident is the cause.
– accident (for example damaged meniscus in knee).
– joint disease (for example rheumatoid arthritis) or an infection in the joint.
– positional deviations of the joints.
• there is no specific preferred location (depending on the joint that is affected).

Body locations with osteoarthritis (arthrosis)
• In the case of osteoarthritis in the hand and wrist, joint inflammation can occur in the wrist and fingers. The joint becomes hot and thick and nodules (Heberden’s nodules) develop at the ends of the fingers. These nodules arise within a few weeks, hurt and are sometimes red. Once these nodules are there, the symptoms often remain stable. At a later stage, the position of your bones and joints in the wrist and hand can change, causing the upper arm, for example, to rise a little higher and the fingers to become crooked in position.
• With osteoarthritis in the neck and spine, we see a loss of strength and tingling in the arm, hand, leg or foot, while nerves can get trapped. People with osteoarthritis in the spine can also suffer from numbness, for example in the bladder and therefore get problems with urinating. Another problem is that the bony protrusions (osteophytes) that sometimes arise at the edges of the joints can start to press on the nerves, which can cause a nerve stimulation. If you suffer from it for a long time, the function of the pinched nerve may fail. Do you suffer from tingling or loss of strength in your hand? Then contact your doctor. At a later stage, the position of your bones may change and your spine and neck may show a forward, backward or lateral inclination, but this is not always visible to a lay person.
• With osteoarthritis in the hip, the symptoms slowly increase over the years with pain in the groin with walking and stiffness. A wrong or not relaxed lying or sitting position when you are sleeping or sitting can make the symptoms worse and the complaints become worse when stooping, heavy lifting, standing or walking too long. Sometimes you can only walk short pieces. At a later stage, the position of your joint can change and we see for example a difference in length between the two legs.
• In the case of osteoarthritis in the knee we see slowly increasing symptoms with inflammation or further damage to the cartilage. A piece of bone can break off (‘mouse’) in the joint and come loose. The piece of broken bone can get stuck at a given moment, causing the joint to lock. The orthopedic surgeon often takes these loose pieces of bone away surgically to prevent further damage to the bone. In a later advanced stage, the position of the joint can change, resulting for example in O-legs or X-legs.
• In the case of osteoarthritis in the ankle and foot, we see an aggravation of the pain due to the load in for example squatting, use of wrong shoes and foot deviations, walking too long and walking on an uneven ground. In osteoarthritis in your ankle joint inflammations can occur, where the joint will start to hurt more and become hot, thick and sometimes red. In a later advanced stage, the position of the joint may change, causing your ankle to turn inward or outward.

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Complaints in osteoarthritis

Osteoarthritis (OA) is a condition of the entire joint, where damage to and loss of articular cartilage is the most characteristic. The cartilage (a protective layer on the ends of the bones) slowly becomes thinner and softer and eventually disappears. The ends of the bones then start to rub against each other when moving. This can cause considerable pain and problems can also arise with the underlying bone.
Sometimes osteoarthritis is limited to one joint, but you can also get osteoarthritis in several joints at the same time.

The cartilage slowly becomes thinner and softer and eventually disappears, causing the ends of the bones to start rubbing against each other when moving. This can cause considerable pain and problems can arise with the underlying bone. At the edge of the bones sharp, bony outgrowths, the osteophyteswill grow. These bony outgrowths stretch the bone membrane and can irritate the joint capsule. The osteophytes at the edges of the joints limit the mobility of the joint and cause nerves to become trapped. The pinching of the nerves causes pain, sensory disturbances and loss of strength. Your joint can feel thicker because of the bony outgrowths. You may start using the affected joint less because of the pain.
As a result after a while the muscles around the joint can become less strong and the joint loses its firmness and stability. Instability of the joint can lead to an overloading of the joint capsule and to the overstretching of the ligaments, which in turn can lead to a fall. When falling you risk breaking a bone. Osteoarthritis is a top cause of disability in older people.

Complaints
Pain complaints in the joints. In the beginning, osteoarthritis mainly causes pain, which is caused by the movement of the joint and which can gradually get worse.
Start stiffness in the joints. The joint is stiff, especially after sleeping or if you are sitting in the same position for a long time. The starting stiffness disappears with movement, but if you have painful, stiff joints, you can not easily move them. The joint with osteoarthritis determines how agile you are. In osteoarthritis in the knee it can be difficult to bend or stretch your knee. Chances are that you will also move less due to pain and stiffness. As a result, the muscles around the joint can slowly become less strong and the joint loses its firmness and stability. The tendons are therefore more burdened. The pain and the instability increase the chance of falling, which can give you an insecure feeling when walking, which in turn can lead to falling.
Knobby swellings at the joint.
Decreased function of the joint.
Deviations from your body posture. The position of your bones changes as a result of the breakdown of the cartilage, causing your knees to turn more inwards. The change in body posture affects the way in which you then burden your other joints, tendons and muscles.
Cracking or grinding noise with joint movement, this is more common in osteoarthritis. Cracking is not harmful or painful in itself. The creaking noise is caused by the changing of the structure of the cartilage and the underlying bone in osteoarthritis.
Ignitions. Because of the inflammation in the joint, there is a lot of fluid in the joint. The joint becomes warm, thick, stiff, painful and sometimes red. Also, the mucus around the joint can become inflamed.

The deterioration of the cartilage and the deformation of the bone do not always lead to complaints. Sometimes you do not notice anything of the osteoarthritis in your joint, because you experience little or no discomfort.

Cartilage

Osteoarthritis (arthrosis) is a condition of the entire joint, where damage to and loss of articular cartilage is the most characteristic. The cartilage (a protective layer on the ends of the bones) slowly becomes thinner and softer and eventually disappears. The ends of the bones then start to rub against each other when moving. This can cause considerable pain and also problems with the underlying bone.

What is cartilage?
At the ends of bones there is a layer of cartilage, so that the bones do not touch each other. Cartilage tissue can resist pressure due to its resilience. The cartilage intermediate material is a solid and resilient substance and consists of cartilage glue (chondrin) containing a variable amount of protein fibers. The cartilage contains no nerves and no blood vessels, so the healing capacity of cartilage tissue is very limited. The cartilage is (with the exception of the joint surfaces) surrounded by a cartilage membrane (perichondrium).

Injury of the cartilage
Damage to the cartilage tissue often has major consequences due to the limited healing capacity of the tissue. Cartilage damage is caused by ageing of the bones, (sports) injury, but also inflammation, rheumatic diseases and osteoarthritis can cause cartilage damage.

Recovery of cartilage
Cartilage stops growing when the human skeleton is fully grown, so no division or formation of new cartilage cells occurs. As a result, cartilage from adults hardly recovers anymore. Damaged cartilage can only recover through the cartilage membrane. Small cartilage defects may recover because cartilage cells fill up the damaged site from the cartilage membrane. Larger defects are filled with scar tissue (fibrous cartilage).
There is no cartilage membrane (perichondrium) present on the joint surfaces, so the healing capacity of this cartilage tissue is very limited.
Cartilage is found in many areas of our body, such as in the ear, at the inter-vertebral discs and at the joint surfaces of bones.

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Types of cartilage

There are three types of cartilage:
On the basis of the number of fibers in the cartilage, a distinction can be made between three types of cartilage: hyaline, elastic and fibrous cartilage.

Hyaline cartilage
The hyaline or vitreous cartilage consists of cells, the chondrocytes, and a virtually homogeneous intermediate. The intermediate material contains many collagen fibers. Collagen fibers consist of white and fibrous protein called collagen. Collagen is a strong and non-elastic, tensile-resistant fiber, so the main function is firmness and shape retention of the body. The fibers and the intermediate material are both transparent (vitreous). This cartilage covers the joint surfaces.

Elastic cartilage
Elastic cartilage contains both elastic and collagen fibers, making it sturdy but also flexible. This cartilage occurs, among other things, in the auricle.

 

Fibrous cartilage
The fibrous cartilage is a composition of strong connective tissue and hyaline cartilage. It consists for the most part of collagen fibers. This cartilage occurs in places where resistance to large tensile forces has to be provided, such as in the inter-vertebral discs and in the meniscus in the knee joint.

Cartilage cells
The cartilage cells can be divided into three types:
ChondrocytesChondrocytes are cartilage cells that ensure the production of intermediate material. The cartilage intermediate material is called chondrine or cartilage glue.
ChondroblastsChondroblasts are the progenitor cells of chondrocytes. The chondroblasts produce intermediate matter until the cells are completely enclosed. The cartilage cells are fixed in cavities (lacunae) in the intermediate substance.
ChondroclastsCartilage calcifies as a result of growth and aging of the skeleton. Chondroclasts ensure that calcified cartilage is broken down.

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Diagnosis in osteoarthritis

Your doctor will base your diagnosis on a combination of the medical history, his findings and additional test results.

Anamneses
At the first visit, the doctor asks you a number of questions to get a good picture of your condition. You can think of the following questions:
– When did your complaints start?
– Can you describe your complaints?
– How are your working conditions?
– What medication do you use?
– Do rheumatic diseases occur in your family?
– What is your medical history?
– Are you under the treatment of other specialists and for what?

If you have complaints, the doctor will perform physical examination and blood tests. Most often doctors detect osteoarthritis based on the typical symptoms and on results of the physical examination.

Physical examination
The doctor examines whether there is moisture in your joints, whether the skin is warm and red and/or if there are palpitations that can be felt.
Sometimes your doctor makes X-rays or other imaging tests, which may be useful to tell the extent of disease or to help rule out other joint problems. However it is not helping in determining the quality of the bone cartilage. On the photo, deviations can be visible, while you have few complaints or on the picture the joint can look good, while you have a lot of pain when moving. The space between two bone ends on the photo says something about the thickness of the cartilage, but the quality of the cartilage can not be determined on the X-ray.

Blood test
The doctor can not diagnose your osteoarthritis through blood tests. A blood test does help to exclude as much as possible other conditions such as rheumatoid arthritis, gout or hemochromatosis (iron storage disease).

Treatment of osteoarthritis

The damage caused by osteoarthritis cannot be reversed. There is no treatment yet to reverse the complete damage of osteoarthritis in the joints or restore the cartilage on the joint.
The goal of the current osteoarthritis treatment is to reduce pain and improve function. Some treatments attempt to slow disease progression. Treatment is useful because it can reduce pain and stiffness. This allows you to move more easily, which is also good for all your joints, tendons and muscles. Treatment is possible with a mixture of physical therapy and drug therapy or surgery.

Osteoarthritis can be treated by
1. reducing or eliminating risk factorfor the development and increase of osteoarthritis.
Some risk factors in osteoarthritis cannot be directly influenced (including your sex), but other risk factors can. It has been shown that osteoarthritis in the knee and hand is related to being obese, so weight loss can help against the aggravation of the symptoms. Overexertion of your joint can also be reduced by various measures, such as wearing better shoes, muscle training and surgical correction of, for example, stall deviations or band injuries.
It is also important to move around every day and continue to do so. You can walk, cycle, swim, tai chi, practice other sports and so on.
2. physical therapy. Exercising each day and loss of weight, if you have obesity, are very important. When you have excess weight to carry around, this puts stress on your knee joints and hips and low back. It has been calculated that for every 10 pounds of weight you lose over 10 years, you can reduce the chance of developing osteoarthritis in the knee by up to 50%. The importance of exercise each day is very big as exercise can improve your muscle strength, decrease joint pain and stiffness and lower the chance of disability due to osteoarthritis.
3. the treatment of  the complaints with drugs, provided over the counter or prescibed by the doctor. Because the main complaint of osteoarthritis is pain, thus painkillers have an important role in the treatment of the complaints.

Drugs without a prescription used for osteoarthritis
• For the pain you can get a simple painkiller with the active ingredient paracetamol without a prescription. Paracetamol helps against pain and fever, does not cause stomach problems, usually does not cause side effects and can be easily combined with other medications.
• An NSAID, an anti-inflammatory analgesic in a lower dose. The abbreviation NSAID stands for Non-Steroidal Anti-Inflammatory Drugs. These painkillers inhibit inflammation. You can also buy a cream at the drugstore in which an anti-inflammatory painkiller, such as diclofenac, is processed at a lower dose. This cream is absorbed in your skin and works on the spot where you thinly apply it. The disadvantage is that it is not clear how much of the anti-inflammatory painkiller your body really absorbs every day. Always discuss the use of these drugs with your doctor beforehand to avoid overuse.
Acetaminophen is the generic name for Tylenol, a pain reliever and fever reducer. It’s one of the most widely used pain medications in the world. It is sold mainly over-the-counter to treat a variety of conditions, such as headaches, muscle aches, toothaches and arthritis. Acetaminophen is the active ingredient not only in Tylenol but also in Panadol, Feverall, and many other drugs.

Do you have physical complaints? Always go to your doctor or specialist for a proper diagnosis and proper treatment.

Drugs on prescription
This is provided by your doctor or rheumatologist or internist.
In the choice of drugs your doctor will look at the severity of the disease, the side-effects that the drug can give and the reaction of your body to the drug. Your doctor will weigh up the damage that the disease can cause to the joints and the possible side effects of a drug. How this balance goes down, is different for everyone. You can get the drug in a pill, in powder form or as a fluid to take orally, while in the case of a severely inflamed joint, the fluid drug can be injected into the joint itself. For osteoarthritis the forms of drug therapy include oral (by mouth) and injections (shots).
Capsaicin cream and lidocaine and diclofenac gel. You apply these drugs directly on the skin over the affected joints.
• Acetaminophen. Acetaminophen (APAP) belongs to a class of painkillers called non-opioid analgesics. They work by blocking the enzyme that produces pain- and inflammation-generating prostaglandins. As a prescription drug and oral pain reliever, acetaminophen is usually combined with narcotic pain medicines, such as codeine or hydrocodone (Norco), to treat more severe pain. Unlike non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, acetaminophen does not reduce swelling or inflammation.
• An NSAID, an anti-inflammatory analgesic, such as naproxen, ibuprofen, meloxicam or indomethacin. The abbreviation NSAID stands for Non-Steroidal Anti-Inflammatory Drugs. These are drugs that are effective against inflammation, pain, stiffness and fever, but do not contain corticosteroids (steroids). They do not prevent joint damage. There is no proof that any one NSAID is better than others. Your doctor will prescribe these prescription drugs with a higher dose of the active substance. High doses of short‐acting NSAIDs give the fastest relief of symptoms. Given in the correct dose and duration, these drugs give great relief for most patients. Your doctor may also prescribe a cream containing an anti-inflammatory painkiller. This cream is absorbed in your skin and works on the spot where you thinly apply it. The disadvantage is that it is not clear how much of the anti-inflammatory painkiller your body really absorbs every day. Do not massage with creams that give a heat reaction.
The NSAIDs may cause stomach upset, ulcers or diarrhea, but they are well tolerated by most people when used for the short term. Some people cannot take NSAIDs because of health conditions such as ulcer disease, impaired kidney function or the use of blood thinners.
• A corticosteroid (an artificial adrenal cortex hormone) is a drug that resembles the natural hormone that the body produces in the adrenal cortex. They are anti-inflammatory drugs that suppress the immune response in the body and inflammation. A corticosteroid drug can be quickly effective for a joint swelling that is localized (not widespread) by an injection or shot into the effected joint or tendon sheath (the membrane around a tendon). Joint injections with corticosteroids (sometimes called cortisone shots) can give months of pain relief from your osteoarthritis disease. This lubricant is given in the knee and these shots may help delay the need for a knee replacement by a few years in some patients. Although they may be effective, a corticosteroid drug taken by mouth is not advised. This is because the high dose required will lead to many side-effects.
Duloxetine is used to treat depression and anxiety. In addition, duloxetine is used to help relieve nerve pain (peripheral neuropathy) in people with diabetes or ongoing pain due to medical conditions such as arthritis, chronic back pain or fibromyalgia (a condition that causes widespread pain). Duloxetine may improve your mood, sleep, appetite and energy level, and decrease nervousness. It can also decrease pain due to certain medical conditions. Duloxetine is known as a serotonin-norepinephrine reuptake inhibitor (SNRI). This medication works by helping to restore the balance of certain natural substances (serotonin and norepinephrine) in the brain. In 2010, the FDA approved the use of duloxetine (Cymbalta) for chronic (long-term) musculoskeletal pain, such as occurs in osteoarthritis. This oral drug is also in use for other health concerns, such as mood disorders, nerve pain and fibromyalgia.
Hyaluronic acid is sometimes given by the orthopedic surgeon in injections with osteoarthritis in the knee. Joint injections with the lubricant hyaluronic acid can give months of pain relief from osteoarthritis. This lubricant is given in the knee, and these shots may help delay the need for a knee replacement by a few years in some patients. However, the effect of this treatment has not yet been sufficiently demonstrated. This injection is also a burden, because the injection should be given once every 3 to 5 weeks and you may suffer from local pain in the joint or hypersensitivity. In an advanced stage of osteoarthritis hyaluronic acid has shown little effect.
• Patients with more serious pain may need stronger medications, such as prescription narcotics.
bisphosphonates. These are medications that are given in osteoporosis and that inhibit bone destruction. The medicine ensures that calcium is absorbed better in the bone. With the extra calcium the bone breakdown and the bone production are then more in balance. If bisphosphonates are used, bone density may even increase slightly.
If you use a bisphosphonate and you have a treatment at the dentist, jaw problems can develop or worsen, such as when pulling a tooth. Always tell your dentist that you are taking a bisphosphonate and also report the dental treatment to your doctor.

4. the treatment of your complaints by treatment in a pain clinic or artificial replacement of your joint.
• Your doctor or specialist can refer you to a pain clinic. Treatment can consist of blocking certain nerves so that pain signals are no longer transmitted.
• Surgical treatment becomes an option for severe cases. This includes when the joint has serious damage or when medical treatment fails to relieve pain and you have major loss of function. Surgery may involve arthroscopy to achieve the repair of the joint through small incisions (cuts). If the joint damage cannot be repaired, you may need a joint replacement. Placing an artificial joint prosthesis by the orthopedic surgeon is a definitive treatment for the complaints. The most common prosthesis placed are artificial hip and knee joints and there are also prosthesis available for other joints (shoulder, elbow, wrist and ankle).

Use of drugs and adherence

• It is important that you take the drugs as prescribed. In order to get your illness under control, it is very important that you take your drugs on a regular basis every day. If you do not, there is no good concentration of the drug in your blood and therefore the drug will work less well.
• Do you have trouble remembering when and how many of your drugs you should take on a daily basis and at what time of the day? Then buy a drug dispenser, in which you can sort your drugs per day.
• Do you have difficulty or objection to taking the drug prescribed to you, for example because of possible side-effects? Then that can lead to you no longer taking the drug regularly. Discuss this with your doctor!

Deterioration of your illness and/or complications
The doctor will look at:
• The dosage and amount of drugs you use.
• Switching to another drug in the same type or a completely new type of drug.
• Combining different drugs at the same time.

Your doctor can tell you
• whether the drug can work for you.
• how you can best use the drug.
• how much and how often you can use the drug.
• how you can best reduce the drug.

You should always tell your doctor or specialist
• if you use other drugs (bought or prescribed by another doctor).
• if you have another medical condition.
• whether you will be operated on soon.
• if you have previously been prescribed an anti-inflammatory analgesic that has caused side effects.
• whether you want to become pregnant or are pregnant.
• if you are breast-feeding.
This is important because your doctor or specialist has to make a careful choice between different medicines.

Side-effects
• All drugs may have side-effects when used, so ask your doctor or pharmacist what side-effects you can expect or read the leaflet.

Reduce or stop
• If you stop using a drug yourself or reduce the number of drugs yourself, your symptoms may worsen. Always consult your doctor or specialist first if you want to use less drugs or want to stop.

Alternative treatments

There are many types of alternative treatments. This refers to all treatments that fall outside normal scientific medical care. No scientific evidence has been provided for the operation of these treatments. The alternative treatments are also called ‘complementary‘ because they can supplement the regular medical treatment by your doctor.
Many people choose an alternative treatment in addition to their regular medical treatment. They hope that this helps extra against their complaints or better helps to deal with the complaints.

Can an alternative treatment be a replacement for your regular medical treatment?
No, if you opt for an alternative treatment method, it is always a supplement to your regular medical treatment. You should not stop your regular treatment, because otherwise you run unnecessary health risks. Always consult your attending doctor before you start an alternative treatment.

What alternative treatments are there for example?
There are many different alternative treatment methods available, which can also be combined. Some examples are:
• Chinese medicine (acupuncture, pressure point massage, nutrition and tai chi).
• homeopathy (products made from plants and minerals).
• Bowen therapy.
• Ayurveda.
• Bach flower treatment.
• shiatsu, foot-sole and classic massage.
• Touch for Health.
• Reiki.
• dietary supplements.

What do you have to pay attention to?
• Many alternative treatments have not shown that they actually work. If you choose to try alternative treatment, make sure that your complaints do not increase. Stop an alternative treatment as soon as your symptoms increase.
• Always consider first why you want to follow an alternative treatment.
• Prepare yourself by looking up and reading information about the alternative treatment. Consult with your attending doctor, because certain complaints may be reduced by some alternative treatment methods.
• Determine yourself in which alternative method you trust for the relief of your complaints and whether you want to start.

What can you do best when choosing an alternative treatment?
• Always consult your doctor about the alternative treatment method you want to follow.
• Consult with your attending doctor and with the alternative therapist if they want to discuss your treatment with each other.
• Choose an alternative therapist who has followed a recognized vocational training and is affiliated to a professional organization.
• Ask your alternative therapist in advance about the purpose, duration, costs and risks of the treatment. How much money you spend depends on which treatment you choose and how long it takes.
• Do not stop your regular medical treatment, as this may worsen your symptoms.
• Weigh during treatment whether you want to continue or stop if your symptoms get worse, if you do not notice any effect of the alternative treatment or if you get side-effects.

Why is your food important?

• Healthy nutrition is important to get the vitamins and minerals and other nutrients that your body needs.
• Obesity creates risks for your health and disease progression. In the case of arthritis and obesity, for example, obesity plays an important role in overburdening and osteoarthritis in the knees, hips and ankles. The pressure on your joints is then simply too great. Healthy eating and exercise (exercising a sport and active in the home and outdoors) can help to reduce or prevent excess weight.
• A healthy diet is always important and the dietitian can support you with the right dietary advice.

What is a healthy diet?
With a healthy diet your body gets the right amount of good nutrients, which it needs. You eat the quantities that your body needs. The dietitian can support you with the right nutritional advice.
The 5 courses to choose from are:
• Vegetables and fruit
• Bread, cereal products and potatoes
• Fish, legumes, meat, egg, nuts and dairy
• Lubrication and preparation fats
• Drinks.

Where can you get advice for a healthy diet?
• You can request advice from your doctor or a dietitian. The doctor can refer you to a dietitian. Some diets may possibly help against your symptoms. Consult with your doctor or dietitian if you want to try a certain diet. And make sure that you do not omit important foods from your daily diet.

What can you do with a painful or dry mouth?
Sometimes you can suffer from a dry or painful mouth for various reasons, also due to your illness. Tips:
• by chewing (for example piece of cucumber, sugar-free candy or chewing gum) and sucking (ice cube) the salivary glands are stimulated to produce saliva.
• good oral care is important: good tooth brushing, flossing and the use of mouthwash.
• rinse your mouth regularly, drink small amounts of water and use a mouth sprayer if necessary.
• let hot drinks cool down first.
• use ice or cold dishes, because the cold numbs the pain.
• do not use sharp herbs and spices, fruit juice, carbonated soft drinks, alcoholic beverages, very salty foods and sour food.
• food with hard crusts, nuts, bones and bones can cause injuries.
• use soup, gravy or sauce with the hot meal to make the food smoother.
• spreadable cheese, spreadable paté or salad, jam or honey on bread, porridge, drinking breakfast and custard, for example, swallows easier than dry spreads.
• if you need to use ground or liquid food, you can use a mixer to grind your meal with some extra moisture.

In some forms of arthritis or use of certain drugs intestinal complaints can occur. The intestinal complaints can arise from the influence of certain drugs on food intake. Conversely, the food you eat can have an effect on the way your drugs work.

Dietary supplements, fish fatty acids, glucosamine and vitamin D?
• Dietary supplements are available as pills, powders, drops, capsules or drinks and are intended as a supplement to inadequate daily nutrition. They contain vitamins, minerals or bio-active substances. These synthetic or isolated vitamins, minerals or bio-active substances have the same effect as the vitamins and minerals that are already naturally in your food and drink.
Many people choose an additional supplement, in addition to their daily diet. The users of dietary supplements indicate that they experience positive effects of the use of certain herbs, vitamins and minerals. The body absorbs the nutrients in pills more easily than the nutrients in food. But if you eat healthy and varied, you do not need additional nutritional supplements, because you already get enough nutrients, minerals and vitamins. Always report to your doctor and pharmacist that you are using dietary supplements.
• Fish fatty acids appear to have a mild anti-inflammatory effect with a high intake. Research has been done especially in rheumatoid arthritis. The advice is to eat oily fish twice a week.
• Glucosamine can act as a mild painkiller for osteoarthritis in the knee, but does not stop arthritis.
• Our body naturally makes vitamin D under the influence of outdoor sunlight. Vitamin D may have a beneficial effect in inflammatory arthritis, but that has not yet been proven sufficiently. People with Lupus erythematosus get vitamin D prescribed as they are not often outside, because sun exposure can lead to lupus flares and skin problems. Vitamine D is given with calcium tablets to ensure a good intake in the body, when you have osteoporosis or osteoarthritis.

Supplements

Many over-the-counter nutrition supplements are being used for osteoarthritis treatment. Most supplements lack good research data to support their effectiveness and safety. Among the most widely used supplements are calcium, vitamin D and omega-3 fatty acids. To ensure safety and avoid drug interactions, consult your doctor or pharmacist before using any of these supplements. This is especially important when you are combining these supplements with prescribed drugs.

Other used supplements
Glucosamine is sugar protein that helps your body build cartilage. It is a naturally occurring substance found in bones, bone marrow, connective tissue, in the fluid in your joints, shellfish and fungus. Your body makes glucosamine itself, but with ageing this becomes less. Glucosamine can have a mild analgesic effect in mild osteoarthritis of the knee. The supplement has not been shown to prevent the worsening of osteoarthritis. Glucosamine has been used in alternative medicine as an aid to relieving joint pain, swelling, and stiffness caused by arthritis. You may experience nausea or headache when using glucosamine, but if you take the supplement with some food or plenty of water, you can prevent this.
The combination of glucosamine sulphate with chondroitin does not seem to make any difference. People who are hypersensitive to crustaceans may also be hypersensitive to glucosamine. Vegetarian glucosamines are also available. When purchasing glucosamine preparations, pay attention to the price and the daily dose.
Not all uses for glucosamine have been approved by the FDA. Glucosamine should not be used in place of medication prescribed for you by your doctor. Glucosamine is often sold as an herbal supplement. There are no regulated manufacturing standards in place for many herbal compounds.
Tiger balm and Arnica cream have an illuminating effect on the affected joint, because they give a heat reaction, so you feel less pain. But their effectiveness has not been proven other that they give temporary relief from pain.

Living with osteoarthritis

It is important to exercise daily if you have osteoarthritis. Exercise can decrease joint pain and improve joint function.

Other advice
• lose weight if you are overweight or obese, as this can reduce pain and slow the progression of osteoarthritis.
eat healthy food, vegetables, fruit and so on.
keep moving: go cycling, swimming or walking and so on.
practice daily with your painful or stiff joints.
avoid repeated motions of the joint, especially frequent bending.
avoid climbing stairs too much, squatting, crawling and kneeling (if you have osteoarthritis in the knee).
adjust furniture, such as raising a chair or toilet seat.
• ensure that your home and workplace have a pleasant temperature and avoid large temperature differences.
protect your joints against cold.
• pay attention to your posture: a bad posture is an extra heavy load. You must properly position and support your neck and back while sitting or sleeping.
change your posture regularly: do not sit, stand or lie in the same position for too long.
• make sure to alternate movement and rest.
do not lift or carry heavy things.
avoid wringing or twisting with your hands (if you have osteoarthritis in the fingers).
use assistive devices that will help you do daily activities. Do not wait until you cannot do anything anymore. Support (‘assistive’) devices, such as orthotics or a walking cane, can help you do your daily activities.
• wear comfortable shoes with sturdy soles that do not pinch and give enough support when walking.
• certain alternative treatments such as spa (hot tub), massage and chiropractic manipulation can help relieve pain for a short time. They can be costly though and require repeated treatments.
heat or cold therapy can help relieve osteoarthritis symptoms for a short time.

You might want to work with a physical therapist or an occupational therapist to learn the best exercises and to choose the best assistive devices.

Osmosis I Osteoarthritis - causes, symptoms, diagnosis, treatment & pathology

Manipal Hospitals I What Causes Osteoarthritis Joint Disease?

Regenerative Health Education I What is Osteoarthritis - A short Introduction

Video sources

Osmosis I Osteoarthritis – causes, symptoms, diagnosis, treatment & pathology I https://youtu.be/sUOlmI-naFs
Regenerative Health Education I What is Osteoarthritis – A short Introduction I https://youtu.be/WErDsqy0vEo
Manipal Hospitals I What Causes Osteoarthritis Joint Disease? I https://youtu.be/rp1z9GjCUjo

Accountability text Osteoarthritis
The information about osteoarthritis is general.
Every situation is different, so if you have any questions or complaints, always consult your doctor, medical specialist or pharmacist.

Patient videos
The patient videos are provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.

The Caribbean Arthritis Foundation does not provide medical advice, diagnosis or treatment!
The contents of the Caribbean Arthritis Foundation Site, such as text, graphics, images, and other material contained on the Caribbean Arthritis Foundation Site, (‘Content’) are for informational purposes only.