Maximizing Treatment for Osteoarthritis: A 3 Part Story (2011 Abstract of Lecture)

Treatment of Osteoarthritis remains a challenge, and reviewing data from the mid 1990’s to present, the advances in understanding the disease have not been matched with advances in treatment,  compared to that seen in rheumatoid arthritis, for instance.

This symposium has 3 parts, namely, new concepts in pathogenesis and pathology that has fueled research in targeted therapy, use of OA treatment guidelines and the future of OA treatment.

Part 1: Osteoarthritis as a disease is a heterogenous entity, with incongruence in its anatomic, radiographic and clinical characteristics. Osteoarthritis in the spine, hands, hips and knees can be different diseases, with different risk factors and remain radiographic entities for extended periods before they manifest clinically as pain. Pain is generated by various mechanisms, the recent concept being, bone marrow lesions (BMLs) that are consistent anatomically with pain and progression of cartilage disease. Inflammatory elements are established in synovium, subchondral bone and periarticular fat pad, triggering studies on new targets of treatment.

Part 2: Treatment has focused on pain control and prevention of disability. Clinical practice guidelines abound, by specialty, country, by advocacy. Adherence to these expensive projects is in question. Western data show low adherence to recommendations on exercise and weight loss, and instead, drug prescription and surgery are resorted to more often than necessary. Non-pharmacologic treatment remains by evidence, the first line treatment for the control of pain and for preserving function. Drug treatment starts with analgesics. The GAIT study shows a rather big placebo effect for OA pain and the effects of many of drugs are small over that of placebo.

Part 3: Targeted treatment and newer approach to control pain and preserve function continue to be explored. Disease modifying OA drugs have long been in the market with inconsistent evidence. Diacerein, avocado unsaponifiables, chondroitin sulphate, glucosamine salts have known anti- metalloproteinase and anti -cytokine effects. The clinical effects of disease modification are difficult to measure. Current studies on monoclonal antibodies are promising for the control of pain, but again, these modalities would suffer from cost considerations.

In summary, treatment for OA can be maximized by considering the patient as a whole, keeping them functional and pain free, in the safest way possible. For now, clinical practice guidelines contain recommendations that have been judiciously studied for evidence of efficacy and safety and should therefore help the clinician achieve the objectives of treatment.

Arthritis IQ

Only 2 took the test....
Hmmmmm....

Arthritis IQ: what do you know about arthritis? (answers next posting)

1. When I have pain in the muscles and joints, I should refrain from eating legumes and fish sauces, meat, etc.
       True
       False
2. Pain in the legs and feet in young adults can be due to:
       A. beer binge last night
       B. poorly fitting shoes
       C. unusually long walks (in the mall... or some field work) )or travel
       D. something I inherited from my parents
3. When my shoulders and back are painful, I should have a back massage.
      True
      False
4. Which infections can also present with arthritis?
      A. hepatitis
      B. HIV
      C. influenza (flu)
      D. all of the above
5. Diabetes is a common disease that can have rheumatism as common symptom.
      True
      False
     

Pain all over

If you are a woman in your 40's and has pain in the neck, chest, upper and lower back, arms and thighs, legs, check out these other symptoms:

1. poor sleep or insomnia
2. non refreshing or non-restorative sleep (tired on waking up in the morning)
3. easily irritated bowels, abdominal pain, diarrhea or constipation
4. headaches
5. "feeling low" and disinterested
6. fatigue

Fibromyalgia

is not an uncommon condition and is now recognized as a distinct form of rheumatism

that causes pain all over -

"achy body".

It can be severely debilitating  and may cause

loss of interest in routine and work-related activities of daily living.

It can come and go, but generally, treatment is needed in order to avoid disability.

It can be treated with both non-drug and drug treatment.
It is important to
search for other causes or diseases, that can cause pain in similar parts of the body,
before ascribing the symptoms solely to fibromyalgia.

A rheumatologist or physical and rehabilitation medicine specialist can help you.

Confusing arthritis with other conditions

Arthritis

is inflammation of joints (shoulders, elbows, knees for example), 

causing swelling, pain, warm joints,

with difficulty to move the joint due to pain and stiffness.

Rheumatism

includes arthritis conditions

and  other diseases that cause

pain and swelling in parts of the body surrounding the joints

like

tendons, muscles, ligaments, skin and other connective tissues.

The arthritis doctor is sometimes consulted for numbness and paralysis, movement disorders like Parkinson's disease, and blood vessel (arteries and veins) disorders like varicose veins and blocked arteries. These conditions are generally caused by diseases of the nerves, blood vessels and brain, and not necessarily arthritis by themselves.

Some arthritis can also affect nerves, blood vessels and brain. A rheumatologist can see the difference.



Some facts about arthritis

Did you know that...

 ... that there are more than 100 different kinds of arthritis?

... of these 100 different kinds, only 1 is caused by uric acid -rich foods?

... that children can have arthritis?

... some arthritis develop after having infections

like

tonsillitis, diarrhea and sexually transmitted diseases?