Osteoarthritis is a diverse collection of diseases also known as osteoarthrosis, degenerative joint disease, or joint failure. It is characterised by progressive disintegration of articular cartilage, usually accompanied by new bone formation at joint margins and beneath the involved cartilage.
There may be synovial inflammation, particularly in advanced disease, but it is different in nature from that seen with rheumatoid arthritis and is usually only a minor component of the disease. Osteoarthritis may be a sequel to trauma, inflammation, or metabolic disorders, but usually the underlying origin is not apparent.
Despite claims based largely on animal studies, there is little evidence from controlled studies in humans that any treatment affects disease progression, although some interesting results have been seen with doxycycline. Management is therefore aimed at relief of pain and maintenance of joint function.
Physical methods of treatment include physiotherapy, heat and cold therapy, exercises, splinting, and weight reduction in the obese. Acupuncture and transcutaneous electrical nerve stimulation (TENS) may also be tried.
For pain relief, paracetamol is often sufficient and should be used first. A low-dose NSAID may be tried when paracetamol is ineffective or when there is a significant inflammatory component but there is the risk of adverse effects with prolonged use of NSAIDs, especially in the elderly. There has also been concern that NSAIDs such as indometacin may accelerate osteoarthritis.
In the light of concerns about cardiovascular safety, treatment with NSAIDs such as celecoxib that are selective inhibitors of cyclo-oxygenase-2 is limited to those patients considered to be at high risk of developing serious gastrointestinal problems if given a non-selective NSAID and who do not have pre-existing cardiovascular risk factors .
If pain relief is inadequate, paracetamol may be combined with an NSAID; opioids such as codeine or dihydrocodeine are sometimes also used with paracetamol. Tramadol may also be given. Dietary supplements such as glucosamine and chondroitin may have some benefit in certain patients.
Topical analgesics such as NSAIDs, or capsaicin or rubefacients, may provide some short-term relief of pain.
Systemic corticosteroids have no place in the management of osteoarthritis. Intra-articular or peri-articular injections of corticosteroids are somewhat controversial but may be of help in some patients with localised inflammation, although if used they should only be given infrequently and as adjunctive therapy.
Intra-articular injections of hyaluronic acid, to improve the viscosity and elasticity of the synovial fluid, may be useful in osteoarthritis of the knee but evidence is weak.
Walking in the uneven surface lead to aggravate pain in the early episodes of knee OA ,if the destruction of articular cartilage lead to spur formation in the tibiofemural joint.Thus, walking in the uneven surface or staring-down should be avoided as much as possible in the early episodes of knee OA.
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