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Osteoarthritis

Some of the ailments that affect us, even being very common, are big unknown. Osteoarthritis is one of them and that's why today we will talk about it in the blog of people who live with pain.

What is osteoarthritis?

Osteoarthritis is one of the types of arthritis with a higher incidence. It is a condition that appears very often from the fifties, as the joints and bones age.



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The most common type of arthritis

Maybe you know there are many types of arthritis . The best known is usually rheumatoid arthritis , but we must not forget other inflammatory and very painful diseases such as, for example, tendonitis , bursitis, so-called carpal tunnel syndrome or  osteoarthritis.

In general we could say that osteoarthritis is a rheumatic disease and very painful. It is produced by the progressive wear of the cartilages of our bones. This type of arthritis is more common among older people . Over time, that tissue called cartilage is losing density and fails to fully or partially fulfill its main function: to get the joints of our arms, elbows, ankles and wrists moving smoothly.

Osteoarthritis: main risk factors

•     Age. People over 50 are more susceptible to this type of arthritis .
•     The sex After 50 years, different medical studies warn of a higher incidence among women of this type of arthritis in the hands, hips and knees . Generally women usually notice the first symptoms a few years before men.
•     The lifestyle. Increases the number of osteoarthritis patients in Western countries. This is in societies where sedentary life prevails and lack of adequate and controlled physical exercise .
•     The obesity. The latest medical advances directly relate osteoarthritis to obesity . There are several theories that could explain this relationship, for example:
•         Excessive ingestion of certain foods can directly damage the internal structure of both the cartilage and the bones.
•         Overweight exerts a continuous and excessive pressure on our joints. It thus promotes the progressive wear and loss of cartilage functions.

Main symptoms of osteoarthritis

The symptoms of osteoarthritis vary depending on the joint that is affected : hands, knees, hip ... Two symptoms common to any type of arthritis could be highlighted: loss of mobility and pain.

•     The loss of mobility. Patients suffering from osteoarthritis see their most basic physical movements limited: walking, going down stairs, sewing, writing, painting, etc.
•     The pain It increases when the affected joint moves, it diminishes when we rest and it appears when we make certain types of movements. It also tends to be more intense at the last minute of the day or when we make an effort, etc. Pain is one of the first and main symptoms that can warn us about the  Osteoarthritis  .

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Osteoarthritis of the thumb: the most effective remedies

Osteoarthritis is a very common ailment and, although it can affect people of all ages, it appears very often starting in the fifties, as the joints and bones age.

It starts being a slight discomfort that is felt in the knuckles or in the phalanges of the fingers. Over time, it is becoming more constant and it is likely that one finger will extend to the rest of the hand. In this article, I'm going to give you some remedies for osteoarthritis of the thumb and hands , both in its early stages and when you're already getting used to living with inflammation.



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Osteoarthritis of the thumb is inflammation of the joints of the bones . It is degenerative so it is important to diagnose it as soon as possible to start treating it with remedies and palliative exercises.

Although in this blog article about people living with pain I'm going to focus on giving you remedies for hand arthritis, there are other types of arthritis that affect joints such as the knee and shoulders , among others.

Osteoarthritis of the thumb and other types

The term arthritis is so generic that with it I can refer to up to 100 different types of ailments related to inflammation of the joints. However, in everyday life, when we talk about arthritis, we are generally referring to two fundamental types: osteoarthritis and rheumatoid arthritis .

Another fairly common type of arthritis is known as gout , a disease known for centuries that did not discriminate between kings and servants. The best known case may be that of Felipe II, who retired to the Monastery of El Escorial to rest afflicted with this ailment.

The symptoms of rheumatoid arthritis are similar in all affected areas: inflammation and pain in the joint, possible deformation (in the case of fingers is where you notice most), morning stiffness, nodules or excessively dry skin.
Osteoarthritis and rheumatoid arthritis

Osteoarthritis mainly affects the cartilage and, unlike other types of arthritis, it does not affect the internal organs, only the joints. Generally, it manifests as pain in the joints and limitation of movement. It is more common after the age of 60 although you can suffer at any age as a result of some joint injury.

Rheumatoid arthritis is a presumably autoimmune inflammatory disease whose cause or causes are still unknown although it is considered that it can have a large genetic load.

Women are three times more likely than men to develop this disease and, unlike in the case of osteoarthritis, which usually occurs in the elderly , rheumatoid arthritis affects mostly the hairpin between the ages of 20 and 40. 40 years old
Pain and swelling of the fingers

If it hurts to shrink your fingers or when temperatures are low or you are in contact with cold water, it is likely that you are living the first stages of arthritis of the hands. You may also notice a certain deformity in the thumb, in the swan neck of the fingers (joint closest to the nails) or in the metacarpophalangeal joint (the continuation of the knuckles).

Arthritis of the hands is painful but it is one of the types of arthritis that best respond to both exercises and simple natural remedies.

Remedies for arthritis of hands

In general, foods, oils and spices with anti-inflammatory properties are recommended to try to alleviate the inflammation and pain of joints affected by arthritis. Sometimes, topical use is made of them (direct application on the fingers and hands); in others, intake is recommended.

Castor oil and olive oil

A couple of times a day, you will be grateful to give you some scrubs or soft massages with castor oil . This oil has an active ingredient called ricinoleic acid that has anti-inflammatory and analgesic properties. Olive oil can also be used to massage the affected area and, of course, is a great ally against arthritis in your daily diet.

Turmeric

Turmeric is a widely used spice in oriental cuisine. It has anti-inflammatory, antiseptic, antibacterial and antioxidant properties. There are many recipes with turmeric (curry takes this spice, for example).

It is advisable to consume turmeric along with other foods since, by itself (in capsules, for example) the body absorbs it badly. The ideal is to mix it with extra virgin olive oil or linen and a pinch of black pepper . It also increases its effectiveness if taken together with soy, citrus juice or green tea.

Honey and cinnamon

A teaspoon of both, mixed, give your body defenses to fight inflammation because they have properties similar to turmeric: anti-inflammatory, antiseptic and antioxidants.

Sales of Epsom

Put hot water in a large bowl, add two cups of Epsom salts , let stand a little and put your hands for about 20 minutes in the liquid. You can repeat this treatment a couple of times a week. These salts will get the affected joints of your fingers to relax, providing relief from joint swelling and stiffness.

To prevent arthritis , a diet rich in blue fish, citrus fruits and olive oil is recommended.
Exercises to relieve arthritis of hands

Three very simple exercises will help you improve the mobility of your fingers and keep arthritis at bay.

Move the thumb by drawing a large circle . First to the side, slowly, about eight times; then, in the opposite direction.

Again with the thumb, you have to touch each one of the yolks of the rest of fingers of the hand . You will see what forms an "o". Do not do it quickly because you will only make the inflamed joint hurt more. When you finish the round of fingers, open your hand, stretch your fingers and recreate "oes". Repeat the exercise eight times.

Open and close the hand flexing , little by little, each of the joints . The fingers shrink as if you wanted to grab something until the fist is closed. Slowly open your fist and stretch your fingers. Again, 8 or 10 times with each hand (if both are affected).

You will tell me how these natural remedies and simple exercises have gone. If you know someone else, do not hesitate to share it through the comments, you can help other people who, like you, want to alleviate the pain!

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Osteoarthritis of the knee: definition, causes, symptoms and treatment

Knowing some of the most common diseases can help us in their treatment. Today in the blog of people who live with pain we talk about osteoarthritis of the knee.

What is osteoarthritis of the knee?

A knee osteoarthritis is also known as arthritis "by use and wear" as it is a common disease in people of middle age. It is the most common degenerative disease of the knee. It appears as the bones age. It is one of the types of arthritis with the highest incidence. The development of the disease occurs slowly and the pain worsens with the passage of time.



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A healthy knee can flex without difficulty. This occurs thanks to a soft and slippery tissue called articular cartilage that protects and cushions the ends of the bones of the knee. Osteoarthritis eats these cartilages.

Also, given the similarities between them, we recommend that you check the differences between arthritis or osteoarthritis .

What are the causes of knee osteoarthritis?

Osteoarthritis of the knee, as we have told you, is among the most frequent knee pain causes .

Osteoarthritis occurs with the passage of time and wear. The cartilage deteriorates and gets rough when you feel pain in the area that is not protected by the cartilage.

When the cartilage wears out completely to compensate for the loss of cartilage, damaged bones can grow and form painful spurs.

Several factors increase the risk of developing osteoarthritis:

•     Age The ability of the cartilage to repair itself can decrease with age.
•     Heritage Some hereditary features, such as bowed legs, knees together or joint laxity, may increase your risk of having this disease.
•     Weight The weight that the knees must support is key to their early development.
•     Injuries A knee injury can cause osteoarthritis in the future.
•     Overexertion People who must kneel or bend over, lift heavy objects and walk as part of their work are more vulnerable to injuries and the subsequent development of osteoarthritis.

Main symptoms of knee osteoarthritis

Pain and stiffness are the most frequent symptoms of knee osteoarthritis. As with other similar conditions, symptoms get worse in the morning or after a period of inactivity.

The symptoms of knee osteoarthritis are common to any type of arthritis : loss of mobility and pain.

•     The loss of mobility. Patients see their physical movements limited: walking, going down stairs, sewing, writing, painting, etc.
•     The pain Increases when moving the affected joint. Otherwise, it decreases when we rest and it appears when we make certain types of movements. It also tends to be more intense at the last minute of the day or when we make an effort, etc.

What are the most common treatments for knee osteoarthritis?

There is no cure for this disease, although there are many treatment options available. These are intended to relieve pain, maintain normal activity and improve the quality of life. These are the main treatments:

•     Exercise. You can perform gentle exercises such as walking, cycling and swimming as excellent options.
•     Weightloss. Losing some weight can decrease the level of tension that supports the articulation of your knee.
•     Physiotherapy. Some assistive devices also help decrease joint tension.
•     Medicines. Your doctor can incorporate some non-steroidal anti-inflammatory to your treatment. Also drugs like Ibuprofen reduce pain and swelling.
•     Surgery. It is possible that due to the condition of the disease it is advisable to perform surgery if the pain also worsens and causes disability.
•     Arthroscopy It may be necessary to remove pieces of cartilage to smooth the surface of worn cartilage.
•     Replacement of the joint . It may be necessary to remove the entire knee joint or some of the damaged parts and replace it with a prosthesis.

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Symptoms and treatment of Osteoarthritis

Osteoarthritis is a disease related to the wear and tear of the joints. This wear leads to a progressive destruction of the cartilage. Joint capsules and muscles near the affected area can also be affected.

The cartilage is very important for the joints, since it is the tissue that cushions the movement of the bones. In the most severe cases, the cartilage wears out in a certain joint. This means that the bones rub against each other. Typically, osteoarthritis occurs in the hands, neck or back. It also occurs in joints that support more body weight, such as the knees and hips.



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Causes of osteoarthritis

The causes that cause osteoarthritis are not yet fully defined . On the other hand, it has been possible to demonstrate that this ailment is directly related to age . It is a risk factor due to the decrease in elasticity and the recovery capacity of the cartilage related to the passage of time. Still many young people already notice the first signs of joint wear.

Thus, it can be assumed therefore that osteoarthritis is caused by a combination of factors.

• Injuries and accidents. About one third of cases of osteoarthritis are due to an accident. The smaller of the lesions causes a process of degeneration of the articular cartilage. Even small tears in tendons and ligaments affect the cartilage.

• Sustained overload. When certain movements are carried out day after day for years can lead to an overload of the affected joints. The cases of osteoarthritis related to work are not at all exceptional. Overweight and obesity are also bad for the joints.

•Genetic heritage. The cause of osteoarthritis can also be in the genes: studies have shown that genetic predisposition can be responsible for joint wear.

• Incorrect posture. Many people have a congenital deformity in the joint. This can accelerate its degradation.

Another cause that may favor the onset of osteoarthritis is the lack of physical activity.

Symptoms of osteoarthritis

Some of the symptoms of osteoarthritis include a feeling of tightness and stiffness in the joint when standing up . It is also typical to feel severe pain when initiating a movement that gradually diminishes with the additional burden. Other symptoms of osteoarthritis are the sound of crunches during movement or muscle tension and inflammation around the joint. Thus, the common symptoms of osteoarthritis are:

Moderate pain

It appears and disappears when doing physical activities such as bending or walking. It is a persistent pain in the joints even when you are still or at the time of sleep.
Rigidity or numbness in the joints

It occurs when a long time in the same position or on the contrary, by excessive movements.

Also, many patients also have an increased sensitivity to moisture and cold.

It should be noted that the more the joint wear increases, the more intense the symptoms become. The pain becomes more frequent, even at rest, and the mobility of the affected joint is less and less.

Exercise to strengthen the joint

The German Society of Sports Medicine and Prevention recommends the practice of the following sports in order to reduce the effects of osteoarthritis: gymnastics, cycling, walking, swimming and water gymnastics.

Other measures to treat osteoarthritis

The treatments differ according to the severity of the symptoms . In general they consist in diminishing the pain and improving the movement of the affected joints. That is why there are treatments for mild osteoarthritis and for the stages that are more serious.

The plans to treat the disease from the medical point of view are based on the combination of medications, physical therapies to relieve pain and education to protect the joints .

What we can do to alleviate the symptoms of osteoarthritis is to rest , control weight , perform moderate physical activity , use heat or cold in the area, swim or take warm baths .

In very advanced cases in which there is joint damage or functional limitations of the joints, surgery will be recommended.

    Pharmacotherapy. While the articular cartilage is not too damaged, some medications may be prescribed. The purpose is to relieve pain and inflammation in order to improve the ability to move.

The most well-known medications for joint pain are non-steroidal antirheumatics (NSAR). The term "non-steroidal" means that they do not contain cortisone. However, NSARs can be used only briefly, and in as small a dose as possible, as they have quite a few side effects. Other medications that are commonly used are selective COX-2 inhibitors, which do not have as many side effects as NSARs.

•     Physiotherapy to treat osteoarthritis. Physiotherapy exercises improve joint mobility and work at the same time reduce pain.
•     The replacement of synovial fluid. This treatment is often used successfully in osteoarthritis of the knee, treatment in which hyaluronic acid is injected directly into the joint cavity.
•     Surgery. Certain operations can be performed on outpatients, such as arthroscopy. Through this minimally invasive surgery, the joint can be cleaned and dried, reinforcing the cartilage. The last resort is the replacement of the joint, an option that should only be considered when other treatments have failed.

More information

Osteoarthritis is not a disease that appears overnight. joint wear and tear is a process that extends over the years . It can be a long time before someone really feels pain in the joints, which, unfortunately, causes that in many cases arthritis is not recognized until it is in a very advanced state. This is a serious impediment, because an early recognition and treatment would be really beneficial. Therefore, it is important to recognize the warning signs of osteoarthritis in time .

Initial stage of osteoarthritis

At the base of each case of osteoarthritis we found a defect in the cartilage layer. Although in the first instance it is limited to a small area, there is already a danger. Even with minimal damage to the cartilage, the joint undergoes profound changes . X-rays can detect these signals that indicate the onset of osteoarthritis. Little by little, the loose particles of cartilage reach the synovial fluid and damage the interior of the joint. This accelerates the development of osteoarthritis

Intermediate stage of osteoarthritis

Many patients are in this intermediate stage of osteoarthritis. The duration of this stage varies from person to person and depends mainly on the degree of load that the damaged joint supports. Because the cartilage is gradually reduced, the pressure on the underlying bone is increasing. The only way for the body to balance this is by distributing it better, which means that the surface of the joint becomes larger and bony prominences called osteophytes are created. These protuberances are visible from the outside of the joint. The changes cause immobilization of the joint and an increase in cartilage damage.

Advanced stage of osteoarthritis

The underlying bones become exposed as the cartilage wears out, leaving it unprotected and coming into direct contact with the opposite bone. The bones of the joint have changed: they are much more compact and hard, and therefore more recognizable in an X-ray. Once the joint cavity has completely disappeared, the affected joint becomes completely rigid , a situation that can only be treated by surgery.


Saving efforts causes more damage

When mere movement causes pain, an effort-saving attitude is automatically assumed involuntarily in order to attenuate the symptoms as much as possible. But this attempt to save the joint can end up inflicting even more damage, because by avoiding certain movements the muscular tension in the joint is crowded .

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Cervical osteoarthritis

The treatment of the manifestations of cervical osteoarthritis, apart from its complications, is essentially medical.

• Associates non-pharmacological and pharmacological media.
• Non-pharmacological treatments

Cervical collar

Orthotic treatment
A cervical collar may be used during painful episodes.
The degree of containment will be variable depending on the intensity of the pains: simple foam collars, with or without rigid reinforcement or support of the anterior chin.

Patient education
The learning of preventive measures is part of the patient's education. This education brings together the notions transmitted to patients, designed to modify their potentially harmful postural habits. They have to give advice of subject of the cervical column to avoid the wide movements of the neck and to carry heavy loads.



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Re-education
Rest is imposed during painful episodes.
The kinesitherapy practiced during painful accesses uses different techniques: relaxing massages, physiotherapy by parafangotherapy, short waves and infrared. Among the accesses, kinesitherapy associates active and passive reeducation, with proprioceptive work, domain of saving techniques. The exercises will be explained to the patient so that he can reproduce them periodically in his home.


Spinal manipulations
The publications related to vertebral manipulations are numerous and very contradictory. According to the recommendations from the Cochrane data bank: "Manipulations practiced in isolation are not indicated, since it is their association with other mobilization techniques and exercises that allows obtaining the best results".

Always be done by a well-trained doctor, and as long as there is no contraindication. There may be some serious complications (paresis, dissection of the vertebral artery, transitory deafness).

Cervical tractions
The cervical tractions, performed in the bed for several hours in a hospital environment, or in a medical consultation at an appropriate table, seem to have an analgesic effect, however, the existing clinical studies have been considered insufficient and there are no recommendations regarding this type of techniques in cervico-osteoarthritis.
Pharmacological treatments

Analgesics, NSAIDs
First grade analgesics are always used: paracetamol remains the most used product, often in the long term. When there are more important pains, minor opioid derivatives (possibly associated with paracetamol) can be used. The analgesic doses must be regular and systematic.

Non-steroidal anti-inflammatories are only used during the most acute painful episodes, and with great caution in the elderly. They can be associated with a gastro-protector or replaced with a coxib, respecting possible contraindications.

Corticosteroid therapy can be used in uncomplicated cervico-osteoarthritis during access in case there are contraindications to NSAIDs. A short cure, generally administered at a dose of 1 mg / kg orally, should be given priority.

The muscle relaxants are useful during acute access, but can promote drowsiness. Your prescription will have to be particularly prudent in active people (car driving) and in the elderly (risk of falls). Its ingestion outside the painful accesses will be especially vespertine. Anti-depressants can be used in case of psychic repercussion of chronic pain.

Raquidian infiltrations
Cervical infiltrations are not indicated in uncomplicated arthritic cervicalgia.
However, in the case of associated cervicobranchial neuralgia, resistant to NSAIDs and oral corticosteroid therapy, hydrocortisone infiltrations are performed through the lumbar route followed by tilt (Trendelenburg) during a short hospital stay. Foraminal injections are contraindicated.

Surgical treatment

Surgical treatment is reserved for complicated forms: cervicoarthrosic myelopathy or cervicobrachial neuralgia due to radicular-osteophytic conflict.

Surgical treatment of cervicoarterotic myelopathy is indicated in case of failure of medical measures, that is, in case of aggravation of a neurological deficit or the reappearance of a deficit that had previously decreased in response to medical treatment.
The goal is spinal decompression.

The intervention performed is the best prognosis if the neurological deficit is recent. In the end, it seems that only a small percentage of patients suffering from cervical-ar- tic myelopathy are operated on.
Currently the complications of this surgery are rare (aggravation of the deficit, new radicular deficit, tetraplegia).

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Lumbar osteoarthritis

The treatment is, above all, medical and associates non-pharmacological and pharmacological measures.

• Non-pharmacological treatments
• lumbar support belt

Orthotic treatment
During acute crises, using an immobilization corset as standard or as a measure has an analgesic effect.

Out of crisis, during activities, using a lumbar support belt (CSL) increases the level of vigilance (avoids potentially painful movements). It should be noted that the use, even prolonged, of a CSL does not entail any risk of muscle loss (abdominal and dorsal muscles).

The "thermal environment" created by the CSL has a myorelaxing and analgesic action. The CSL has a proprioceptive function. Its psychological impact is important. Patient compliance depends on your comfort. An effective lumbar orthosis is an orthosis that allows the patient to be more mobile and has an analgesic effect.



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Patient education
Although no study demonstrates the efficacy of a slimming regimen in patients with lumbosteoarthritis, it is always good to make an overweight or obese patient lose weight. The participation of a nutritionist or a dietitian may be necessary. As in other chronic diseases, compliance depends on the patient's understanding of their disease, and requires an adapted education.

• Reeducation, exercises and sports
• During acute painful attacks, rest is essential.

Outside of the crisis, the re-educator will give joint savings advice and recommend kinesitherapy exercises whose main objective will be a strengthening of the abdominals.
Regular sports activities adapted to the patient's function will also be recommended, which will contribute to the maintenance of an "ad hoc" weight.
Pharmacological treatments

Analgesics, NSAIDs, muscle relaxants
If a long-term medication is necessary, an analgesic treatment such as paracetamol will be preferred. Myrelaxants can also be proposed. In case of failure, and especially in case of acute painful episode, anti-inflammatories associated with a gastroprotector, or a coxib, may be prescribed, respecting possible contraindications and for the shortest possible period due to potential side effects.

Raquidian infiltrations can be performed in some cases.

•     Indications
•     Epidural infiltrations have no indication in lumbalgias with lumbosteoarthritis, unless there is an associated radiculalgia.
•     Subsequent zygapophyseal infiltrations can be made in case of posterior joint syndrome. They must be carried out under radiographic control to guarantee their intra-articular character.
•     If there is a symptomatic narrow lumbar canal, epidural infiltrations of cortisoned derivatives may be proposed, or even an intradural infiltration, which requires a short hospitalization. It should be noted that some teams no longer perform this last gesture due to potential complications (cerebral thrombophlebitis).
•     It has not been shown that these infiltrations in the indication "narrow lumbar canal" decrease the use of surgery, but often make the symptoms disappear for a few months. Usually, 2 or 3 epidural injections are performed.
•     Possible complications
•     The most frequent are the aggravation of rachialgia and vasovagal syncope. More rarely, a post-lumbar puncture syndrome, epidural hematomas, neurological injuries or even infections (epidural abscesses, meningitis) may occur.
•     Precautions
•     Due to the possible hemorrhagic complications, this gesture is contraindicated in patients treated with anticoagulants (AVK). If it is necessary to practice infiltration, the AVK will be interrupted, replacing it with a low molecular weight heparin (LMWH), and it will be performed when the INR is less than 1.5 and 24 hours after the injection of LMWH. If anti-coagulant treatment has been prescribed in cardiology, it is essential to have the agreement of cardiologists before stopping treatment.
•     It is not recommended to perform an epidural infiltration in case of treatment with an antiplatelet drug. The infiltration will take place ten days after the abandonment of the antiplatelet drug.

Surgical treatment

The example of the narrow lumbar canal (CLE)
There are few indications for lumbosteoarthritis surgery other than CLE.

In case of CLE type affection and / or in case of medical treatment failure, it may be decided to perform a surgical treatment. However, medical treatment may be interrupted to perform early surgery, in case of motor and / or sphincter problems or severe restriction of the maximum perimeter of travel.

Its objective is to make the lumbar duct reach a sufficient diameter to eliminate any cause of root conflict. Normally, a lumbar recalibration is performed (extension of the stenosed sections). This intervention gives good results. In cases in which there is fear of a destabilization of the spine in the post-operative phase, it may be useful to associate an arthrodesis of the operated sections.

Complications of spinal surgery
Complications of lumbar recalibration surgery are rare. However, there are possible neurological complications. These may be the consequence of a direct trauma to the roots or the post-operative constitution of a compressive intracanal hematoma. The dural gap is the most frequent perioperative incident.

The other complications are those that are linked to any surgical act, such as phlebitis, embolism and infection. In the long term, a spinal destabilization can occur if an arthrodesis has not been performed.

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Osteoarthritis of the foot

It can affect one or several joints: talonavicular, sub-talian and phalangeal metatarsus, the most frequent.

It usually appears because of a static problem of the foot or after a trauma. The best treatment is preventive: correction of static problems (use of corrective templates) and acquired or constitutional architectural vices, rapid treatment of eventual fractures.

There are no specific recommendations for its treatment, which does not differ from the treatments usually proposed in Osteoarthritis and is based, therefore, on the association of non-pharmacological and pharmacological measures.



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Non-pharmacological treatments

Orthotic treatment

•     Standard standard footwear
•     Footwear is paramount. The doctor must insist on its importance to the patient. The latter should privilege wide and deep shoes. The heel should not be more than 4 cm. The sole must be thick and of good quality to absorb the loads and the blows.

Orthopedics Osteoarthritis of the foot

•     The plantar orthoses
•     Custom-made plantar orthoses can be made. They must be made by a podiatrist with precision, they must be adapted to the patient and can be used in standard shoes as long as they do not have a heel of more than 4 cm. Indeed, beyond 4 cm, the back of the foot is no longer functional and the front of the foot does not extend when performing the step, which suppresses the possibilities of action of the sole. Sometimes it may also be necessary to resort to new shoes or a half number plus, to enter the template.
•     The plantar orthoses are made with flexible materials. They must adapt to the expected objective: distribution of the supports, absorption of the blows, maximum comfort, rigid sole in the form of cradle to reduce to the maximum the movement of the metatarso-phalangeal joint in the case of hallux rigidus. The patient must be warned that the plantar orthosis, like the appliances, requires an adaptation time (usually 8 to 15 days).
•     The other adapted solutions
•     In case of major deformations of the foot in relation to an evolved Osteoarthritis, customized orthopedic shoes can be made.
•     Orthoplasty
•     Orthoplasty consists of manufacturing a custom-made toe device designed to reduce a deformation or suppress a painful support. The toe orthosis is worn with the use of shoes. It can be associated with a plantar orthosis. For example, in the case of dorsal osteophyte in relation to a metatarso-phalangeal osteoarthritis of the first radius (hallux rigidus), limiting rubbing with the shoe.

Patient education It is necessary to inform the patient about the importance of joint saving measures. They have to give advice for joint rest. This rest consists of a limitation of standing stops and long walks.

Re-education
Its objective is to maintain the functional potential. Associates various techniques such as reeducation of walking, foot and plant massage, flexibility exercises, active and passive mobilizations (hallux rigidus incipient), muscular reinforcement, proprioception and sensory afferentation (stimulates plantar sensitivity), physiotherapy that associates the thermotherapy and ultrasound.

Local treatments

They must be privileged with regard to systemic treatments.

Topics
Applied locally, NSAIDs are effective in superficial Osteoarthritis. They have fewer side effects and are better tolerated than oral NSAIDs.

Intra-articular corticosteroid treatments
Used as a symptomatic treatment for all arthrotic joints, they can be injected intra-articularly in case of painful access to quickly relieve the patient.
Its effects usually disappear after a few weeks. Relative rest of the infiltrated joint is recommended for 24-48 hours.

Systemic treatments

Analgesics: paracetamol
The choice of analgesic treatment is based on an accurate estimate of pain. The intensity of the pains should be taken into account to prescribe an analgesic of adapted effectiveness. The recommended analgesic of first intention is paracetamol, up to 3 grams a day.

It is necessary to take repeated shots to be effective, and this must be explained to the patient. Your tolerance is good. In case of renal insufficiency or chronic alcoholism, it is convenient to adapt the doses.

Non-steroidal anti-inflammatories and Coxibs
NSAIDs should be reserved as a 2nd option in case of failure of paracetamol and / or in case of inflammatory access.
They should always be prescribed and used at the lowest effective dose and for the shortest possible time.

The choice of an NSAID should be made taking into account its safety profile and the individual risk factors of the patient.
There is no need to prescribe conventional NSAIDs or coxibs in case of an evolutive peptic ulcer or gastro-intestinal bleeding, a history of digestive bleeding or perforation during NSAID treatment.
NSAIDs are susceptible to induce an acute IR, it is necessary to remain particularly attentive with patients treated with diuretics, which present a risk of hypovolemia or impaired renal function.

In patients with confirmed ischemic heart disease, peripheral arterial disease and / or history of stroke (including transient ischemic attack), coxibs are contraindicated and non-selective anti-inflammatory drugs should be used with caution after thorough evaluation.

Opioid analgesics
In case of rebellious pain, intolerance to paracetamol or counter-indication to NSAIDs, it is possible to resort to analgesics of sections 2 and 3 of WHO (weak and strong opioids).
They can allow to pass a painful episode, but they have frequent undesirable effects (nausea-vomiting, problems of higher functions, severe constipation).
Its indication and its benefit / risk ratio must be well evaluated.
Surgical treatment
hallux rigidus

Surgical treatment concerns, in 90% of cases, hallux rigidus.

It is summarized to the arthrodesis that indolence contributes in exchange for a loss of mobility that, in general, is already very compromised. The prosthetic replacement of the first metatarsophalangeal joint remains controversial. In effect, all the prostheses have shown to have a high complication rate (early unsealing, implant fracture, dislocation ...) Outside the first radius, surgery is proposed as a last resort.

It should be noted that foot surgery is delicate and, depending on the series, complications reach 10 to 30% of cases. The most frequent complications are: infection, phlebitis, unsightly scars or protrusions and difficulties to wear (residual edema).

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Osteoarthritis of the knee

The treatment of Osteoarthritis is based on hygienic-dietetic measures, physical treatments, medication treatments, local treatments and surgery.

Several expert societies have issued recommendations: EULAR in 2003 and OARSI in 2008. All agree on the importance of therapeutics without drugs.

Above all, the patient must be held accountable and educated. Self-management must be encouraged more than a passive attitude.



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Non-pharmacological treatments

Weightloss
Arthritic patients who are overweight or obese have an increased risk of aggravation of their gonOsteoarthritis, or of the development of a contralateral gonOsteoarthritis. It is important to advise that you lose weight to an overweight or obese patient. It may be necessary the intervention of a dietitian or a nutritionist doctor in the overall treatment of the patient.

Physical exercise
Physical activity improves function and quality of life. Obviously, we must adapt the exercise to the patient's capabilities.
The increase in physical activity improves the effectiveness of the slimming regimen. In effect, the loss of weight is linked to the amount of physical exercises.

A patient can be advised of an exercise program. They are learned and planned in the consultation of a kinesitherapist, a physical doctor or a reeducation center to be applied by the patient at home. To be effective, they have to be practiced regularly.
You can advise, for example, to walk regularly.

Footwear and insoles
Flexible orthopedic insoles that absorb shocks can be useful. In case of Osteoarthritis of the internal femoro-tibial compartment, templates with lateral elevation will be recommended. High heels more than 4 cm. they are discouraged, since they favor the flessum.

Orthoses and canes
The containment of the knee can go from the simple knee brace to the rigid orthosis. The walking cane (or a simple umbrella) is useful, since it allows the articular discharge. The cane can be attached to the side opposite the arthrosic joint. This cane is recommended during the marches or during the accesses of the disease to put the joint in partial discharge.
In case of gonOsteoarthritis bilateral, in a patient can change the cane by a walker that, eventually, can have rollers.

Re-educational treatments

This treatment has several objectives:

•     Fight against pain thanks to massage, physiotherapy and balneotherapy, enabling a discharge work,
•     To preserve the joint and muscular mobility through the work of postures and the muscular reinforcement of the quadriceps, as well as of the other stabilizing muscle groups of the knee,
•     Prevent vicious attitudes (flessum),
•     Educate the patient about the interest of joint savings. Joint rest is essential in case of pain. The patient should be advised to avoid carrying heavy loads, stand for a long time, walk for a long time on uneven terrain, up and down stairs, squat and work on their knees.

Systemic treatments

Analgesics: paracetamol
The choice of analgesic treatment is based on an accurate estimate of pain. The intensity of the pains should be taken into account to prescribe an analgesic of adapted effectiveness. The recommended analgesic of first intention is paracetamol, up to 3 grams a day.

It is necessary to take repeated shots to be effective, and this should be explained to the patient. Your tolerance is good. In case of renal insufficiency or chronic alcoholism, it is convenient to adapt the doses.

Non-steroidal anti-inflammatories and Coxibs
NSAIDs should be reserved as a 2nd option in case of failure of paracetamol and / or in case of inflammatory access.
They should always be prescribed and used at the lowest effective dose and for the shortest possible time.

The choice of an NSAID should be made taking into account its safety profile and the individual risk factors of the patient.
There is no need to prescribe conventional NSAIDs or coxibs in case of an evolutive peptic ulcer or gastro-intestinal bleeding, a history of digestive bleeding or perforation during NSAID treatment.
NSAIDs are susceptible to induce an acute IR, it is necessary to remain particularly attentive with patients treated with diuretics, which present a risk of hypovolemia or impaired renal function.

In patients suffering from confirmed ischemic heart disease, peripheral arterial disease and / or history of stroke (including transient ischemic attack), coxibs are contraindicated and non-selective anti-inflammatory drugs should be used with caution.

Symptomatic anti-arthritic slow-acting
In several studies related to gonarthrosis and coxOsteoarthritis, AASAL have shown efficacy in pain and functional disability. They act after several weeks.
Some have a residual effect of 1 to 2 months when they are left and significantly reduce the use of NSAIDs.

Opioid analgesics
In case of rebellious pain, intolerance to paracetamol or counter-indication to NSAIDs, it is possible to resort to analgesics of grades 2 and 3 of WHO (weak and strong opioids).

They can allow to pass a painful episode, but they have frequent undesirable effects (nausea-vomiting, problems of higher functions, severe constipation).
Its indication and its benefit / risk ratio must be well evaluated.
Local treatments

Topics
Applied locally, NSAIDs are effective in superficial Osteoarthritis. They have fewer side effects and are better tolerated than oral NSAIDs.

viscosupplementation Hyaluronic acid

Intra-articular treatments
Analgesic treatments administered intra-articularly can also be used.

Corticoids
Used as a symptomatic treatment for all arthrotic joints, they can be injected in case of painful access to quickly relieve the patient.
Its effects usually disappear after a few weeks. In osteoarthritis of the knee, infiltration under "scopic" or ultrasound control is not necessary. Relative rest of the infiltrated joint is recommended for 24-48 hours.

Hyaluronic acid
Injections of hyaluronic acid have a delayed analgesic effect whose effect is prolonged in the medium term (from 3 - 6 months and up to 12 months) in Osteoarthritis of the knee, and are part of the recommendations of the EULAR in the symptomatic treatment of the Gonarthrosis.

Treatment with hyaluronic acid is indicated in moderate-severe gonarthrosis. It consists of three intra-articular injections spaced a week apart.
This treatment acts deferred. Its duration of action is between 6 and 12 months. Recently, unique injection forms have been developed, which have no difference in efficacy with respect to the forms that require three injections. This therapeutic effect is significantly higher than that of placebo. This treatment is well tolerated and carries few side effects. The studies related to possible structural effects are contradictory and, currently, do not allow the use of molecules with a structural purpose. There are numerous commercialized hyaluronic acids (HA). Its main difference is its molecular weight.
There is no formal proof of the superiority of high molecular weight AHs over low weight ones.

• Surgical treatments
• knee prosthesis surgery

A conservative surgery may be considered in young patients with a defect in the axis and a less developed unicompartmental Osteoarthritis. This surgery is based on centering osteotomies.

Arthroscopic lavage with debridement is controversial.

It may be necessary to resort to a knee prosthesis. This is necessary in the case of an evolved radiological anatomical osteoarthritis, a pain and / or a greater functional disability despite a well-performed medical treatment for a sufficient period of time.

The use of knee arthrodesis is exceptional, it is reserved for the failures or complications of prostheses and for patients who have a defect of the extensor device.

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Osteoarthritis of the hand

The EULAR ( European League Against Rheumatism ) issued recommendations in 2006 for the treatment of Osteoarthritis of the hand. They refer to rhizo-Osteoarthritis and Osteoarthritis of the fingers.

The best approach combines pharmacological treatments with non-pharmacological treatments. However, the choice of treatments remains difficult due to the absence of good quality clinical trials and the low level of testing.

It is necessary, above all, to specify the patient's complaint to know if it refers more to the aesthetic repercussion, pain or disability. Individual treatment and self-management by the patient are paramount.

Non-pharmacological treatments, including ergotherapy, reeducation, the use of technical aids (orthosis or splints) occupy an important place in the recommendations.



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Non-pharmacological treatments

Re-education
The aim of reeducation is to limit joint tensions and maintain joint mobility.
Several techniques are used, such as analgesic massage, thermotherapy, ultrasound and gymnastics. It is important to fight joint stiffness through reeducation, since once installed, it is irreversible.

The local application of heat (hot bandages or paraffin wax) and ultrasound can provide antialgia in a short period, and are proposed before the exercises.

Ergotherapy
Ergonomic measures have to be taken. The patient must be advised to practice "joint savings". For example, you can write with a large diameter ballpoint pen, modify instruments that require a fine grip, etc.

Technical support orthosis thumb

Technical help
The splints can prevent stiffness in bad position, particularly at long fingers. At the level of the thumb, the fight against deformation is also important. It must be early, since progressive degradation of the joint results in an adductus thumb, a loss of mobility and an often important functional discomfort. The latter is aggravated by the atrophy of the thenar eminence against which you have to fight doing exercises.

The thumb orthosis stabilizes the thumb in the function position. It has an orthopedic function against deformation, but it is also analgesic. It can be worn continuously during acute painful periods, or only at night, outside of crises, when the pains are less disabling.

In practice, the orthoses molded to measure in the patient, allow a better adaptation, especially in case of rigidity already installed. Good compliance depends on a good tolerance of the orthosis by the patient.
Pharmacological treatments

With regard to pharmacological treatments, it is necessary to favor the molecule with the best benefit / risk ratio and to re-evaluate the indication regularly.

Local treatments are still preferable to systemic treatments.

Local treatments
Topical NSAIDs can be used with a good symptomatic effect.

Paracetamol
Paracetamol is the reference analgesic since it is effective and has a very good tolerance. You can take up to 3 grams a day.

NSAID and Coxibs orally
NSAIDs should be reserved as a 2nd option in case of failure of paracetamol and / or in case of inflammatory access.
They should always be prescribed and used at the lowest effective dose and for the shortest possible time.

• The choice of an NSAID should be made taking into account its safety profile and the individual risk factors of the patient.
• There is no need to prescribe conventional NSAIDs or coxibs in case of an evolutive peptic ulcer or gastro-intestinal bleeding, a history of digestive bleeding or perforation during NSAID treatment.
• NSAIDs are susceptible to induce an acute IR, it is necessary to remain particularly attentive with patients treated with diuretics, which present a risk of hypovolemia or impaired renal function.
• In patients suffering from confirmed ischemic heart disease, peripheral arterial disease and / or history of stroke (including transient ischemic attack), coxibs are contraindicated and non-selective anti-inflammatory drugs should be used with caution.

Infiltrations of corticosteroids
During painful accesses, intra-articular corticosteroid infiltrations may be proposed to patients. Eventually they can be radio-guided, as access to the joint is often difficult, due to joint pinching and the presence of osteophytes.

Surgical treatments

In case of persistent painful symptoms or a handicap with deformation despite optimal medical treatment, surgical treatment may be considered.

Joint excision consists of a resection of the osteophytic protrusions. This intervention does not modify the osteoarthritic evolution and allows pain and joint discomfort to persist. This surgery is carried out more on a psychological basis.

Digital centering osteotomies can help in the case of particularly disturbed off-center joints.

Arthrodesis aims to fuse the joint in a position of function. It allows a good relief and a centering, but it entails a loss of mobility.

It may be interesting for the distal interphalangeal.

The arthroplasties are used for the proximal interphalangeal ones, since at this level a conservation of the mobility is indispensable.

In the particular case of rhizo-osteoarthritis, there are 3 surgical possibilities:

•     trapezectomy,
•     the escafotrapezoidal arthrodesis,
•     the trapezometacarpal prostheses.

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How to treat osteoarthritis of the knee

How is osteoarthritis of the knee treated?

Your doctor will recommend therapies to help relieve pain. Your doctor can tell you that:

•     Rest your knee or avoid activities that make your pain worse.
•     Put ice on the knee for 20 to 30 minutes a few times a day, to reduce inflammation and relieve pain.
•     Take an over-the-counter medication, such as acetaminophen (one brand: Tylenol) or ibuprofen (one brand: Motrin).
•     Do physical therapy or certain exercises to help strengthen the muscles that surround the joint.

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Are there other options?

Yes. If oral medications and physical therapy do not help the knee enough, your doctor may consider giving you an injection of pain medication (called an anesthetic). This can stop the pain for days to weeks. Adding another medication (called a corticosteroid) to the anesthetic can prevent pain and inflammation for longer. If this does not help enough, your doctor may talk to you about surgery or injections of hyaluronic acid.
What are hyaluronic acid injections?

Some of the hyaluronic acid is already in the joint fluid. In people who have osteoarthritis, hyaluronic acid becomes less thick. When this happens, there is not enough hyaluronic acid to protect the joint. Injections can introduce more hyaluronic acid into the knee joint to help protect it.

Injections of hyaluronic acid may relieve pain more than oral medications. These injections can help the pain go away for 6 months to a year and, sometimes, longer. Unfortunately, these injections do not help all people.

Hyaluronic acid injections are also expensive, but many health insurance programs cover them. It is possible that hyaluronic acid injections are an option for you. Your doctor will talk with you about the advantages and disadvantages of hyaluronic acid injections and whether they are right for you.

What happens with the surgery?

Sometimes osteoarthritis of the knee is so intense that surgery is required to relieve the symptoms. Surgical options include:

•     Arthroscopy is performed with a small endoscope (or camera) that is inserted through the tiny cuts made by a surgeon in the knee. With the endoscope, the surgeon can see the degree of severity of the damage that osteoarthritis has caused in the knee. With other small instruments, the surgeon can remove the damaged parts of the knee joint (this is called debridement), and clean or purge the joint to remove any loose part (called washing or irrigation) that may be causing pain. . Arthroscopy is not suitable for all people and can only provide temporary pain relief or delay the need for other surgeries.
•     Osteotomy is a surgery that re-locates or reshapes the bones of the knee where osteoarthritis has caused damage. This procedure can only be done when only one area or one side of the knee is damaged. This procedure changes the position or alignment of the knee so that the weight is removed from the damaged area. This procedure restores movement in the knee and relieves pain. However, it is possible that people who underwent an osteotomy will need knee replacement surgery in the future.
•     Arthroplasty is also called joint or knee replacement therapy. A surgeon removes the part of the knee damaged by osteoarthritis and replaces it with an artificial joint made of metals and plastic. In this procedure, all or part of the knee joint can be replaced. Although the recovery may take a long time depending on the magnitude of the surgery, the results of the arthroplasty are often successful. Knee replacement therapy can help put an end to your pain and improve or restore movement of the knee.

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High costs and social problems due to lack of treatment of osteoarthritis

It is estimated that 0.4% of GDP in Mexico is destined for the attention of musculoskeletal diseases. Osteoarthritis (OA) is one of the main causes of disability after 40 years of age.

Therefore, multimodal treatment that includes pharmacological and non-pharmacological measures, from the more traditional such as analgesics and the most recent such as viscosupplementation, is important, noted the Mexican Initiative for Patients with Osteoarthritis and Rheumatoid Arthritis (IMPACTAR).



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At the press conference to announce the actions of IMPACTAR to celebrate the World Day for Rheumatic Diseases, Dr. Fernando Torres Roldán, President of the Mexican College of Orthopedics and Traumatology (CMOT), said that the prevalence of osteoarthritis, and in general of this group of ailments, has as a consequence physical, social and economic problems, both within the family and for health institutions. " By 2050 it is expected that the number of people over 60 will triple, since Mexico ranks sixth in terms of aging ."

OA is a chronic inflammatory condition that causes degeneration in the joints, mainly of the hip, hands, knees, lower back (back) and neck. It is estimated that it affects approximately 2.5 million people in Mexico, with a prevalence of 10.5% of the population and this is due to wear in the upper layer of cartilage that generates friction between the bones of the joint. It manifests clinically in pain, swelling and loss of movement.

It is estimated that rheumatic diseases diminish up to seven healthy years and in women the reduction is up to 13 years. These are problems that derive from total or partial disability caused by these diseases, because they generate high economic costs, due to the type of specialized care that includes the use of orthopedic devices and rehabilitation therapies, as well as the payment of subsidies and disability pensions. There lies the importance of adequately treating patients with options that slow the progression of the disease and provide them with quality of life, said Dr. Torres Roldán.

The specialist said that the management of patients with OA has evolved both from the diagnostic and therapeutic point of view, due to scientific advances on pharmacological interventions increasingly effective and safe to improve joint function and reduce pain caused by the deterioration of joints in patients. " There are new treatment patterns, such as viscosupplementation, which consists of the infiltration of a viscous and elastic substance with properties similar to those of synovial fluid in healthy patients, which have favorably contributed to optimizing the condition of the affected joint, especially on the knees".

In addition to the presentation of these new treatment patterns obtained through various studies and the research protocol carried out by the Initiative, the IMPACTAR race was announced, aimed at raising awareness about joint care, mainly in the knees. "We call on society in general to join in the race to be held on October 17, in the second section of Bosque de Chapultepec, to offer information about these diseases and the impact of the lack of timely diagnosis and treatment, as well as as in the quality of life of patients .