In daily life, this disease is often misunderstood by patients with Osteoporosis and Gout arthritis. This may be due to the nomenclature which is almost the same as osteoporosis and the lack of medical knowledge in our society in general. According to the American College of Rheumatology, this disease affects almost two-thirds of people over the age of 65 years, with a prevalence of 60.5% in men and 70.5% in women. Meanwhile, data from the rheumatology polyclinic at RSUPN Dr. Cipto Mangunkusumo, around 56.7% of patients were diagnosed with osteoarthritis (Soenarto, 2010).
Osteoarthritis (OA) is a degenerative joint disease characterized by damage to the hyaline cartilage of the joint, increased thickness and sclerosis of the bony plates, growth of osteophytes at the joint margins, stretching of the joint capsule, inflammation, and weakening of the muscles connecting the joints.
Based on the pathogenesis, OA is divided into primary OA and secondary OA . Primary OA, also known as idiopathic OA, is OA whose cause is unknown and has nothing to do with systemic disease or local changes in the joints.
Secondary OA is OA based on endocrine, inflammatory, metabolic, growth and long immobilization disorders.
Primary OA is more common than secondary OA. This disease is slowly progressive and generally occurs in old age (especially at age > 50 years ), although age is not the only risk factor.
Several risk factors in OA
- Age ( > 50 years )
- Gender ( Female > male )
- Race/ethnicity
- genetic factor
- Lifestyle ; like smoking
- Obesity
- Excessive physical activity (standing for a long time/lifting heavy weights)
- Hard impact sports athletes such as martial arts, football, marathon running, and others
Clinical symptoms commonly found in clinics include:
- Pain (main symptom)
- joint stiffness
- Crepitus/sensation of crackling sound
- Swelling
- Joint deformity / joint disorders
To determine the diagnosis of OA, apart from a physical examination, supporting examinations such as radiology and others are also needed. Plain radiographs can be used to help establish the diagnosis of OA even though their sensitivity is low, especially in the early stages of OA.
The distribution/classification of OA can be enforced from radiological examination. Degree Radiographic classification of OA according to the Kellgren-Lawrence criteria
- Grade 0 (Normal) There are no abnormal radiographic features
- Grade 1 (Doubtful) Small osteophytes seen
- Grade 2 (Minimum) Osteophyte appearance, normal joint space
- Grade 3 (Moderate) Clear osteophytes, joint space narrowing
- Grade 4 (Severe) Severe joint space narrowing and Sclerosis
Management of patients with OA aims to eliminate complaints, optimize joint function, reduce dependency and improve quality of life, inhibit disease progression and prevent complications.
There are several ways of managing OA.
- Non-pharmacological, in the form of:
- Education : especially giving an understanding that OA is a chronic disease, so it needs to be understood that maybe to a certain degree there will still be pain, stiffness and limitations of movement and function
- Diet : diet aims to lose weight in obese OA patients. This should be the main program of OA treatment. Weight loss can often reduce complaints and inflammation.
- Physical therapy : Exercise by cycling or by doing floor exercises for 30 minutes a day three times a week. Another option is swimming.
- Pharmacology , in the form of:
- Analgesic / anti-inflammatory agents
- Glucocorticoid injection
- Hyaluronic acid injection
- Chondroitin sulfate
- Physiotherapy , in the form of: Physiotherapy for OA patients including traction, stretching, acupuncture, transverse friction (a special massage technique for OA sufferers), muscle stimulation exercises, electrotherapy.
- Orthopedic aids are sometimes important, such as shoes that are designed specifically for OA patients inside and outside, orthoses are also used to reduce pain and improve joint function.
- surgery ; performed in patients with severe OA. Operations that are usually performed include arthroscopic debridement, joint debridement, bone decompression, osteotomy and arthroplasty.
Even though surgery can relieve pain in the OA joint, sometimes joint function cannot be repaired adequately, so pre and postoperative physical therapy must be well prepared.
Conclusion
- Osteoarthritis is a chronic joint disorder in which there is a process of weakening and disintegration of the joint cartilage accompanied by the growth of new bone and cartilage in the joints.
- Joint pain is the main complaint felt by patients.
- The goal of treatment in OA patients is to reduce symptoms and prevent stiffness and muscle wasting.
- Education, what is important is convincing the patient to be independent, not always dependent on others even though OA cannot be cured, but the patient's quality of life can be improved and an understanding of the basis of therapy is needed to ensure the success of osteoarthritis therapy.
Article written by dr. Dipa Yunta Firmanda, Sp.OT (Orthopedic & Traumatology Specialist at EMC Cikarang Hospital).