Osteoarthritis

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Contents

General Description

Osteoarthritis is a disease that causes joint pain. The cartilage in the joints can become rough and thin. Beneath the cartilage the bone thickens and grows outwards at the edges forming bony spurs. The synovium, the inner layer of the fibrous sleeve surrounding the joint that produces a lubricating fluid, swells and may produce fluid that inflames the joint. Osteoarthritis affects between 10–20% of the elderly aged over 65, which is approximately 8 million in the UK.

Osteoarthritis can be caused by several factors, many of which are closely related to other age related issues discussed in CAPSIL. Age is the leading cause and can begin to manifest itself in the late 40’s. Osteoarthritis tends to be more common in women than men and can be more severe. Osteoarthritis can also be hereditary and run in families. The most common joints to be affected are the knees, hips, hands, spine, neck and big toe, however, the disease can affect people very differently from causing little to no discomfort to being very painful with limited joint motion. Over time symptoms tend to gradually increase, usually characterised by pain and stiffness of the joint. However, it is common to experience good spells and bad spells where symptoms improve or worsen for periods of time. Another contributing factor to osteoarthritis is obesity as the increased weight puts more pressure on the joints. Injury to the joint may also cause osteoarthritis later in life due to hard repetitive activities [1].

Due to the pain and stiffness in the joints caused by osteoarthritis, in severe cases, difficulty can experienced in many aspect of life such as pain, stiffness in the joints, walking, and activities that require fine motor skills. This can cause a great impact on the quality of life by making simple tasks difficult to conduct, such as activities involving fine motor skills including writing and sewing, and opening some food packaging or opening childproof medicine bottles. Stiffness of the knees and hips, for example, may lead to a high likelihood of falling; stiffness may take some time to work out before allowing free motion of the joint making initial movements awkward and painful.

Issues

Osteoarthritis (OA) affects an estimated 21 million Americans [2] [3]. Recent studies suggest that symptomatic knee OA occurs in 13% of persons aged 60 and over [4] [5].

The risk of mobility disability (defined as needing help walking or climbing stairs) attributable to knee OA alone is greater than that due to any other medical condition in people aged 65 and over [6] [7] . Although this prevalence is high, it is expected to increase even further with the increasing prevalence of obesity and the aging of the community [8]. Despite its high prevalence, OA is a condition that is poorly understood, and heretofore a condition for which few effective and safe therapeutic options are available. Furthermore, many individuals with knee OA ultimately require total knee arthroplasty (replacement), a procedure that is also not without inherent morbidity and cost. Although osteoarthritis can be treated surgically, there are many patients for whom this is inappropriate, because of medical comorbidity, old age or other circumstances [9]. In the younger and more active individual, it is desirable to delay arthroplasty due to the limited lifespan of the prosthesis and the necessary lifestyle changes that go with it.

Justification

An estimated 46 million adults in the United States reported being told by a doctor that they have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia. [10] In 2003–2005, 50% of adults 65 years or older reported an arthritis diagnosis. By 2030, an estimated 67 million Americans ages 18 years or older are projected to have doctor-diagnosed arthritis [11]. In 2003, the total cost attributed to arthritis and other rheumatic conditions in the United States was 128 billion dollars, up from 86.2 billion dollars in 1997. Medical expenditures (direct costs) for arthritis and other rheumatic conditions in 2003 were 80.8 billion dollars, up from 51.1 billion in 1997. Earnings losses (indirect costs) for arthritis and other rheumatic conditions in 2003 were 47 billion dollars, up from 35.1 billion in 1997 [12]. Almost 44% of adults with doctor-diagnosed arthritis report no leisure time physical activity compared with 36% of adults without arthritis. Among older adults with knee osteoarthritis, engaging in moderate physical activity at least 3 times per week can reduce the risk of arthritis-related disability by 47% [13]. In Japan, around 12 million people are affected by osteoarthritis, with about 7 million of those requiring treatment [14].


Research

There are many research organisations and charities, such as the Arthritis Research Campaign and Arthritis Care, around the world working towards a better understanding of osteoarthritis and developing better treatments for patients. Much of the work done by these organisations also helps provide information for both families and suffers to aid their understanding and help them manage their illness.

Loughborough University has developed an osteoarthritis simulation suit [2] to enable doctors, nurses etc an insight into the effects of osteoarthritis. This suit could also be used as a tool to enable homes, home appliances, food and product packaging, to name but a few, to be designed more ergonomically for osteoarthritis sufferers [3]. Other age simulation suits have been developed that also include visual and hearing impairment, and weights for the arms and legs [4].

Despite various drugs and treatments, there is potential room for monitoring devices that, combined with lifestyle changes such as joint exercise and weight control, can ameliorate joint stress and delay cartilage deterioration.

In Japan, the Japan Knee Osteoarthritis Measure or JKOM is used to examine patients. There are various researches related to its validity as well as its impact on QOL.


Future Vision

The potential for monitoring sensors is huge in this field. Monitoring sensors can be attached to braces and other devices used to help patients walk. The sensors can monitor the patient’s gait and progress through a strict exercise regime that can ameliorate patients already suffering from this disease or delay the onset of it. The data gathered by the sensors can be used to analyze osteoarthritis’s affects on gait movement, leading to potential new therapies for doctors to recommend and for patients to follow.


References

  1. ↑ [1]
  2. ↑ Lawrence RC, Helmick CG, Arnett FC, Deyo RA, Felson DT, Giannini EH et al.: Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States, Arthritis & Rheumatism 1998, 41: 778-799
  3. ↑ Prevalence and impact of chronic joint symptoms--seven states, 1996. MMWR - Morbidity & Mortality Weekly Report 1998, 47: 345-351
  4. ↑ Prevalence and impact of chronic joint symptoms--seven states, 1996. MMWR - Morbidity & Mortality Weekly Report 1998, 47: 345-351
  5. ↑ Dunlop DD, Manheim LM, Song J, Chang RW: Arthritis prevalence and activity limitations in older adults. Arthritis & Rheumatism 2001, 44: 212-221
  6. ↑ Prevalence of disabilities and associated health conditions among adults--United States, 1999. [erratum appears in MMWR Morb Mortal Wkly Rep 2001 Mar 2;50(8):149.]. MMWR - Morbidity & Mortality Weekly Report 2001, 50: 120-125.
  7. ↑ Guccione AA, Felson DT, Anderson JJ, Anthony JM, Zhang Y, Wilson PW et al.: The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. American Journal of Public Health 1994, 84: 351-358
  8. ↑ Arthritis prevalence and activity limitations--United States, 1990. MMWR - Morbidity & Mortality Weekly Report 1994, 43: 433-438
  9. ↑ Zhang W, Moskovitz R, Nuki G, Abramson S, Altman R, Arden N et al.: OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis & Cartilage 2008, 16: 137-162
  10. ↑ Arthritis – Data and Statistics - Arthritis Related Statistics http://www.cdc.gov/ARTHRITIS/data_statistics/arthritis_related_statistics.htm
  11. ↑ Arthritis – Data and Statistics - Arthritis Related Statistics http://www.cdc.gov/ARTHRITIS/data_statistics/arthritis_related_statistics.htm
  12. ↑ Arthritis – Data and Statistics - Arthritis Related Statistics http://www.cdc.gov/ARTHRITIS/data_statistics/arthritis_related_statistics.htm
  13. ↑ Arthritis – Data and Statistics - Arthritis Related Statistics http://www.cdc.gov/ARTHRITIS/data_statistics/arthritis_related_statistics.htm
  14. ↑ http://www.tmg.gr.jp/hokensinpou/040201-hizakansetusyo.html


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