1

2

OA is “Wear-and-Tear” kind of arthritis.

It is a chronic condition characterized by the breakdown of the joint’s cartilage which causes the bones to rub against each other, causing stiffness, pain and loss of movement in the joint.

Osteoarthritis is by far the most common type of arthritis.

Osteoarthritis is known by many different names, including Degenerative Joint Disease, Ostoarthrosis, Hypertrophic Arthritis and Degenerative Arthritis.

3

It is thought that OA dates back to ancient humans. Evidence of OA has been found in ice-aged skeletons.

Today, an estimated 27 million Americans live with OA. It is the #1 cause of disability in America.

According to National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), by 2030, 20 percent of Americans -- about 72 million people -- will have passed their 65th birthday and will be at high risk for this disease.

Approximately 80-90% of individuals older than 65 years have evidence of Primary Osteoarthritis.

The symptoms of OA usually appear in middle age and almost everyone has them by age 70. Before age 55, the condition occurs equally in both sexes. However, after 55 it is more common in women.

4

OA affects the Synovial Joints of our body.

A material called the “cartilage”, which keeps bones from rubbing against each other during motion, covers the ends of the 2 bones in a joint.

There is a small bag called the “synovium” that holds synovial fluid between the 2 pieces of cartilage.

The combination of cartilage and synovial fluid allows for a smooth, painless motion in the joints.

5

• OA most commonly occurs in Weight-Bearing Joints.

• The Most Obvious Joints are – Hip Joint Knee Joint Finger Joints (Postmenopausal Women) Toe Joints Intervertebral Joints of the Spine

• Less Common Joints are – Wrist Joint Ankle Joint Shoulder Joint

6

7

Age

Obesity

Physical Inactivity

Injury or Overuse (Athletes, Patients having Surgery, Fracture, or Soft tissue injury surrounding the joint)

Genetics or Heredity

Muscle Weakness

Other Types of Arthritis (RA, Septic Arthritis)

Other Diseases or Conditions (Hemochromotosis, Acromegaly)

8

OA is primarily a disease of cartilage.

The exact initiating factor in Primary Osteoarthritis is not known.

Interleukin-1 (IL-1) is a potent pro-inflammatory cytokine that, in vitro, is capable of inducing chondrocytes and synovial cells to synthesize MMPs.

These MMPs (Matrix Metallo Proteinases) are the primary enzymes responsible for the degradation of articular cartilage.

In addition, IL-1 suppresses the synthesis of type II collagen and proteoglycans, and inhibits the transforming growth factor-ß stimulated chondrocyte proliferation.

This ultimately leads to the degeneration of articular cartilage and thus OA.

9

10

11

12

13

14

15

Joint Soreness after periods of overuse or inactivity.

Stiffness after periods of rest that goes away quickly when activity resumes.

Morning Stiffness, which usually lasts no more than 30 minutes.

Pain caused by the weakening of muscles surrounding the joint due to inactivity.

Joint Pain is usually less in the morning and worse in the evening after a day’s activity.

Joint Swelling

Deterioration of Coordination, Posture and Walking due to pain and stiffness.

16

Pain in Groin, Inner Thigh and Buttock

Referred Pain in Knee and side of Thigh

Limping when Walking

17

Pain when moving the Knee

Grating or Catching when moving the Knee

Pain when Walking up and down Stairs or getting up from a Chair

Weakened large Thigh muscles

18

Pain and Swelling of the Finger Joints

Bony Growth Spurs at the joint at the end of the Finger, called “Heberden’s Nodes”, or at the middle joint, called “Bouchard’s Nodes”

Difficulty with Pinching Movements, such as picking an item up from a table or grasping a pencil or pen

19

Stiffness and Pain in the Neck and Lower Back

Pain in the Neck, Shoulder, Arm, Lower Back and Legs

Weakness or Numbness in Arms and Legs due to pinched nerves result in inflammation

20

Damage to Cartilage triggers inflammation as the tissue tries to repair itself.

This Inflammation causes Pain, which can lead to a decrease in exercise and, in turn, to a loss in muscle tone and strength.

Less Exercise combined with Muscle Loss can lead to Weight Problems or Obesity, which can increase stress on the damaged joint and more cartilage breakdown.

21

• As the opposing cartilage surfaces wear away, the knee collapses causing deformities such as –

Bowleggedness (Genu Varus) Knock Knees (Genu Valgus)

• These deformities can contribute to pain and functional losses of the knee.

22

Early Diagnosis and Treatment is the key to controlling Osteoarthritis. No single test can diagnose Osteoarthritis. Most doctors use a

combination of the following methods to diagnose the disease and rule out other conditions:

23

The doctor begins by asking the patient to describe the symptoms, and when and how the condition started, as well as how the symptoms have changed over time.

The doctor will also ask about any other medical problems the patient and close family members have and about any medications the patient is taking.

Accurate answers to these questions can help the doctor make a diagnosis and understand the impact the disease has on patient’s life.

24

• Doctor will be looking for common features reported in OA, including:

Joint Swelling

Joint Tenderness

Crepitus

Loss of ROM in Joints (Joint Stiffness)

Muscle Weakness

Joint Damage caused by Bony Growths in or around the Joint

Pattern of Affected Joints

25

• Your doctor will probably use these lab tests to confirm a diagnosis of osteoarthritis (OA):

Joint Aspiration (or Arthrocentesis)

X-Rays

MRI

The doctor may order Blood Tests to rule out other causes of symptoms.

26

27

To date, no definitive treatment or cure of OA has been identified.

Most successful treatment programs involve a combination of treatments tailored to the patient's needs, lifestyle, and health.

The Programs include ways to Manage Pain and Improve Function.

28

Control Pain

Improve Joint Function

Improve Ability to do ADLs

Maintain Normal Body Weight

Slow Down the Disease progress

29

Patient Education by Counseling

Exercises

Weight Control

Joint Protection (Rest and Relief from Stress on the Joints)

Physical Therapy and Occupational Therapy

Medications

Surgery

Complementary and Alternative Therapies (Acupuncture, Folk Remedies)

30

Most people with Osteoarthritis will use Drug Therapy to ease the symptoms of the disease.

Most Drugs focus mainly on Relieving Pain, but some are targeted at other symptoms and slowing disease progression.

31

Person taking NSAIDs regularly should be monitored by a doctor.

Certain Health Problems and Lifestyle Habits can increase the risk of side effects from NSAIDs. These include a history of Peptic Ulcers or Digestive Tract Bleeding, use of Oral Corticosteroids or Anticoagulants (Blood Thinners), Smoking, and Alcohol Use.

People over age 65 should use NSAIDs with caution.

NSAIDs can cause Stomach Irritation or, less often, they can affect Kidney Function.

NSAIDs sometimes are associated with serious Gastrointestinal Problems, including Ulcers, Bleeding, and Perforation of the Stomach or Intestine.

32

Sometimes OA can affect your ability to do everyday tasks such as Bathing, Dressing and Walking.

A Physical or Occupational Therapist can give you more good recommendations on protecting your joints.

Physical Therapy works on Strengthening your muscles and improving your Flexibility and your joint Mobility.

Physical therapist will work with you on a specific Exercise Program and other Pain Management Techniques.

Occupational Therapy focuses on helping you manage your daily activities. Occupational Therapist will show you ways to perform tasks without putting

damaging stress on your joints. They also may show you how to use Splints and Braces to stabilize your joints

and reduce pain. They also know which products can help you complete tasks more comfortably.

33

34

Weight Loss can reduce stress on weight-bearing joints, limit further injury, and increase mobility.

A Dietitian can help you develop Healthy Eating Habits.

A Healthy Diet and Regular Exercise help reduce weight.

35

36

Exercise is the most effective Non-Drug Treatment for reducing pain and improving movement in Osteoarthritis.

A potential barrier to recommending regular physical activity to patients with OA is the belief that exercise will exacerbate joint symptoms.

However, the results of randomized, controlled clinical trials indicate that increased physical activity does not produce or exacerbate joint symptoms and in fact, confers significant health benefits.

37

All patients with arthritis should see their doctor for a careful history and physical examination before beginning an exercise program.

A Comprehensive Evaluation is the initial step in designing a physical activity program individualized for the patient with OA.

Assessment Objectives can be divided into 2 broad categories:1) Arthritis-related Factors (Current Medications, Joint Pain, Inflammation,

Stability, and ROM)2) Impairments associated with Inactivity (Altered Body Composition,

Muscle Weakness, and Poor Cardio-Vascular Fitness)

38

Individuals with OA tend to be more deconditioned than sedentary individuals without OA, increasing the risk of Cardiovascular Disease in general.

Assessment of physiologic function should include Cardio-Pulmonary Capacity, Neuro-Muscular Status, and Flexibility.

A symptom-limited Exercise Test should be considered to screen for Coronary Artery Disease, when appropriate, in those wishing to exercise and to guide their training.

Modifications of traditional protocols may be warranted depending on functional limitations and an early onset of fatigue.

Choose a mode of exercise based on the most pain-free method for exercise.

Standard Contraindications for Exercise Testing should also be followed.

39

Acute Myocardial Infarction (within 2 days) or other acute cardiac event Significant change on the ECG suggesting ischemia, MI, or other acute

cardiac event Unstable Angina not stabilized by medical therapy Uncontrolled Cardiac Dysrhythmias causing symptoms or hemodynamic

compromise Symptomatic Severe Aortic Stenosis Uncontrolled Symptomatic Heart Failure Acute Pulmonary Embolus or Pulmonary Infarction Acute Myocarditis or Pericarditis Suspected or known Dissecting Ventricular or Aortic Aneurysm Acute Infections (Influenza, Rhinovirus)

40

Cycle Ergometry is generally the preferred mode of testing.

Low-to moderate risk individuals can participate in Moderate Intensity Exercise, defined as an intensity of 3-6 METs, or 40-60 % VO2max, without an Exercise Test. As a screening, these individuals should complete a questionnaire that can identify any preexisting conditions.

OA patients should have small incremental changes in workload, for instance, increments of 10-15 W/min on Cycle Ergometer, or using the modified Naughton protocol using a treadmill.

Submaximal Testing can be used to predict aerobic capacity.

41

Site-specific Exercise Recommendations should be considered for each joint affected by OA.

A primary consideration should be to know the disease stage of OA.

The focus of Exercise Therapy for chronic stages of OA should be to maintain or improve function while minimizing or avoiding exacerbations.

When beginning an exercise program, Joint Protection is very important for persons with OA.

Be careful not to overstretch lax joints, and when joint pain and swelling follow activity, they should be treated as an “Overuse" injury, with Ice and Rest. Steps should be taken to strengthen the joint in preparation to return to an activity. On days when the disease flares in one or a few joints, it is possible to alternate activities so the exercise habit is maintained, but joints are protected. Weight bearing should be no longer than 2-4 hours and should be followed by 1 hour of non-weight bearing.

42

Isotonic Exercise is preferred over Isometric Exercise for Dynamic Strength Training during chronic stages of OA.

Low-Intensity Isometric Exercise is preferred for Muscle Strengthening during the acute arthritic stage.

Aerobic Training is ideally achieved by using a mode that minimize the magnitude and rate of joint loading. The best types includes Free-speed Walking, Cycling, and Pool Exericse.

Adopting a low intensity but regular activity significantly decreases risks for a number of diseases such as Chronic Heart disease and Osteoporosis.

43

Focus on improvement of both Functional Status as well as Physical Fitness.

In a single Exercise Session, progress from Flexibility Exercises (affected joints), to Neuromuscular Muscle Function Exercises (Strength and Endurance), to Aerobic Activities (Weight-bearing and/or Non-Weight bearing).

Avoid exercise during arthritic flare-up.

Conditions for Exercise Termination include:• Unusual or Persistent Fatigue• Increased Weakness• Decreased ROM• Increased Joint Swelling• Continuing Pain that lasts more than 1 hour after exercise

44

Hydrotherapy may attenuate pain and stiffness and reduce reliance on NSAIDs.

Regular use of NSAIDs may cause Anemia because of gastrointestinal bleeding and mask the musculoskeletal pain.

Contraindications to exercise include vigorous, highly repetitive exercise with unstable joints, overstretching and hypermobility.

45

Regular Motion and Weight Bearing nourishes cartilage and bone and strengthens joints.

Physical Activity decreases feelings of depression and improves sleep and mood.

Physical Activity promotes general health.

Physical Activity strengthens muscles around joints to protect them and absorb shock.

Physical Activity decreases pain and stiffness.

Strong Bones reduce the risk of osteoporosis and injury.

Exercise decreases the risk of heart disease.

Exercise improves the daily energy level.

46

Thank You…………..