26. June 2017

    Arthritis

    Arthritis

    Arthritis is inflammation and/or stiffness around a joint, commonly resulting in pain.

     

    The NHS advise around 10 million people in the UK suffer with arthritis. The most common types are Osteoarthritis (OA) and Rheumatoid Arthritis (RA), with OA affecting around 8 million of people and RA affecting  400,000 people.

     

    http://www.nhs.uk/Conditions/Arthritis/Pages/Introduction.aspx  

     

    As this is such a large topic, this month we are focusing on Osteoarthritis, and next month we will take a closer look at Rheumatoid Arthritis.

     

    For more information on how we can help you with treatment, scroll to the end of this article or follow this link to chiropractic treatments available at TWC.

    Osteoarthritis

     

     

     

     

    OA is the most common type of arthritis.  It can lead to chronic disability.  It can also be present without any symptoms. However as it progresses it can lead to pain, stiffness and decrease in range of motion of joints..  The most common areas affected are the spine, knees and hips.  

     

     

     

     

     

    Prevalence 

    • Females are more than likely to develop the condition than men.
    • Risk develops with age.  With estimate age to be around 40's onward

    Risk Factors

    • Obesity - people who are overweight are more likely to develop  OA.
    • Occupation - jobs which involve: squatting or kneeling are more likely to develop knee OA: lifting or standing more likely to develop hip OA and manual dexterity (CHIROPRACTORS) more likely to develop hand/wrist OA.
    • Joint abnormalities - such as development abnormalities are at more risk.
    • Genetic Factors.

    The above information has been taken from Musculoskeletal Health 2017, Arthritis Research UK. 

    http://www.arthritisresearchuk.org/arthritis-information/data-and-statistics/state-of-musculoskeletal-health.aspx

    Causes of Osteoarthritis

    The cause of OA is unknown.  OA develops due to a loss of hyaline cartilage within a joint which can result in bony changes, such as bony outgrowths (osteophytes) and increased bone thickness (sclerosis).  The soft tissues around the joint can also be affected: Synovium becomes inflamed, ligaments become lax, and muscles become weak.  It is unclear as to whether there is a single cause to OA or if there are multiple factors.  

     

    Different parts of the body have different risk factors, such as the hip joint will undergo more weight bearing in comparison with the interphalangeal joints of the hands which have more repetitive use.  

     

    There can be secondary causes of OA where the cause is known i.e trauma; or primary causes where the cause is unknown.

     

    Research has suggested there are relationships between the following:

    • Hormonal status and bone density as there is a higher incidence of OA in post menopausal women.                                                                                                 
      Nevitt
      MC, 
      Cummings
      SR, 
      Lane
      NE, 
      Hochberg
      MC, 
      Scott
      JC, 
      Pressman
      AR, 
      et al. 
      Association of estrogen replacement therapy with the risk of osteoarthritis of the hip in elderly white women. Study of Osteoporotic Fractures Research Group
      Arch Intern Med
      1996
      156
      2073
      80
    • Increased prevalence to age related disorders such as OA to those who are continuously exposed to oxidants.                                                                              
      Frei
      B. 
      Reactive oxygen species and antioxidant vitamins: mechanisms of action
      Am J Med
      1994
      97
      5S
      13S
    • Genetic causes to OA.                                                                               
    Spector
    TD, 
    Cicuttini
    F, 
    Baker
    J, 
    Loughlin
    J, 
    Hart
    D. 
    Genetic influences on osteoarthritis in women: a twin study
    BMJ
    1996
    312
    940
    3

    Symptoms

    OA symptoms will develop gradually over time.  The most common symptoms are:

    • Pain - during or after movement.
    • Tenderness - over or around affected joint.
    • Stiffness - especially in the morning or after period of inactivity.
    • Noisy joints - grinding or constant clicking of joints.
    • Bone spurs - hard lumps around affected joint. 

    Diagnosis

    The health practitioner will examine for any tenderness, swelling, redness, changes in temperature of skin, and assess the range of motion within the joint.  Followed by other provocative tests.

     

    If required then further imaging can be requested:

    • XRAY - to assess the joint space of the joints, whether there is any bony spurs or sclerosis occurring.
    • MRI - not as common but will allow visualization of the cartilage to assess degree of damage.  

    Lab tests can also be requested:

    • Blood tests - there are no specific blood tests for OA so it would be used to rule out other diagnosis such as RA.
    • Joint Fluid Analysis - fluid is drawn from the joint space to assess for inflammation and to determine any other causes such as infection or gout.  

    Treatment

    OA cannot be reversed, so conservative treatments are aimed at assisting with management of the pain, maximising the range of motion and function within the affected area.  Changes in lifestyle, including exercise and health management, are effective in managing OA.

     

    Medications

    • Acetaminophen. 
    • NSAIDs - over the counted or higher dosages are supplied.
    • Duloxetine.

    Therapies

    • CHIROPRACTIC can help through both hands on treatment and exercises to help support and strengthen the affected areas. To find out what types of treatments our chiropractors can provide at TWC follow this link
    • Physical therapy and exercise.
    • Occupational Therapy.
    • Acupuncture/dry needling.
    • Nutritional supplements such as Glucosamine and Chondroitin.

    Surgery

    Surgery is not always required and is the last resort if the above has not been beneficial.

    • Cortisone Injections - assist with relieving pain but are usually limited to 3 or 4 a year due to the long term effects it can have to the joint.
    • Lubrication Injections - injections of Hyaluronic Acid can assist with pain relief and contribute to the cushioning of the joint particularly the knee. However research is limited in this area.
    • Realigning the bones - through an Osteotomy.
    • Joint replacement

    Here at The Whitchurch Clinic we see great results with Chiropractic care and the management of OA.  We offer a range of therapies:

    https://www.thewhitchurchclinic.co.uk/twc-chiropractic/treatments/

     

    References

    Strunk RG, Hanses M. Chiropractic care of a 70-year-old female patient with hip osteoarthritis. Journal of Chiropractic Medicine. 2011;10(1):54-59. doi:10.1016/j.jcm.2010.10.001.

    Nahin RL, Straus SE. Research into complementary and alternative medicine: problems and potential. BMJ : British Medical Journal. 2001;322(7279):161-164.

    http://www.arthritisresearchuk.org