oa SA Pharmaceutical Journal - Osteoarthritis : clinical
OA results from a combination of factors that include genetic predisposition, joint integrity, local mechanical forces and inflammatory responses. <br>Traditionally, OA has been divided into primary or secondary type. <br>The joint involvement in the primary form often affects the hands, feet, knee, hip and spine. <br>Secondary OA often follows on an insult to a joint, e.g. trauma, inflammation from rheumatoid arthritis, joint sepsis or crystal deposition. <br>The primary pathology in OA is articular cartilage failure. <br>Risk factors are age, female gender, obesity, muscle weakness, a combination of exercise with proprioceptive defects, and calcium crystal pyrophosphate deposition disease. <br>The diagnosis of OA remains a clinical one, based on patient history, examination and radiographic findings. <br>The aims of management are to control pain, improve quality of life and prevent progression of the disease. <br>Non-pharmacological therapy includes weight management, short-term rest and low-impact exercise. <br>Pharmacological treatment should start with paracetamol. Tramadol may be added and NSAIDs are sometimes used, but must be administered with caution, particularly in the elderly. <br>Intra-articular glucocorticoid therapy can be useful, as can diseasemodifying drugs. <br>Surgery is reserved for patients with intractable pain in whom nonpharmacological and pharmacological management have failed, or who suffer loss of function.
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