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Osteoarthritis

Osteoarthritis (OA, also known as degenerative arthritis or degenerative joint disease, and sometimes referred to as "arthrosis" or "osteoarthrosis"), is a condition in which low-grade inflammation results in pain in the joints, caused by wearing of the cartilage that covers and acts as a cushion inside joints. As the bone surfaces become less well protected by cartilage, the patient experiences pain upon weight bearing, including walking and standing. Due to decreased movement because of the pain, regional muscles may atrophy, and ligaments may become more lax. OA is the most common form of arthritis. more...

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The word is derived from the Greek word "osteo", meaning "of the bone", "arthro", meaning "joint", and "itis", meaning inflammation, although many sufferers have little or no inflammation.

OA affects nearly 21 million people in the United States, accounting for 25% of visits to primary care physicians, and half of all NSAID (Non-Steroidal Anti-Inflammatory Drugs) prescriptions. It is estimated that 80% of the population will have radiographic evidence of OA by age 65, although only 60% of those will be symptomatic (Green 2001). Treatment is with NSAIDs, local glucocorticoid injections, and in severe cases, with joint replacement surgery. There is no cure for OA, as it is impossible for the cartilage to grow back.

Signs and symptoms

The main symptom is chronic pain, causing loss of mobility and often stiffness. "Pain" is generally described as a sharp ache, or a burning sensation in the associated muscles and tendons. OA can cause a crackling noise (called "crepitus") when the affected joint is moved or touched, and patients may experience muscle spasm and contractions in the tendons. Occasionally, the joints may also be filled with fluid. Humid weather increases the pain in many patients.

OA commonly affects the hand, feet, spine, and the large weight-bearing joints, such as the hips and knees, although in theory, any joint in the body can be affected. Progressive degeneration of cartilage, technically known as synovium (joint lining), in the knees can lead to them curving outwards in a condition known as "bow legged". As OA progresses, the affected joints appear larger, are stiff and painful, and usually feel worse, the more they are used throughout the day, thus distinguishing it from rheumatoid arthritis.

In smaller joints, such as at the fingers, hard bony enlargements, called Heberden's nodes and/or Bouchard's nodes, may form, and though they are not necessarily painful, they do limit the movement of the fingers significantly. OA at the toes leads to the formation of bunions, rendering them red or swollen.

Causes of disease

The crucial factor in the development of OA is the wearing out and eventual disappearance of synovium, and later, all cartilage of the affected joints. OA may be divided into two types:

  • Primary OA: This type is caused by ageing. As a person ages, the water content of the cartilage increases, and the protein composition in it degenerates, thus degenerating the cartilage through repetitive use or misuse. Inflammation can also occur, and stimulate new bone outgrowths, called "spurs" (osteophyte), to form around the joints. Sufferers find their every movement so painful and debilitating that it can also affect them emotionally and psychologically.
  • Secondary OA: This type is caused by other diseases or conditions such as:
    • obesity. Obesity puts added weight on the joints, especially the knees.
    • diabetes
    • repeated trauma. Certain sports, such as weightlifting, or even football, put undue pressure on the knee joints.
    • hormonal disorders
    • osteoporosis
    • surgery to the joint structures
    • congenital hip luxation (which is genetically determined)
    • inflammatory diseases (such as Perthes' disease), and all chronic forms of arthritis (e.g. rheumatoid arthritis and gout). In gout, uric acid crystals cause the cartilage to degenerate at a faster pace.
    • People with abnormally-formed joints are more vulnerable to OA, as added stress is specifically placed on the joints whenever they move.
    • Ligamentous deterioration or instability may be a factor.

OA often affects multiple members of the same family, suggesting that there is a hereditary basis for this condition. A number of studies have shown that the there is a greater prevalence of the disease between siblings, and especially twins, indicating a hereditary basis. In the population as a whole up to 60% of OA is thought to be as a result of genetic factors.

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Acupuncture effective for osteoarthritis of the knee
From Journal of Family Practice, 3/1/05

* CLINICAL QUESTION

Is acupuncture effective in decreasing pain and improving function in patients with osteoarthritis of the knee?

* BOTTOM LINE

Acupuncture, as compared with sham acupuncture treatment or no treatment, decreases pain scores by an average of 40% and improves traction similarly in patients who stick with it. The acupuncture used in this study was based on the Traditional Chinese Medicine meridian theory and was used for the entire 6 months of the study. (LOE=lb)

* STUDY DESIGN

Randomized controlled trial (double-blinded)

* ALLOCATION

Concealed

* SETTING

Outpatient (any)

* SYNOPSIS

This is the largest and most rigorous study to date of the effect of acupuncture in the treatment of osteoarthritis. The authors enrolled 570 patients who had radiologic and clinical evidence of osteoarthritis of the knee and who had not had any intra-articular injections.

The patients were assigned to 1 of 3 treatment groups: (1) "true acupuncture" based on Traditional Chinese Medicine meridian theory to treat knee joint pain; (2) a sham treatment that mimicked true acupuncture, except that the needles weren't actually inserted (the acupuncture guiding tubes were tapped at sham points, followed by affixing needles, without insertion, at these sites with adhesive tape); and (3) a control group that received six 2-hour group education sessions lead by a patient education specialist, with follow-up mailed educational materials. Treatment was rendered twice a week for 8 weeks, tapering over the next month to 1 treatment per month, which was continued through the end of the study. This design addresses 2 issues that have plagued previous acupuncture research by providing a sham-treatment as well as a no-treatment group.

At week 14, pain scores using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) decreased from an initial average score of 8.9 (of a possible 20) by 3.6 units (40% improvement) in the true acupuncture group compared with a 2.7-unit increase in the sham group and a 1.5-unit decrease in the education group. This change with true acupuncture was statistically significant compared with the other 2 groups.

Pain scores continued to improve in all 3 groups over the course of the study, though true acupuncture scores continued to improve statistically more than the other 2 groups. Functional deficit diminished from an average 32 units (of a possible 68 at baseline) to 19 units at the end of the study, an almost 40% improvement that was statistically better than the other 2 groups. Patient global assessment scores also improved in the acupuncture group to a statistically greater extent than in either other group. Distance during the 6-minute walk and 36-Item Short-Form Health Survey scores improved more with true and sham acupuncture treatment than with education, but the results were similar between those 2 groups.

Copyright 1995-2005 InfoPOEM, Inc. All rights reserved, www.infopoems.com

Berman BM, Lao L, Langenberg P, Lee WL, Gilpin AM, Hochberg MC. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Ann Intern Med 2004; 141:901-910.

COPYRIGHT 2005 Dowden Health Media, Inc.
COPYRIGHT 2005 Gale Group

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