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GRATING sound in the joint

Dr Romayne Edwards

Sunday, May 11, 2014    

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OSTEOARTHRITIS, also known as degenerative joint disease or "wear and tear" arthritis, is the most common form of arthritis.

It is characterised by the breakdown of cartilage, which cushions the bone ends and its underlying bone within a joint, as well as bony overgrowth.

It is most prevalent in adults with increasing age and occurs mainly after age 40. Women suffer more from osteoarthritis than men, especially after 50 years old.

Osteoarthritis can damage any joint, but mainly affects the hands, neck, lower back, hips, knees, and foot. It is one of the leading causes of disability among older adults.

Risk factors

The risk factors for developing osteoarthritis can be modifiable and non-modifiable. The modifiable factors include excess weight; joint trauma from sports, work or accidents; occupation that entails lots of mechanical stress such as heavy lifting, bending of joints, repetitive actions seen in labourers, farmers, construction workers; lack of exercise; depression; other chronic illnesses such as diabetes mellitus, hypothyroidism or gout; estrogen deficiency, osteoporosis; and people with weak muscles or defective cartilage, joint and bone deformities.

The non-modifiable factors are increasing age, and gender, race, and genetic predisposition.

Signs and symptoms

The signs and symptoms are mainly pain at rest or with movement, tenderness, swelling, locking, joint effusion, loss of flexibility, and joint stiffness, especially after periods of inactivity like sleeping.

The symptoms worsen with time as the protective cartilage that enables smooth movement of the bones in the joint wears down. Gradually bones start to rub over bone during movement, often creating a grating sound.

Diagnosis

Diagnosis is based on the symptoms and signs that are reported, the examination of the joint and the features seen on a radiograph after an X-ray is done. These include joint space narrowing, new bone formation, subchondral sclerosis or increased bone density, and bone cysts.

Although not routinely requested, a Magnetic Resonance Image (MRI) is able to show details of the bone and soft tissue in the joint. Blood tests may be done to exclude other causes of arthritis, and joint fluid tests may be done after removal of excess fluid from the joint to help reduce pain and improve movement. Analysing this fluid also confirms that other causes and infection are not present.

Treatment

No cure exists at this time for osteoarthritis, however, treatment is available to relieve the symptoms and slow the progression of the disease so that quality of life and function can be unaffected or improved.

Patients and family members can be educated to effect changes in behaviour that promotes the disease. Treatment also includes physical therapy to strengthen the muscles around the joint, increase the joint flexibility and reduce the pain; weight control; braces splints or shoe inserts to help relieve weight off the joint; and medication such as acetaminophen (panadol), non-steroidal anti-inflammatory drugs and narcotics. Topical creams and gels with painkillers added are also available to rub the skin over the joint.

The orthopedic surgeon may also discuss cortisone joint injections, injecting similar components to joint fluid within the joint and realigning bones, if applicable.

Complimentary therapies such as acupuncture, herbal therapy, yoga and tai chi, and nutritional supplements have also been used in managing osteoarthritis with varying success reported.

If conservative management fails, the orthopedic surgeon will discuss joint replacement. This is where the damaged joint, usually hip or knee, is replaced with prostheses.

Dr Romayne Edwards is a consultant emergency physician at the University Hospital of the West Indies and an associate lecturer at the University of the West Indies.

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