Prevention of Osteoarthritis

Osteoarthritis (OA) is a degenerative joint disease common among older individuals, and it has significant economic impact on our healthcare system. Researchers do not completely understand how this disease develops, and there is no known cure. OA is thought to be the result of a breakdown of joint structures as a result of both molecular and mechanical events. OA affects the knees and hips most frequently but can also affect other joints. The predominant symptoms are pain, stiffness, decreased range of motion, and deformity.

Researchers are focusing on the prevention of OA, employing exercise, physical therapy, and sporting activities in the preventive and therapy programs. Since muscle weakness is associated with OA, current strengthening programs also offer ways to prevent OA. As obesity is an important predictor regarding the progression of this disease, prevention also focuses on avoiding excess weight or obesity, as well as joint injuries and repetitive joint usage. Pain can depend on many factors, and is related to some co-morbid conditions, such as sleep, seclusion, and mood disorders. Therefore, prevention and treatment of these conditions are main goals.

Treatment and management of OA focus on the relief of symptoms and improvement of musculoskeletal function. Methods of therapy include weight loss, surgery, physical therapy, and medication.

The Epidemiology of Osteoarthritis

Recent estimates regarding the prevalence of OA show that 27% of adults over the age of 26 have radiographic hand OA, and around 19 – 28% of adults age 45 and older have hip OA. Regarding ethnicity, African-American men have a higher prevalence of radiographic hip OA than Caucasian men. Arthritis affects approximately 1.4 million Australians or approximately 7.3 % of the population.More than 2% of the total healthcare-related expenditure by the government, individuals, and industry of Australia is for OA, with an estimate of $1.2 billion in costs.

Risk Factors of Osteoarthritis

There are several risk factors associated with the incidence of OA. The three primary ones are age, female gender, and obesity. Researchers found that those who are overweight or obese have three times the risk of knee OA development compared to those with a normal weight. There is a significant research suggesting that primary prevention of OA involves weight management.

Other risk factors include knee injury, leg length inequality and high systemic bone mineral density (BMD). With a knee injury, there is a 4-fold increased risk of OA development of this joint. Knee injury includes sports-related injuries and repetitive use injuries. Certain occupational activities are associated with meniscal tears, which lead to degeneration of the knee joint. Current studies show that avoiding injury and maintaining an intact meniscus of the knee protects against OA development. Another risk factor for the development of OA is leg length inequality (LLI). Individuals with this correctable leg abnormality are twice as likely to have radiographic knee OA.

One recent clinical trial found that higher systemic bone mineral density was directly related to an increased risk of OA. It is not clear exactly why this is, but experts theorize this is genetically determined. Most current genetic studies focus on existence of OA but offer some insight into the pathophysiologic pathways that contribute to OA risk. The GDF5 gene has been associated with OA in some studies.

Exercise, Strengthening, and Sporting Activities

Physical therapy can strengthen the muscles that surround the joints as well as improve cartilage health. When the muscles are strong they provide joint stability and flexibility, helping to protect the joint from injury due to impact and/or heavy weight-bearing. Researchers found that exercise improves OA pain and restores function to joints. Because regular exercise is needed for weight maintenance and loss, it is also beneficial for disease prevention and treatment.

A recent study by Dr. Thomas Link and associates found that participants who participated in high-impact activities, such as running, has a higher risk of OA as did those who has very low levels of physical activity. Lower impact sporting activities and exercise is the most beneficial for prevention of cartilage degeneration. Two other recent studies were published regarding the protective effect of exercise in the prevention of cartilage loss at the tibiofemoral joint (at the knee).

Animal studies and clinical trials show that exercise has a protective effect on joint cartilage, and this may reduce the chance of OA development. Prevention of OA involves regular exercise and sporting activities to delay the onset of the disorder, and strengthening activities and therapy to prevent joint degeneration and cartilage destruction.

Conclusions

OA is a multifactorial disease with several risk factors that are not modifiable. While you cannot change your gender, age, or genes, you can change your activity level and weight and protect yourself against joint injury. Try to avoid high-impact exercise such as running and aerobics, instead, do fast pace walking or swimming. Injury prevention involves wearing the right shoes and protective gear when participating in sporting activities and avoiding overuse of a joint.

In conclusion, the prevention of OA involves weight maintenance, exercising in the right way and preventing joint injury.

References

  • Australian Institute of Health and Welfare (2007). A picture of osteoarthritis. Retrieved on December 18, 2012 from: http://www.aihw.gov.au/publication-detail/?id=6442468033
  • Centers for Disease Control and Prevention (2012). Arthritis – osteoarthritis. Retrieved on December 18, 2012 from: http://www.cdc.gov/arthritis/basics/osteoarthritis.htm
  • Greenen, R. & Bijisma, J.W. (2010). Psychological management of osteoarthritis pain. Osteoarthritis and Cartilage / OARS, Osteoarthritis Research Society, 18(7): 873 – 875.
  • March, L.M. & Bagga, H. (2004). Epidemiology of osteoarthritis in Australia. Medical Journal of Australia, 180(5): 6 – 10.
  • Neogi, T. & Zhang, Y. (2011). Osteoarthritis prevention. Current Opinions in Rheumatology, 23(2), 185-191. Doi: 10.1097/BOR.0b013e32834307eb
  • Prescott, V. of the Australian Institute of Health and Welfare, Australia Dept. of Health and Aging, Better Arthritis and Osteoporosis Care Program, Arthritis Australia. (2007). A picture of osteoarthritis in Australia. Canberra: Australian Institute of Health and Welfare, iv, 28.
  • Spearing, N. of Center of National Research on Disability and Rehabilitation Medicine, National Arthritis and Musculoskeletal Conditions Advisory Group, Australia Dept. of Health and Aging (2004). Evidence to support the national action plan for osteoarthritis, rheumatoid arthritis, and osteoporosis: opportunities to improve health-related quality of life and reduce burden of disease and disability. Canberra, A.C.T. : Dept. of Health and Aging, v. 118.
  • Valderrabanno, V. & Steiger, C. (2011). Treatment and prevention of osteoarthritis through exercise and sports. Journal of Aging Research, Article ID 374653. Doi: 10.4061/2011/374653
  • Wise, B.L., Niu, J., Zhang, Y., Wang, N., Jordan, J.M., Choy, E. et al. (2010). Psychological factors and their relation to osteoarthritis pain. Osteoarthritis Cartilage, 18(7): 883 – 887.

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Merlin Thomas is a physician and a scientist. His research laboratory is at the JDRF/ Danielle Alberti Memorial Centre for the study of Diabetes Complications at the Baker IDI Heart and Diabetes Institute in Melbourne.
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