51 RISK FACTORS 1. AGE NOT and inevitable consequence of ageing, BUT strongly related to age Uncommon in people under 45 Prevalence increases up to age 65, when al least 50% of people have RX evidence of OA in at least one joint group May represent cumulative insult to the joint, possibly aggravated by decline in neuromuscular function
52 2. SEX Pronounced FEMALE preponderance in hands and knee 3. ETHNIC GROUP Uncommon in Black and Asian populations This seems to reflect genetic rather than cultural differences
57 PATIENT EDUCATION Trials contrasting education vs. effects of NSAIDs confirmed a significant beneficial effect on education in joint pain but not on disability. Any member of the care team can provide education in several forms: literature, audiocassette, computer Emphasise weight reduction and exercise
58 SOCIAL SUPPORT In OA of the knee controlled studies have shown that regular telephone contact from healthcare produces significant improvement in pain and function OCCUPATIONAL THERAPY Walking aids, orthoses, splints
59 Φυσικοθεραπεία Μυική ενδυνάμωση Ειδική για τις αρθρώσεις Μείωση πόνου και αναπηρίας TENS (transcutaneous electrical nerve stimulation) Μέτρια αναλγησία σε σχέση με placebo TENS Βελονισμός
60 Μεταβολές στον τρόπο ζωής ασθενών με ΟΑ Γενικά μέτρα Διατήρηση βάρους Ενθάρρυνση δραστηριότητας Τακτική άσκηση Θετική προσέγγιση Ειδικά μέτρα Ενδυνάμωση τοπικών μυών Κατάλληλα υποδήματα Βοηθήματα βάδισης Pay attention to specific problems caused by
61 Μεταβολές στον τρόπο ζωής ασθενών με ΟΑ Ειδικά μέτρα Ενδυνάμωση τοπικών μυών Κατάλληλα υποδήματα Βοηθήματα βάδισης Λύσιμο προβλημάτων που οφείλονται στην αναπηρία
62 ANALGESICS, NSAIDs, COX-2 i PARACETAMOL It is safe and effective Slight benefit from addition of dextropropoxyphene NSAIDs More effective than placebo in reducing pain and improving function Few studies have lasted longer than 2 years
63 Evidence that MISOPROSTOL and PPI reduce risk of upper GI injury Cost utility of prophylactic use is controversial Recommended to initiate NSAIDs only after consideration of side effects Prescription should be reviewed every 6 months COX-2 INHIBITORS Published data remains scarce Trials have shown similar efficacy to NSAIDs with GI toxicity comparable with placebo Cost effective strategy for their use far from
64 Relative contraindications to starting treatment with NSAIDs * Gastrointestinal toxicity. Caution in: - Those aged >65 years - Patients with a history of peptic ulcer disease - Concomitant treatment with corticosteroids and anticoagulants - Smokers - Patients with cardiovascular disease - Heavy alcohol drinkers * Renal toxicity. Caution in: - Those aged >65 years - Patients with hypertension - Patients with congestive cardiac failure - Concomitant medication with ACE inhibitors and diuretics
65 TOPICAL TREATMENT NSAIDs and CAPSAICIN Strong evidence that they are effective and safe Fewer side effects probably should be used more often However substantial doubt as their superiority over simple rubefacients
66 INTRA-ARTICULAR THERAPY CORTICOSTEROIDS Use controversial in uncomplicated OA Superior short term efficacy to intra-articular placebo Benefits last 2 to 4 weeks Indicated in patients with acute crystal associated synovitis and those unfit for or awaiting surgery Potential for multiple injections to accelerate cartilage damage
67 HYALURONIC ACID In people with OA there is a reduced concentration of this acid Trials suggest superior pain relief to placebo and equivalent to corticosteroids injections with greater duration of action TIDAL IRRIGATION Irrigation of knee joint with saline Trials suggest some role in treatment of knee OA
68 CHONDROPROTECTIVE AGENTS Clinical trials provide some justification for the use of CHONDROITIN and GLUCOSAMINE preparations but only for their analgesic or anti-inflammatory effects
72 Al.yami200 What can I do to help myself? Although there is no cure for osteoarthritis, there are many ways in which you can relieve your symptoms and reduce the likelihood of things progressing. Doctors, nurses and therapists are there to guide you, but it is important that you get to know about osteoarthritis and its treatments so you can take the lead in looking after yourself and your osteoarthritis. Two aspects of your daily routine and lifestyle may need to be changed. These can prove more important in the long term in helping your osteoarthritis than any tablet or medication.
73 Al.yami200 Reduce stress on the joints This can be done in a variety of ways: Keep to your ideal weight. If you are overweight, losing even a few pounds will reduce the stress on your hips, knees and feet. Regaining your ideal weight is extremely important for your joints, but is difficult and you need to be determined. Combining regular exercise with a diet is often better than dieting alone. 'Dieting' means altering your eating habits forever, not just for a few months. Pace your activities through the day. Spread physically hard jobs (such as housework, mowing the lawn) at intervals through the day, rather than tackling them all at once.
74 Al.yami200 Reduce stress on the joints This can be done in a variety of ways: Wear shoes with thick soft soles that act as shock absorbers for your feet, knees, hips and back. Trainers with 'air' soles are ideal, but many fashion shoes now use these soles. For women it is also important to have flat heels. Raised heels alter the angle of the knee and hip and put additional strain on these joints. Use a walking stick to reduce the weight and stress on a painful hip or knee. A therapist or doctor can advise on the correct length of the stick and how to use it properly.
75 Al.yami200 Activity and exercise Secondly, you need to keep your joints moving. There are two types of exercise that you need to do. Firstly, strengthening exercise will improve the strength and tone of the muscles that act over your osteoarthritic joint (for example, the front thigh muscle, or quadriceps, for knee osteoarthritis). This helps to stabilize and protect osteoarthritic joints and reduces the pain. Such strengthening exercise also reduces your risk of falling over, a common problem in older people. Secondly, any exercise that increases your pulse rate and makes you breathless (aerobic( exercise) ) can also reduce your pain and allow you to do more. Regular aerobic exercise encourages a better night's sleep and is very good for your general health and well-being. Regularly undertaking both forms of exercise can greatly help people with osteoarthritis, and over several months can relieve pain and improve movement.
76 Al.yami200 Activity and Learning how to relax your muscles and get the tension out of your body can also help enormously, especially when you are in pain. Physiotherapists and occupational therapists can give you advice on how to relax, how to overcome mobility problems, how to avoid joint strain and how to cope with pain. exercise
77 Al.yami200 A physiotherapist can teach the correct exercises, but then it is up to you to continue them as part of your daily routine, just like brushing your teeth. Appropriate exercises can be planned to fit the individual and can benefit anybody regardless of age. Activity and exercise
78 Al.yami200 Will any tablets or creams help? Painkillers often help symptoms and make it easier to get about. They do not affect the arthritis itself, but take the edge off pain and stiffness. They are best used occasionally for bad spells, or when extra exercise is likely. Never take more than the recommended dose. Paracetamol is the simplest and safest painkiller and is the best one to try first. Combined painkillers (e.g. cocodamol, codydramol) contain paracetamol and a second codeine-like drug. They may be stronger than paracetamol but are more likely to cause side-effects, such as constipation or dizziness.
79 Will any tablets or creams help? Inflammation in the joint may contribute to the pain and stiffness so your doctor may prescribe a course of non- steroidal anti-inflammatory drugs (NSAIDs( NSAIDs). NSAID creams and gels often help, especially for knee and hand osteoarthritis. These are extremely safe very little is absorbed into the bloodstream. Capsaicin cream (made from capsicum, the pepper plant) is also an effective and safe painkiller. The first few times it is applied it may cause a warming or burning feeling, but this wears off with regular use. It needs to be regularly applied each day to be effective. There are stronger painkillers (e.g. tramadol, nefopam, meptazinol) ) that may be required for people with severe pain that is unrelieved by the medications mentioned above. Unfortunately, although they are stronger painkillers they commonly have side-effects, especially nausea, dizziness and confusion, and need to be taken carefully under regular supervision from your doctor. Al.yami200
80 How can severe Al.yami200 osteoarthritis be treated? A steroid injection into the joint may successfully improve pain for several weeks, especially in a knee or thumb. This is mainly reserved for very painful osteoarthritis, and for attacks of pseudogout. It often works very well and very quickly (within a day). Some people may be helped by an injection of hyaluronan into their knee. Hyaluronan is similar to the thick, viscous component of normal joint fluid and is normally given as a course of injections once a week for 3 5 weeks. It takes longer to work than a steroid injection.
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