Osteoarthritis Arthritis Disease
Summary
Osteoarthritis (OA) is the most common type of arthritis or degenerative joint disease. It is a leading cause of chronic disability. The disease most commonly affects the middle-aged and elderly, although younger people may be affected as a result of injury or overuse. Age is the strongest predictor of the disease and therefore increasing age and extended life expectancy will result in a greater occurrence of the disease. Patients affected by this disease suffer from pain and loss of function.
At present, there is no cure for OA. The management of OA is broadly divided into non-pharmacological, pharmacological, and surgical treatments. Surgical management is generally reserved for failed medical management where functional disability affects a patient’s quality of life.
Pharmacological management includes control of pain and improvement in function and quality of life while limiting drug toxicity. Experts in this field suggest that appropriate therapy for OA combines one or more pharmacological agents with exercise, weight loss and physical therapy (i.e. non-pharmacological therapy).
1.Introduction
There are more than 100 different types of arthritis.1 The most common type of arthritis is osteoarthritis (OA) or degenerative joint disease. It is a common chronic, progressive musculoskeletal disorder characterized by gradual loss of articular cartilage. The disease most commonly affects the middle-aged and elderly, although it may begin earlier as a result of injury or overuse. It is often more painful in weight bearing joints such as the knee, hip, and spine than in the wrist, elbow, and shoulder joints. All joints may be more affected if they are used extensively in work or sports, or if they have been damaged from fractures or other injuries.1,
2.Size and Nature of Disease Burden
Musculoskeletal conditions are a major burden on individuals as well as health and social care systems, with significant indirect costs.
Incidence and prevalence
Figure 1 Burden of disease of OA by age groups and regions
Figure 2. Prevalence of osteoarthritis5
Country impact
Aggregate numbers on the overall impact of OA are not available. Therefore, statistical highlights and the impact of arthritis from individual countries that have reported information are presented.
Figure 3. Levels of physical activity reported by women with arthritis in the US, 7
3.Control Strategy
Patients with OA suffer from pain and loss of function. Objectives of OA management are to reduce the level of pain, reduce inflammation, slow cartilage degradation, improve function and reduce disability. This section reviews pharmacological and nonconventional, non-pharmacological OA therapies.
Diagnosis and medical management 1, 2, 3, 4, 7, , ,
Table 1. Therapeutic options in osteoarthritis 2, 3, 4, 13, ,
*Misoprostol and proton pump inhibitors are recommendations by ACR and are recommended in patients who are at increased risk of gastrointestinal adverse effects.
Non-pharmacological therapy review
According to various recommendations, non-pharmacological treatment of OA should include education, exercise, physical aids (such as canes, insoles and knee braces) and weight reduction.2, 3
Education2, 16
There is evidence that misoprostol, proton pump inhibitors and H2 blockers may reduce the gastrointestinal adverse effects induced by NSAIDs. However, the cost utility or prophylactic
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Herbals, ,
4.Major Problems and Challenges for Disease Control
(Why Does the Disease Burden Persist?)
The aetiology of OA is multifactorial and includes both generalized and constitutional factors (e.g. ageing, sex, obesity, heredity, and reproductive variables) and local adverse mechanical factors (e.g. trauma, occupational and recreational usage). There are also genetic components in the prevalence of OA, with heritability estimates from twin studies of 0.39 to 0.69, independent of known environmental or demographic confounders.7, OA is associated with pain and functional disability and as the disease progresses, physical disability arising from pain and loss of functional capacity reduces quality of life and increases the risk of further morbidity and mortality.12
Risk factors for incidence and progression of osteoarthritis
While exciting breakthrough treatments continue to become available for rheumatoid arthritis, highly effective therapies do not exist for OA. Currently, the research to support treatments in OA is not as advanced as compared to rheumatoid arthritis. Interestingly, it has been discovered that the cytokines that are driving inflammation and destruction of bone and cartilage in rheumatoid arthritis may also drive the destructive process in OA.46 This discovery may potentially be helpful since some of the knowledge about rheumatoid arthritis may be transferred and applied to osteoarthritis. Furthermore, with better understanding through research of the molecular process, progress may be achieved in the development of medications to effectively control the symptoms and disease progression of OA as well.46
The prevalence of OA is increasing and this places a globally major burden on individuals; health systems, and social care systems. OA, the most common arthritis condition, is a major cause of impaired mobility and disability for the ageing populations. While there are several drugs available on the market that mitigate pain and improve function, there are no drugs that can cure, reverse or halt disease progression.
OA is also now regarded as a complex disease whose etiology is not completely understood. In addition there are also several areas where information is still lacking; these include epidemiology, path physiology, environmental risk factors, genetic predisposition and lifestyle. Information related to these topics may assist in the overall management and planning of this disabling condition.
There are a number of drugs in the pipeline under development and several studies also evaluating alternative therapies. There are, however, several drugs on the market whose clinical effectiveness and long-term safety still need to be determined. This is especially important since OA requires long disease management and the disease primarily affects people over the age of 60, who are most prone to drug toxicity. In addition, data is lacking about the therapeutic effectiveness of certain drugs within a class as well as between classes.
Information on the impact of the disease to society and both the cost of medicines and cost of disease management (including pharmacological and non pharmacological treatments) need to be evaluated. Finally, while there is substantial research in this area, most experts emphasize that research into new diagnostics, biomarkers and imaging technology is going to be important and useful for the management of OA and the development of disease modifying drugs.
