Many Filipinos tend to indicate pain coming from their joints and bones as “rayuma”. It is a term loosely used to describe pain coming from any bony part of the body, be it the knees, hips, hands, or even the feet.
There are many types of different bony problems and rayuma does not correctly pertain to these conditions. One of the most common conditions that needs to be distinguished is osteoarthritis. Affecting many Filipinos, this diseases condition joint damage resulting to pain and stiffness frequently in the hips or knees.
What is OSTEOARTHRITIS?
Osteoarthritis (OA) is a condition associated with pain in the joints due to worn down cartilage. Cartilage inside joints serve as a protective cushion between bones so that we can perform various ranges of movement in our limbs.
Over time, the cartilage covering the bones within our joints is thinned out due to wear and tear. This is especially true for weight-bearing joints like the hips and knees.
The damage within the joints causes pain and stiffness. As a result, the range of motion is decreased leading to limitations in daily activity.
In more severe cases, cartilage can become completely thinned out exposing the underlying bone on both surfaces in the joint. The rubbing together of bone-on-bone causes severe pain and may result to a knee deformity if not addressed.
What are the types of OSTEOARTHRITIS?
There are two main types of osteoarthritis:
1. Primary osteoarthritis
This type of arthritis may result from genetic predisposition. As patients use their joints more and more, osteoarthritis can develop because of aging and wear-and-tear.
2. Secondary osteoarthritis
Secondary osteoarthritis results from pre-existing condition that increases the risk for arthritis. Examples would include a previous trauma to the joint surfaces, mechanical misalignment, or history of previous joint infections.
Other orthopedic conditions may predispose a patient to develop secondary osteoarthritis faster. Examples of these conditions are Anterior Cruciate Ligament tear and meniscal tears.
These condition, if not treated, result to higher friction within the joint increasing the risk of arthritis later on.
What are the signs and symptoms of osteoarthritis?
There are several signs and symptoms that may suggest that you have osteoarthritis:
- Pain or stiffness during joint movement, such as when standing from a sitting position
- Limitation of joint range of motion
- The presence of “crepitus”, or a grinding or clicking sound as you move the joint
- Mild swelling around the joint
What are the risk factors for osteoarthritis?
- Age – People more advanced in years are more likely to have accumulated wear-and-tear within their weight-bearing joints. The older you are, the higher your chances for developing osteoarthritis
- Genetics – Some individuals have familial or genetic predisposition to osteoarthritis. People who have a family history of arthritis are more likely to have osteoarthritis later on.
- Hormonal changes – In particular, women after menopause will have a reduction in estrogen. This accelerates the development of osteoarthritis.
- Trauma – previous trauma in the joint may predispose a person to develop osteoarthritis.
- Repetitive stress injuries – people that engage in physical activities as part of their work that put repetitive stress or loads on their joints (like hard laborers) are predisposed to develop osteoarthritis
- Obesity or being overweight – Excessive weight places increased loads on weight-bearing joints such as the hips and knees
What is the treatment?
As of the moment, there is no cure for osteoarthritis. This is a progressive disease that will run its natural course. However, several treatment options are available so that patients are able to better manage the symptoms of osteoarthritis.
Non-surgical management is the initial treatment option for patients experiencing osteoarthritis in its early stages. For mild disease, this is the treatment of choice.
For moderate to severe osteoarthritis, surgical management provides the best chance at a pain-free quality of life.
Conservative / Non-surgical Management
Diet & Changing Physical Activity
Osteoarthritis can progress faster with increased weight-bearing on the joints. That is, the condition is more likely to progress in individuals who are overweight.
For this reason, weight loss for overweight or obese patients is recommended. The target is to maintain a Body Mass Index (BMI) of <25 k/m2.
Patients are also encourage to change up their choice of regular physical activity. If you had previously engaged in walking or jogging, consider changing to low-impact physical activities such as swimming or cycling. These activities alleviate the load on your joints possibly decreasing the likelihood for developing arthritis later on.
Pain medications or NSAIDs
One of the cornerstones of conservative management for osteoarthritis is pain treatment. Most doctors can sufficiently address this through over-the-counter pain medications such as ibuprofen or naproxen. These medications are categorized as non-steroidal anti-inflammatory drugs or NSAIDs for short. Often, these are the initial medication of choice for most orthopedic surgeons.
NSAIDs are known to cause uncomfortable side effects such as stomach irritation. However, newer generation of drugs have been manufactured to alleviate this concern. So-called COX-2 inhibitors not only have fewer side effects, but also provides more effective pain control.
Orthopedic surgeons may also offer steroid injections as part of the range of treatment for osteoarthritis, particularly for knees. This anti-inflammatory treatment may provide better and longer-lasting pain relief than regular oral medications.
Several studies have shown that physical therapy programs highlighting strength training for osteoarthritis result to better functional outcomes.
In 2013, the American Association of Orthopedic Surgeons came out with clinical practice guidelines for the non-surgical management of knee osteoarthritis. In these guidelines, strength training done within the context of a supervised physical therapy programs led to improved scores in patient-reported functional outcomes.
Some studies even show increased benefits in combined physical therapy programs with calisthenic exercises such as yoga. That said, patients seeking consult with their orthopedic surgeons or rehabilitation medicine doctors may be referred for physical therapy programs done as outpatient or as a home exercise service.
When conservative management can no longer provide pain relief and mobility, then surgical treatment is the next logical option. The goal of treatment is to relieve pain and to allow patients to return to their normal activities. In this regard, Total Joint Replacement Surgery is the best option to achieve this goal.
Osteoarthritis is a painful condition affecting several Filipinos. Upon recognizing the signs and symptoms, it’s important that you consult with our orthopedic surgeons for timely medical or surgical treatment. That way, you’re able to take control of your health and maximize your quality of life.
Dr. Efren dela Dingco is a board-certified, residency-trained Orthopedic Surgeon practicing in Angeles City and Tarlac Province.
He completed his specialty training in Orthopedic Surgery from the Philippine Orthopedic Center and is a graduate of the Doctor of Medicine Program of the University of Santo Tomas (UST) Faculty of Medicine and Surgery.
Currently, he is the Chief Administrative Officer of PRI Medical Center.