3-9 May 2013 #654

Creaking joints

Osteoarthritis is so prevalent in Nepal that doctors see hundreds every week at their clinics
Dhanvantari by Buddha Basnyat, MD

A 60-year-old woman came to our clinic complaining of pain in her right knee that had lasted more than two months and got worse every time she walked. She had a medical history of obesity and hypertension. Another patient, a 51-year-old man without any other medical problems, also suffered from chronic pain in both knees for months. Both had been taking ‘brufen’ without much relief.

The two patients have osteoarthritis of the knee, a condition where the cartilage degenerates due to ‘wear and tear’ of the joints. Not surprisingly, the single most important risk factor is age. A young joint has protective mechanisms to preserve the cartilage matrix even with excessive stress. But as people cross 50, articular cartilage starts to gradually get damaged. While those who injure their joints during youth have a strong predisposition to osteoarthritis later on in life, obesity is another common cause.

Osteoarthritis is so prevalent in Nepal that internists and rheumatologists (joint doctors) see numerous patients every week at their clinics. In general this particular kind of arthritis is diagnosed clinically and does not usually require advanced imaging techniques like CT scan or magnetic resonance imaging.

Since osteoarthritis is a mechanical problem (as opposed to an inflammation), non-pharmacological therapy is the first recommended treatment. Avoiding activities that cause pain to the joints (no running if there is pain while jogging), strengthening and conditioning adjacent muscles to the joint, and using canes to lessen the joint load can sometimes even reverse the initial cartilage damage.

As obesity becomes an epidemic in Kathmandu and other urban areas, maintaining a healthy weight is also paramount to avoiding osteoarthritis because each extra kilo increases the load across the weight bearing joint several times. Obesity appears to play major role in osteoarthritis of the hand as well (where there is hardly any weight bearing) suggesting that obesity has both a mechanical and metabolic mechanism of action. For over-weight osteoarthritis patients, shedding those spare kilos should be the primary goal. Surgical therapy with joint replacement with prosthesis may be required in severe cases of osteoarthritis.

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