Osteoarthritis 504841 225842555 2008-07-15T17:32:36Z Nsaa 113357 Reverted edits by [[Special:Contributions/71.114.212.36|71.114.212.36]] to last version by 91.84.142.133 (using [[WP:HG|Huggle]]) {{Infobox_Disease | Name = Osteoarthritis | Image = Gonarthrose-Knorpelaufbrauch.jpg | Caption = | DiseasesDB = 9313 | ICD10 = {{ICD10|M|15||m|15}}-{{ICD10|M|19||m|15}}, {{ICD10|M|47||m|45}} | ICD9 = {{ICD9|715}} | ICDO = | OMIM = 165720 | MedlinePlus = 000423 | eMedicineSubj = med | eMedicineTopic = 1682 | eMedicine_mult = {{eMedicine2|orthoped|427}} {{eMedicine2|pmr|93}} {{eMedicine2|radio|492}} | MeshID = D010003 | }} '''Osteoarthritis''' ('''OA''', also known as '''degenerative [[arthritis]]''', '''degenerative joint disease'''), is a clinical syndrome in which low-grade inflammation results in pain in the joints, caused by abnormal wearing of the [[cartilage]] that covers and acts as a cushion inside joints and destruction or decrease of [[synovial fluid]] that lubricates those joints. As the bone surfaces become less well protected by cartilage, the patient experiences pain upon weight bearing, including walking and standing. Due to decreased movement because of the pain, regional muscles may [[atrophy]], and [[ligament]]s may become more lax.<ref name="NICE">{{cite web | last = Conaghan | first = Phillip | title = Osteoarthritis - National clinical guideline for care and management in adults | url=http://www.nice.org.uk/nicemedia/pdf/CG059FullGuideline.pdf | accessdate = 2008-04-29 }}</ref> OA is the most common form of arthritis.<ref name="NICE"/> "Osteoarthritis" is derived from the Greek word "''osteo''", meaning "of the bone", "''arthro''", meaning "joint", and "''itis''", meaning [[inflammation]], although many sufferers have little or no inflammation. A common misconception is that OA is due solely to wear and tear, due to the fact that OA typically is not present in younger people. However, while age is correlated with OA incidence, this merely illustrates that OA is a process that takes time to develop. There is usually an underlying cause for OA, in which case it is described as ''secondary OA''. If no underlying cause can be identified it is described as ''primary OA''. "Degenerative arthritis", often used as a synonym for OA, but the latter involves both degenerative and regenerative changes. OA affects nearly 21 million people in the [[United States]], accounting for 25% of visits to [[primary care physician]]s, and half of all [[NSAID]] (Non-Steroidal Anti-Inflammatory Drugs) [[Medical prescription|prescriptions]]. It is estimated that 80% of the population will have [[radiograph]]ic evidence of OA by age 65, although only 60% of those will be [[symptomatic]].<ref>Green GA. ''Understanding NSAIDS: from aspirin to COX-2''. Clin Cornerstone 2001; 3:50-59. PMID 11464731.</ref> ==Signs and symptoms== The main symptom is [[chronic pain]], causing loss of [[mobility]] and often stiffness. "Pain" is generally described as a sharp ache, or a burning sensation in the associated [[muscle]]s and [[tendon]]s. OA can cause a crackling noise (called "[[crepitus]]") when the affected joint is moved or touched, and patients may experience muscle [[spasm]] and contractions in the tendons. Occasionally, the joints may also be filled with fluid. Humid weather increases the pain in many patients.<ref>[http://www.nlm.nih.gov/medlineplus/ency/article/000423.htm MedlinePlus Medical Encyclopedia: Osteoarthritis]</ref> OA commonly affects the [[hands]], [[Foot|feet]], [[vertebral column|spine]], and the large [[weight bearing]] joints, such as the [[hip joint|hips]] and [[knee]]s, although in theory, any joint in the body can be affected. As OA progresses, the affected joints appear larger, are stiff and painful, and usually feel ''worse'', the more they are used throughout the day, thus distinguishing it from [[rheumatoid arthritis]]. In smaller joints, such as at the fingers, hard bony enlargements, called [[Heberden's node]]s (on the distal interphalangeal joints) and/or [[Bouchard's nodes]] (on the proximal interphalangeal joints), may form, and though they are not necessarily painful, they do limit the movement of the fingers significantly. OA at the toes leads to the formation of [[bunion]]s, rendering them red or swollen. OA is the most common cause of ''[[water on the knee]]'', an accumulation of excess fluid in or around the knee joint. <ref>[http://www.mayoclinic.com/health/water-on-the-knee/DS00662 Water on the knee], MayoClinic.com</ref> == Causes == Although it commonly arises from trauma, osteoarthritis often affects multiple members of the same family, suggesting that there is [[hereditary]] susceptibility to this condition. A number of studies have shown that there is a greater prevalence of the disease between [[sibling]]s and especially [[Twin#Identical twins|identical twins]], indicating a hereditary basis {{Fact|date=February 2007}}. Up to 60% of OA cases are thought to result from genetic factors. Researchers are also investigating the possibility of [[Allergy|allergies]], [[infection]]s, or [[Mycosis|fungi]] as a cause. There is some evidence that allergies, whether fungal, infectious or systemically induced, may be a significant contributing factor to the appearance of osteoarthritis in a synovial sac.{{Fact|date=July 2008}} == Two types == OA affects nearly 21 million people in the United States, accounting for 25% of visits to primary care physicians, and half of all NSAID (Non-Steroidal Anti-Inflammatory Drugs) prescriptions. It is estimated that 80% of the population will have radiographic evidence of OA by age 65, although only 60% of those will be symptomatic.<ref>Green GA. ''Understanding NSAIDS: from aspirin to COX-2''. Clin Cornerstone 2001; 3:50-59. PMID 11464731.</ref> Treatment is with NSAIDs, local injections of [[glucocorticoid]] or [[hyaluronan]], and in severe cases, with [[joint replacement]] surgery. There has been no cure for OA, as cartilage has not been induced to regenerate. However, if OA is caused by cartilage damage (for example as a result of an injury) Autologous Chondrocyte Implantation may be a possible treatment.<ref>[http://biomed.brown.edu/Courses/BI108/BI108_1999_Groups/Cartilage_Team/christine/HowitWorks.html Autologous Chondrocyte Implantation]</ref> Clinical trials employing [[tissue engineering|tissue-engineering]] methods have demonstrated regeneration of cartilage in damaged knees, including those that had progressed to osteoarthritis.<ref>{{cite journal |author=Hollander AP, Dickinson SC, Sims TJ, ''et al'' |title=Maturation of tissue engineered cartilage implanted in injured and osteoarthritic human knees |journal=Tissue Eng. |volume=12 |issue=7 |pages=1787–98 |year=2006 |pmid=16889509 |doi=10.1089/ten.2006.12.1787}}</ref> Further, in January 2007, Johns Hopkins University was offering to license a technology of this kind, <ref>[http://www.birchbob.com/MarketingPieces/jhu/indexJE.htm Repairing knee joints by growing new cartilage using an injectable hydrogel]</ref> listing several clinical competitors in its market analysis. === Primary === [[Image:Osteoarthritis left knee.jpg|thumb|Primary OA in the left knee of an elderly female.]] This type of OA is a chronic degenerative disorder related to but not caused by [[aging]], as there are people well into their nineties who have no clinical or functional signs of the disease. As a person ages, the water content of the cartilage decreases due to a reduced [[proteoglycan]] content, thus causing the cartilage to be less resilient. Without the protective effects of the proteoglycans, the [[collagen]] fibers of the cartilage can become susceptible to degradation and thus exacerbate the degeneration. [[Inflammation]] of the surrounding [[joint capsule]] can also occur, though often mild (compared to that which occurs in rheumatoid arthritis). This can happen as breakdown products from the cartilage are released into the synovial space, and the cells lining the joint attempt to remove them. New [[bone]] outgrowths, called "spurs" or [[osteophyte]]s, can form on the margins of the joints, possibly in an attempt to improve the congruence of the articular cartilage surfaces. These bone changes, together with the inflammation, can be both painful and debilitating. === Secondary === This type of OA is caused by other factors or diseases but the resulting pathology is the same as for primary OA: * [[Congenital]] [[disease|disorder]]s, such as: ** [[Congenital hip luxation]] ** People with [[abnormally-formed joints]] (e.g. [[hip dysplasia (human)]]) are more vulnerable to OA, as added stress is specifically placed on the joints whenever they move. [However, recent studies have shown that double-jointedness may actually protect the fingers and hand from osteoarthritis.] * [[Cracking joints]]&mdash;the evidence is weak at best that this has any connection to arthritis. * [[Diabetes]]. * Inflammatory diseases (such as [[Perthes' disease]]), ([[Lyme disease]]), and all chronic forms of arthritis (e.g. [[costochondritis]], [[gout]], and rheumatoid arthritis). In gout, [[uric acid]] crystals cause the cartilage to degenerate at a faster pace. * [[Injury]] to joints, as a result of an [[accident]]. * A joint infection, e.g. from an injury. * [[Hormone|Hormonal]] disorders. * [[Ligamentous]] deterioration or instability may be a factor. * [[Obesity]]. Obesity puts added weight on the joints, especially the knees. * [[Sports injuries]], or similar injuries from exercise or work. Certain sports, such as [[running]] or [[football]], put undue pressure on the knee joints. Injuries resulting in broken ligaments can lead to instability of the joint and over time to wear on the cartilage and eventually osteoarthritis. * [[Pregnancy]] * [[Alkaptonuria]] * [[Hemochromatosis]] and [[Wilson's disease]] ==Diagnosis== [[Diagnosis]] is normally done through [[x-ray]]s. This is possible because loss of cartilage, subchondral ("below cartilage") [[sclerosis]], subchondral [[cyst]]s, narrowing of the joint space between the articulating bones, and [[bone spur]] formation (osteophytes) show up clearly on x-rays. Plain films, however, often do not correlate well with the findings of physical examination of the affected joints. With or without other techniques, such as [[Magnetic resonance imaging|MRI]] (magnetic resonance imaging), [[arthrocentesis]] and [[arthroscopy]], diagnosis can be made by a careful study of the duration, location, the character of the joint symptoms, and the appearance of the joints themselves. As yet, there are no methods available to detect OA in its early and potentially treatable stages. In 1990, the [http://www.rheumatology.org/about/index.asp?aud=mem|American College of Rheumatology], using data from a multi-center study, developed a set of criteria for the [http://patients.uptodate.com/topic.asp?file=arth_rhe/2266| diagnosis of hand osteoarthritis] based on hard tissue enlargement and swelling of certain joints. These criteria were found to be 92% [[sensitivity (tests)|sensitive]] and 98% [[specificity (tests)|specific]] for hand osteoarthritis versus other entities such as rheumatoid arthritis and [[spondyloarthropathy|spondyloarthropities]] <ref>{{cite journal |author=Altman R, Alarcón G, Appelrouth D, ''et al'' |title=The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand |journal=Arthritis Rheum. |volume=33 |issue=11 |pages=1601–10 |year=1990 |pmid=2242058|doi=10.1002/art.1780331101}}</ref>. Related pathologies whose names may be confused with osteoarthritis include '''pseudo-arthrosis'''. This is derived from the Greek words pseudo, meaning "false", and arthrosis, meaning "joint." Radiographic diagnosis results in diagnosis of a fracture within a joint, which is not to be confused with osteoarthritis which is a degenerative pathology affecting a high incidence of distal phalangeal joints of female patients. ==Treatment== Generally speaking, the process of clinically detectable osteoarthritis is irreversible, and typical treatment consists of medication or other interventions that can reduce the pain of OA and thereby improve the function of the joint. ===Conservative care=== No matter the severity or location of OA, conservative measures such as [[weight control]], appropriate [[rest]] and [[exercise]], and the use of mechanical support devices are usually beneficial. In OA of the knees, [[knee braces]], a cane, or a [[walker]] can be helpful for walking and support. Regular exercise, if possible, in the form of [[walking]] or [[swimming]], is encouraged. Applying local heat before, and [[cold pack]]s after exercise, can help relieve pain and inflammation, as can [[relaxation technique]]s. Heat &mdash; often moist heat &mdash; eases inflammation and swelling, and may improve [[blood circulation|circulation]], which has a healing effect on the local area. Weight loss can relieve joint stress and may delay progression {{Fact|date=February 2007}}. Proper advice and guidance by a health care provider is important in OA management, enabling people with this condition to improve their quality of life. In 2002, a randomized, blinded assessor trial was published showing a positive effect on hand function with patients who practiced home joint protection exercises (JPE). Grip strength, the primary outcome parameter, increased by 25% in the exercise group versus no improvement in the control group. Global hand function improved by 65% for those undertaking JPE. <ref>{{cite journal |author=Stamm TA, Machold KP, Smolen JS, ''et al'' |title=Joint protection and home hand exercises improve hand function in patients with hand osteoarthritis: a randomized controlled trial |journal=Arthritis Rheum. |volume=47 |issue=1 |pages=44–9 |year=2002 |pmid=11932877|doi=10.1002/art1.10246}}</ref> ===Medical treatment=== Medical treatment includes NSAIDs, local injections of glucocorticoid or hyaluronan, and in severe cases, with joint replacement surgery. There has been no cure for OA, as cartilage has not been induced to regenerate. However, if OA is caused by cartilage damage (for example as a result of an injury) Autologous Chondrocyte Implantation may be a possible treatment.<ref>[http://biomed.brown.edu/Courses/BI108/BI108_1999_Groups/Cartilage_Team/christine/HowitWorks.html Autologous Chondrocyte Implantation]</ref> Clinical trials employing tissue-engineering methods have demonstrated regeneration of cartilage in damaged knees, including those that had progressed to osteoarthritis.<ref>{{cite journal |author=Hollander AP, Dickinson SC, Sims TJ, ''et al'' |title=Maturation of tissue engineered cartilage implanted in injured and osteoarthritic human knees |journal=Tissue Eng. |volume=12 |issue=7 |pages=1787–98 |year=2006 |pmid=16889509 |doi=10.1089/ten.2006.12.1787}}</ref> Further, in January 2007, Johns Hopkins University was offering to license a technology of this kind, <ref>[http://www.birchbob.com/MarketingPieces/jhu/indexJE.htm Repairing knee joints by growing new cartilage using an injectable hydrogel]</ref> listing several clinical competitors in its market analysis. ===Dietary=== Supplements which may be useful for treating OA include: ====Glucosamine==== A molecule derived from glucosamine is used by the body to make some of the components of cartilage and synovial fluid. Supplemental [[glucosamine]] may improve symptoms of OA and delay its progression.<ref name="pmid15855241">{{cite journal |author=Poolsup N, Suthisisang C, Channark P, Kittikulsuth W |title=Glucosamine long-term treatment and the progression of knee osteoarthritis: systematic review of randomized controlled trials |journal=The Annals of pharmacotherapy |volume=39 |issue=6 |pages=1080–7 |year=2005 |pmid=15855241 |doi=10.1345/aph.1E576}}</ref> However, a large study suggests that glucosamine is not effective in treating OA of the knee.<ref>McAlindon T, Formica M, LaValley M, Lehmer M, Kabbara K. ''Effectiveness of glucosamine for symptoms of knee osteoarthritis: Results from an internet-based randomized double-blind controlled trial.'' Am J Med 2004; 117:643-9. PMID 15501201.</ref> A subsequent [[meta-analysis]] that includes this trial concluded that glucosamine hydrochloride is not effective and that the effect of glucosamine sulfate is uncertain.<ref name="pmid17599746">{{cite journal |author=Vlad SC, Lavalley MP, McAlindon TE, Felson DT |title=Glucosamine for pain in osteoarthritis: Why do trial results differ? |journal= Arthritis & Rheumatism|volume=56 |issue=7 |pages=2267–2277 |year=2007 |pmid=17599746 |doi=10.1002/art.22728}}</ref> ====Chondroitin==== Along with glucosamine, [[chondroitin sulfate]] has become a widely used [[dietary supplement]] for treatment of osteoarthritis. A meta-analysis of [[randomized controlled trials]] found no benefit from chondroitin.<ref name="pmid17438317">{{cite journal |author=Reichenbach S, Sterchi R, Scherer M, ''et al'' |title=Meta-analysis: chondroitin for osteoarthritis of the knee or hip |journal=Ann. Intern. Med. |volume=146 |issue=8 |pages=580–90 |year=2007 |pmid=17438317 |doi=}}</ref> The Osteoarthritis Research Society International is in support of the use of chondroitin sulfate for OA. ====Other supplements==== * [[Omega-3 fatty acid]],a vitamin supplement comprised of important oils derived from fish. {{Fact|date=April 2008}} * [[Boswellia]], an herbal supplement known in [[Ayurvedic]] medicine. It is widely available in health food stores and online. {{Fact|date=April 2008}} * [[Bromelain]], a protease enzymes extracted from the plant family [[Bromeliaceae]], blocks some proinflammatory [[metabolites]].<ref>{{cite journal |author=Brien S, Lewith G, Walker A |title=Bromelain as a Treatment for Osteoarthritis: a Review of Clinical Studies |journal=Evidence-based complementary and alternative medicine: eCAM. |volume=1 |issue=3 |pages=251–257 |year=2004 |pmid=15841258 |doi=10.1093/ecam/neh035}}</ref> * [[Antioxidant]]s, including [[Vitamin C|vitamins C]] and [[Vitamin E|E]] in both foods and supplements, provide pain relief from OA. <ref>McAlindon TE, Jacques P, Zhang Y, et al. Do antioxidant micronutrients protect against the development and progression of knee osteoarthritis? Arthritis Rheum 1996; 39:648-656</ref> * [[Hydrolyzed collagen (hydrolysate)]] (a gelatin product) may also prove beneficial in the relief of OA symptoms, as substantiated in a German study by Beuker F. et al. and Seeligmuller et al. In their 6-month placebo-controlled study of 100 elderly patients, the verum group showed significant improvement in joint mobility. {{Fact|date=August 2007}} * [[Ginger]] ([[rhizome]]) extract - has improved knee symptoms moderately.<ref>Altman RD, Marcussen KC. Arthritis Rheum. 2001 Nov; 44(11):2531-8</ref> * [[Selenium]] deficiency has been correlated with a higher risk and severity of OA.<ref>{{cite web |url=http://www.unc.edu/news/archives/nov05/jordan111005.htm |title=UNC News release -- Study links low selenium levels with higher risk of osteoarthritis |accessdate=2007-06-22 |format= |work=}}</ref> * [[Vitamin B9|vitamins B9]] ([[folate]]) and [[Vitamin B12|B12]] ([[cobalamin]]) taken in large doses has been thought to reduce OA hand pain in one very small, non-quantitative study of 25 people. The results of which are extremely vague at best.<ref>Flynn MA, Irvin W, Krause G. J Am Coll Nutr. 1994 Aug; 13(4):351-6.</ref> The risk from large doses would suggest that this is not a safe treatment. * [[Vitamin D]] [[deficiency]] has been reported in patients with OA, and supplementation with [[Vitamin D3]] is recommended for pain relief.<ref>Arabelovic S, McAlindon TE. Curr Rheumatol Rep. 2005 Mar; 7(1):29-35.</ref> * [[Bone Morphogenetic Protein]] 6 (BMP-6) has recently been shown to have a functional role in the maintenance of joint integrity and is now being produced in an orally ingested form. <ref> K. Bobacz, R. Gurber, A Soleiman, L. Erlacher, J.S. Smolen, and W.B. Grainger, Arthritis & Rheumatism 2003 Sep; 48(9) 2501 </ref> Other nutritional changes shown to aid in the treatment of OA include decreasing [[saturated fat]] intake<ref>Wilhelmi G. Z Rheumatol. 1993 May-Jun; 52(3):174-9. Vasishta VG et al, Rotational Field Magnetic Resonance (RFQMR) in treatment of osteoarthritis of the knee joint, Indian Journal of Aerospace Medicine, 48 (2), 2004; 1-7.</ref> and using a low energy diet to decrease [[body fat]].<ref>Christensen R. Osteoarthritis Cartilage. 2005 Jan; 13(1):20-7.</ref> Lifestyle change may be needed for effective symptomatic relief, especially for knee OA.<ref>De Filippis L et al. Reumatismo. 2004 Jul-Sep; 56(3):169-84.</ref> ===Complications=== Dealing with chronic pain can be difficult and result in [[clinical depression|depression]]. Communicating with other patients and caregivers can be helpful, as can maintaining a [[positive attitude]]. People who take control of their treatment, communicate with their health care provider, and actively manage their arthritis experience can reduce pain and improve function. {{Fact|date=February 2007}} ===Specific medications=== ====Paracetamol==== A mild [[pain reliever]] may be sufficiently efficacious. [[Paracetamol]] (tylenol/acetaminophen), is commonly used to treat the pain from OA, although unlike NSAIDs, acetaminophen does not treat the inflammation.{{Fact|date=August 2007}} A [[randomized controlled trial]] comparing [[paracetamol]] with [[ibuprofen]] in x-ray-proven mild to moderate osteoarthritis of the hip or knee found equal benefit.<ref name="pmid2052056">{{cite journal |author=Bradley JD, Brandt KD, Katz BP, Kalasinski LA, Ryan SI |title=Comparison of an antiinflammatory dose of ibuprofen, an analgesic dose of ibuprofen, and paracetamol in the treatment of patients with osteoarthritis of the knee |journal=N. Engl. J. Med. |volume=325 |issue=2 |pages=87–91 |year=1991 |pmid=2052056 |doi=}}</ref> However, [[acetaminophen]] at a dose of 4 grams per day can increase [[liver function test]]s.<ref name="pmid16820551">{{cite journal |author=Watkins PB, Kaplowitz N, Slattery JT, ''et al'' |title=Aminotransferase elevations in healthy adults receiving 4 grams of acetaminophen daily: a randomized controlled trial |journal=JAMA |volume=296 |issue=1 |pages=87–93 |year=2006 |pmid=16820551 |doi=10.1001/jama.296.1.87}}</ref> ====Non-steroidal anti-inflammatory drugs==== In more severe cases, [[non-steroidal anti-inflammatory drug]]s (NSAID) may reduce both the pain and inflammation. These include medications such as [[diclofenac]], ibuprofen and [[naproxen]]. High doses are often required. All NSAIDs act by inhibiting the formation of [[prostaglandin]]s, which play a central role in inflammation and pain. However, these drugs are rather taxing on the [[gastrointestinal tract]], and may cause [[stomach]] upset, [[cramp]]ing, [[diarrhea]], and [[peptic ulcer]]. Diclofenac has also been found to cause damage to the articular cartilage. ====COX-2 selective inhibitors==== Another type of NSAID, [[COX-2 selective inhibitor]]s (such as [[celecoxib]], and the withdrawn [[rofecoxib]] and [[valdecoxib]]) reduce this risk substantially. These latter NSAIDs carry an elevated risk for [[cardiovascular disease]], and some have now been withdrawn from the market. ====Corticosteroids==== Most doctors nowadays avoid the use of [[steroid]]s in the treatment of OA as their effect is modest and the adverse effects may outweigh the benefits. ====Narcotics==== For moderate to severe pain, [[narcotic]] pain relievers such as [[tramadol]], and eventually [[opioid]]s ([[hydrocodone]], [[oxycodone]] or [[morphine]]) may be necessary. ===Topical=== "Topical treatments" are treatments designed for local application and action. Some NSAIDs are available for topical use (e.g. ibuprofen and diclofenac) and may improve symptoms without having systemic side-effects. [[emollient|Cream]]s and [[lotion]]s, containing [[capsaicin]], are effective in treating pain associated with OA if they are applied with sufficient frequency. Severe pain in specific joints can be treated with local [[lidocaine]] [[Injection (medicine)|injection]]s or similar local [[anaesthetic]]s, and glucocorticoids (such as [[hydrocortisone]]). Corticosteroids (cortisone and similar agents) may temporarily reduce the pain. ===Surgery=== If the above management is ineffective, joint replacement [[surgery]] may be required. Individuals with very painful OA joints may require surgery such as fragment removal, repositioning bones, or fusing bone to increase stability and reduce pain. ===Other approaches=== There are various other modalities in use for osteoarthritis: ====Acupuncture==== A meta-analysis of randomized controlled trials of [[acupuncture]] for knee osteoarthritis concluded "clinically relevant benefits, some of which may be due to [[placebo]] or expectation effects".<ref name="pmid17577006">{{cite journal |author=Manheimer E, Linde K, Lao L, Bouter LM, Berman BM |title=Meta-analysis: acupuncture for osteoarthritis of the knee |journal=Ann. Intern. Med. |volume=146 |issue=12 |pages=868–77 |year=2007 |pmid=17577006 |doi=10.1001/archinte.146.5.868}}</ref> ====Low level laser therapy==== Low level laser therapy is a light wave based treatment that may reduce pain. The treatment is painless, inexpensive and without risks or side effects. Unfortunately, it may not actually have any real benefits.[http://www.jr2.ox.ac.uk/bandolier/booth/alternat/lasarth.html] ====Osteopathy==== [[Osteopathy]] is a form of physical therapy by licensed medical practitioners in both the US and the UK. Osteopathic treatment focuses on reducing pain, easing swelling and improving the mobility and range of joint movements.<ref>[http://www.osteopathy.org.uk/about_osteo/Arthritis.pdf Osteopathy:arthritis Fact Sheet]</ref> Recent research has shown benefits of resistance therapy for patients with knee osteoarthritis.<ref>[http://www.osteopath-help.co.uk/osteopaths/cranial-osteopathy/downloads/clinical_effects_of_resistance_training_in_patients_with_knee_osteoarthritis.pdf Clinical Effects of Resistance Training on Knee Osteoarthritis]</ref> ====Prolotherapy==== [[Prolotherapy]] (proliferative therapy) is the injection of an irritant substance (such as [[dextrose]]) to create an acute inflammatory reaction. It is claimed to strengthen and heal damaged tissues including ligaments, tendons and cartilage as part of this reaction. The injection is painful (like corticosteroids or hyaluronic acid) and may cause an increase in pain for a few days afterwards. The only other significant risk is the rare possibility of infection. ====Radiosynoviorthesis==== A radioactive isotope (a beta-ray emitter with a brief half-life) is injected into the joint to soften the tissue. Due to the involvement of radioactive material, this is an elaborate and costly procedure, but it has a success rate of around 80%. ==Prognosis== The most common course of OA is an intermittent, progressive worsening of symptoms over time, although in some patients the disease stabilizes. Prognosis also varies depending on which joint is involved. Factors associated with progression of OA: *Knees: High [[body mass index]], [[genu varum|varus]] or [[genu valgum|valgus knee]] [[deformity]]. *Hips: Night pain, presence of [[femur|femoral]] osteophytes, and subchondral sclerosis in females. *Hands: Older age. ==References== {{Reflist|2}} ==See also== *[[Back pain]] *[[Chronic pain]] *[[Osteoimmunology]] *Prolotherapy *[[Partial knee replacement]] *[[Arthritis Care]] == External links == * [http://www.rheumatology.org/public/factsheets/oa_new.asp?aud=pat American College of Rheumatology Factsheet on OA] *[http://www.arthritis.org/disease-center.php?disease_id=32 Osteoarthritis] The Arthritis Foundation *[http://www.arthritiscare.org.uk Arthritis Care] major UK charity * [http://my.webmd.com/content/article/78/95594.htm WebMDHealth: Osteoarthritis Basics] at [[WebMD]] * [http://www.nlm.nih.gov/medlineplus/osteoarthritis.html MedlinePlus: Osteoarthritis] at [[National Institutes of Health]] * [http://www.oatrial.com Osteoarthritis Clinical Trials Resource] at oatrial.com * [http://www.umm.edu/patiented/articles/what_osteoarthritis_000035_1.htm Overview] at [[University of Maryland, Baltimore|University of Maryland]] * [http://www.paremanifesto.org Focuses on living with arthritis with links to support groups in 16 different countries] at paremanifesto.org * [http://news.bbc.co.uk/1/hi/health/1556883.stm BBC Coverage of Autologous Chondrocyte graft in UK] * [http://www.action.org.uk/touching_lives/pdfs/touching_lives.2003.autumn.pdf UK Health Charity covers Autologous Chondrocyte grafts] * [http://www.oxfordclinic.org.uk/education-research/ Treatment Information for Arthritis Sufferers] {{Diseases of the musculoskeletal system and connective tissue}} [[Category:Arthritis]] [[Category:General practice]] [[ar:خشونة المفاصل]] [[bg:Артроза]] [[ca:Artrosi]] [[cs:Osteoartróza]] [[de:Arthrose]] [[es:Artrosis]] [[eo:Artrozo]] [[fr:Arthrose]] [[it:Artrosi]] [[he:דלקת מפרקים ניוונית]] [[lt:Osteoartritas]] [[nl:Artrose]] [[no:Artrose]] [[pl:Choroba zwyrodnieniowa stawów]] [[pt:Osteoartrite]] [[ru:Остеоартроз]] [[sv:Artros]]