1. What is OA and who does it affect?
    • Most common form of arthritis
    • Degenerative joint disease
    • Resulting in pain, deformity, and limitation of joint motion.
    • Affects approximately 1 in 7 people (primarily elderly)
    • Men and women affected equally
    • Primary - Wear and tear (ageing decreases the ability to restore and synthesise normal collagen structures).
    • Secondary - Predisposing factors for degeneration (hyper-mobility, trauma, obesity, fractures, surgery, previous inflammatory disease of joint (RA, Gout)).
  2. Signs and symptoms
    • Localised joint pain which is present with movement
    • Initially pain is relieved by rest.
    • Morning stiffness/ after rest
    • Stiffness during rest may develop.
    • Joint swelling and tenderness.
    • Affects weight-bearing joints
    • A ‘grating’ sound when the joint is moved.
    • Later stages result in bone deformities.
    • Pain is the main reason people with OA seek treatment.
  3. Causes and risk factors
    • Breakdown of cartilage matrix
    • Erosion of cartilage surface which releases fragments into the synovial fluid.
    • Chronic inflammatory response in synovium
    • Compensatory bone overgrowth to try and stabilise the joint.
    • Increasing age
    • Obesity
    • Diabetes
    • High levels of Uric acid
    • Food sensitivities / allergies.
    • Salicylate and Amine rich foods.
    • Past trauma to the joint.
    • Infection and inflammatory response to joint tissue.
    • Osteoporosis
    • Genetic factors.
    • History of inflammatory arthritis.
    • Hormones may initiate or accelerate: 
    • Oestradiol 
    • Insulin 
    • Thyroid
  4. Diagnosis and Conventional treatment
    • Via presence of S&S
    • Radiography
    • Asymmetric joint-space narrowing
    • NSAIDs and salicylates for pain relief (however can lead to peptic ulcers and may even accelerate the progression of OA because they appear to inhibit cartilage repair).
    • Glucocorticosteroids: Prescribed for control of inflammatory response, via intraarticular injection
    • Hyaluronic acid via intra-articular injections (Not recommended by NICE).
  5. Nutritional protocol and supplements
    • Glucosamine:
    • Primary building block for glycolipids, glycoproteins, glycosaminoglycans (GAGs), and hyaluronate, which are essential building blocks for cartilage and synovial fluid.
    • Inhibits certain enzymes, such as collagenase and phospholipase, which destroy cartilage.
    • Anti-inflammatory activity by inhibiting the synthesis of inflammatory mediators such as COX and down-regulating NF-kB.
    • The therapeutic effect of glucosamine is not immediate (usually takes from 1 to 8 weeks to appear) but continues long after discontinuation.
    • Chondroitin:
    • The most abundant GAG in articular cartilage.
    • Competitively inhibits many of the degradative enzymes that break down the cartilage matrix and synovial fluid.
    • Increases the amount of hyaluronic acid in the joints
    • Bromelain
    • Vitamin E
    • Vitamin C
    • Vitamin D
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