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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)).
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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.
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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
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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).
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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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