Osteoarthritis

7

Pathology for The Physical Therapy Assistant – Osteoarthritis

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Abstract

Osteoarthritis, an arthritis that takes place when protective tissue at the ends of bones wears downs, is a prime cause of disability globally and has become more prevalent in recent decades due to an increasingly ageing and obese population. The condition is progressive and degenerative in nature, as the wearing down of the flexible tissue at the cartilages happens gradually and deteriorates over time, and hence the name “wear and tear disease”. The primary treatment modality for osteoarthritis is therapy and patient education to manage pain and improve functionality and quality of life, both delivered by physical therapists. Surgery and pharmacological therapy are modalities in severe cases of OA.

Critical Review of Articles

Article 1

In “Epidemiology of osteoarthritis: literature update”, Vina & Kwoh (2018) identify osteoarthritis (OA) as a leading cause of morbidity and healthcare cost in the US and across the globe. OA is a heterogeneous disease with a complex pathology and various phenotypes, comprising: chronic pain, metabolic syndrome, inflammation, bone and cartilage metabolism, mechanical overload and minimal joint disease. As of 2018, findings from the National Health Interview Survey point out that roughly 14 million people suffer from knee osteoarthritis, with about 22% of them being from racial minorities and more than half being below 65 years of age. OA impacts physical health in various ways. It is a chief cause of disability globally and is a heightened risk factor for cardiovascular disease and myocardial infarction. It also affects mental health, as those with OA exhibit higher odds of developing depressive symptoms, suicidal ideation and memory loss. It is linked to great risks of hospitalization and emergency departments and is thus associated with consumption of extensive healthcare resources and costs.

The development and progression of OA is tied to various systemic risk factors. Sociodemographically, age, gender and race play a role as older age (above 64 years), women and African-Americans are more prone to OA. Genetic factor plays a role given that approximately 30% to 65% of the risk of OA is genetically ascertained. Obesity and metabolic syndrome are common risk factors for knee osteoarthritis while intense bone mineral density is a risk factor associated with incidence and lower extremity OA. Joint levels risk factors relating to development and progression of OA include bone/joint shape, muscle strength, joint loads and alignment and occupation and sports. According to Vina & Kwoh (2018), some of the risk factors are complex to modify, but others are more amenable to medical and behavioral interventions such as physical therapy, for instance obesity and muscle strength. The article is highly reliable as it uses systematic and literature review to update information on OA.

Article 2

In “Knee osteoarthritis: key treatments and implications for physical therapy”, Dantas et al. (2021) identify knee osteoarthritis as a chronic progressive condition that transmits a heavy socioeconomic implication to both healthcare systems and society. The pervasiveness of knee OA around the globe has risen disproportionately due to lifestyle changes and factors such as increased life expectancy and obesity. There still exists neglect of evidence based modalities in medical practice over knee OA, which is the most prevalent form of osteoarthritis.

The universally recommended first line as well as the safest and most effectual treatment approach for knee OA is physical exercise, patient education and weight loss for the obese patient population, delivered by physical therapists. However, many patients of OA do not get this treatment option, with only approximately 40% receiving this kind of recommended intervention. Many patients of knee OA should be treated in primary care through non-surgical modalities. Surgical treatment is the last resource for the treatment of OA. Using adjunct therapies in isolation or in conjunction with gold standard treatments for knee OA treatment is questionable and not evidence-based. Thus, there is an essentiality for healthcare professionals treating OA patients to comprehend the current recommended treatment modalities for efficacious rehabilitation. This is a published medical journal presenting evidence-based approaches to knee OA and is thus valid and reliable.

Article 3

In “Knee osteoarthritis: pathophysiology and current treatment modalities”, Mora, Przkora & Cruz-Almeida (2018) assert that there are several complexities and controversies surrounding the pathophysiology and treatment modalities of knee osteoarthritis (OA). OA is a regressive and progressive joint condition; the most typical form of arthritis; one of the leading causes of disability and impacts over 250 million people around the globe. The knee is susceptible to OA and other joint conditions because it is the biggest synovial joint in human beings and thus exposed to high use and frequent stress. The disease is multifactorial, comprising multiple causative factors such as trauma, inflammation, mechanical forces, metabolic derangements and biochemical reactions. As it progresses, joint structures are impacted in multiple ways including: bone remodeling, weakening of periarticular muscles, osteophyte formation, synovial effusion and laxity of ligaments.

With its progressive and degenerative nature, OA exhibits improbable regression and restoration of damaged features. Current management modalities are geared towards symptom control (pain control and enhance functionality and quality of life) unless severity compels surgical intervention with joint replacement. Thus, non-pharmacological therapies should always be sought out as the first line of treatment for knee OA. Light to moderate physical activity, tailored to every patient’s preferences and tolerances, offer several benefits to this patient population. Exercise modalities for OA include stretching, aerobics, strength training and balance modalities. Aquatic therapy and weigh management also play a significant role in symptom management. The article integrates extensive research and has been published and cited by the National Institute of Health, and is thus reliable.

Article 4

In “Physical therapy for patients with knee and hip osteoarthritis: supervised, active treatment is current best practice”, Skou & Roos (2019) identify joint pain and functional disabilities as cardinal symptoms of knee and hip OA. In OA, multiple biopsychosocial factors and behavioral responses interact to impact a person’s joint health. This illuminates the significant role of active, non-surgical treatment modalities in OA management. In most healthcare systems, exercise therapy is conventionally delivered by physical therapists.

The first line treatment for knee and hip OA is exercise, patient education and weight loss. If exercise therapy and patient education are unsuccessful in enhancing function and pain, a physical therapist may offer supplementary treatments such as knee orthoses and manual treatment. Exercise therapy has been considered the most significant nonsurgical treatment modality of knee and hip OA because of improved clinical effect on joint symptoms as well as prevention of chronic conditions. The article is an evidence research paper in clinical biomechanics and is thus reliable for use.

Conclusion

Thus, osteoarthritis is a progressive and degenerative disease that impairs functionality of the joints and affects millions of people globally, with knee and hip being the most affected peripheral joints. OA is a multifactorial disease having a complex pathology. Risk factors include socio demographic factors, genetics, obesity, metabolic syndrome, joint shape, muscle strength and occupation among others. Primary treatment modality for OA is management of symptoms given that it is progressive and degenerative in nature, making correction difficult. The evidence-based first line approach to management of OA is exercise, patient education and weight loss in the case of obesity, delivered by the physical therapist. They are associated with multiple clinical benefits for an OA patient. Physical therapists should individualize therapies to needs and preferences of individual patient.

References

Dantas, L. O., de Fátima Salvini, T., & McAlindon, T. E. (2021). Knee osteoarthritis: key treatments and implications for physical therapy. Brazilian journal of physical therapy, 25(2), 135-146.

Mora, J. C., Przkora, R., & Cruz-Almeida, Y. (2018). Knee osteoarthritis: pathophysiology and current treatment modalities. Journal of pain research, 11, 2189.

Skou, S. T., & Roos, E. M. (2019). Physical therapy for patients with knee and hip osteoarthritis: supervised, active treatment is current best practice. Clin Exp Rheumatol, 37(suppl 120), 112-17.

Vina, E. R., & Kwoh, C. K. (2018). Epidemiology of osteoarthritis: literature update. Current opinion in rheumatology, 30(2), 160.