Osteoarthritis: A disease common in aging females than males

By Verah Mugambi & Winfred Gumbo

MAIN PHOTO | NICHOLAS WAMALWA

Wyclife Tatayo Iyadi, a physiotherapist at KNH applying an armsling to a patient in the ward

Globally, on the 8th of September every year, the world joins physiotherapists to celebrate World Physiotherapy Day. Each year has different themes and is celebrated to raise awareness about the critical role of physical therapists in keeping people healthy, mobile and independent.

This year’s theme is Osteoarthritis (OA) and the role of physiotherapists in its prevention and the management of people affected by it.

Osteoarthritis (OA) is the most common form of arthritis, affecting millions of people worldwide. It occurs when the protective cartilage that cushions the ends of the bones wears down over time. Although osteoarthritis can damage any joint, the disorder most commonly affects joints in your hands, knees, hips, and spine.

According to the World Health Organization (WHO), Osteoarthritis is the most common joint condition: 520 million people around the world have OA, and 60% of OA cases affect the knee.

In a global study of 291 conditions, hip and knee OA was ranked as the 11th highest contributor to disability.

In preparation for world physiotherapy day, Newsline sat down with KNH Physiotherapist Mr. Wycliffe Tatayo Iyadi at the Physiotherapy Department and he helped demystify OA.

“Physiotherapy is a health care profession that uses physical approaches to promote, maintain and restore physical, psychological, and social well-being. It is sciencebased and committed to extending, applying, evaluating, and reviewing “The first line of treatment for OA is exercise. A physiotherapist can give guidance and instruction on managing OA and methods of pain treatment. People with OA can learn from us about how to increase the range of motion in their joints and build muscle,” Mr. Tatayo the evidence that underpins and informs its practice and delivery.

“The first line of treatment for OA is exercise. A physiotherapist can give guidance and instruction on managing OA and methods of pain treatment. People with OA can learn from us about how to increase the range of motion in their joints and build muscle,” Mr. Tatayo started the interview while describing what his profession does.

OA affects about 3.3 to 3.6% of the population globally. It causes moderate to severe disability in 43 million people, making it the 11th most debilitating disease worldwide. Although osteoarthritis affects people of all ages, the prevalence increases sharply from the age of 45 years.

According to Mr. Tatayo, OA is more common in females than males and some of the risk factors for developing OA include age, female gender, obesity, anatomical factors, muscle weakness, and joint injury (occupation/sports activities).

“OA is categorized into two; Primary OA and Secondary OA. Primary OA is the most common subset of the disease and can be diagnosed even in the absence of a predisposing trauma or disease (idiopathic). It is associated with the aforementioned risk factors. Secondary OA on the other hand occurs with a pre-existing joint abnormality,” Mr. Tatayo explained.

Predisposing conditions include; trauma or injury, congenital joint disorders, inflammatory arthritis, gout, Systematic Lupus Erythematosus (SLE), RA avascular necrosis, infectious arthritis, Paget disease- interference of the body’s bone recycling process, Osteopetrosis- an extremely rare condition where bones harden and become denser, osteochondritis dissecans -subchondral bone death due to insufficient perfusion.

“During the physical exam, your doctor will check your affected joint for tenderness, swelling, redness, and flexibility. Osteoarthritis is irreversible, but treatment can alleviate pain and help you move better. Diagnostic procedure or investigation includes; plain x-ray, blood tests, synovial fluid analysis; blood -injury in the joint or a body-wide bleeding problem, Pus -infection in the joint, and so on,” Mr. Tatayo continued.

Treatment may include, non-pharmacotherapy, pharmacotherapy, and surgical procedure.

Non-pharmacotherapy:

• Patient education; Cause, pathophysiology, duration of treatment, cost, when to consult surgeon, and other patient’s concerns. • Adjustments that may be of help- raise the toilet seat or chair • Weight loss • Assistive devise to offload the joint, braces if need be • Falls prevention strategies- ramp instead of stairs • Physiotherapy- exercise prescription and other interventions • Advise the patient to “keep moving to improve” • Above all build confidence

Pharmacotherapy

• Paracetamol-Rx of choice • NSAIDs- e.g., Ibuprofen and coxibs. Lower dose due to side effects. • Weak opioids- occasionally required e.g., Dihydrocodeine • Intra-articular corticosteroid injections- when patients have flare-ups and do not respond to

PCM and NSAIDs

Surgical

It should be considered for those not responding to pharmacotherapy. • Arthroscopy-removal or repair of damaged tissue inside the joint • Osteotomy e.g., Wedge osteitis is done on the lateral tibia to offload the injured medial tibia • Arthroplasty- total or Hemi • Arthrodesis

“It is important to note that drugs cannot reverse or slow the progression or damage caused by OA,” emphasized Mr. Tatayo.

Maintaining a healthy lifestyle with regular exercise, getting plenty of rest enough sleep, maintaining a healthy diet and weight control are simple ways you can reduce and manage OA symptoms so that you can live a healthy and fulfilling life,” concluded Mr. Tatayo.

Some of the Myths and facts about OA

1. Physiotherapy is only for muscle problems.

Fact: Physiotherapy is a diverse health care practice that helps prevent injury and pain, and promotes mobility, health, and wellness. From sports injuries to post-fracture rehab to joint pains, back pain, cardiac rehabilitation, and stroke management.

2. Physiotherapy helps only postinjury.

Fact: With the help of a detailed history and assessment, a

Physiotherapist can identify areas that are at risk for injury.

With a tailor-made exercise program, that area can be strengthened, avoiding injury altogether.

3. Physiotherapy sessions are of long duration always.

Fact: The prognosis depends on the body part which is injured.

For example – a fracture takes 6-8 weeks to heal, hence rehab can start only after that. While simple muscle strains take much lesser time to heal.

4. Physiotherapy is a modernized term for massage therapy.

Fact: Physiotherapy and massage are two completely separate things. Physiotherapy is a practice to cure pain and disabilities while on the other hand, while massage is a practice mostly for relaxation.

Besides, physiotherapy is based on comprehensive history taking, physical examination, and diagnosis.

SIDE NOTE

KNH joined the rest of the world to celebrate World Physiotherapy Day.

Despite the cold weather, warmth was radiated by representatives from various institutions including Physiotherapy Society of Kenya (PSK), Kenya Medical Training College (KMTC), Nairobi Hospital, Aga Khan University Hospital, Mater Hospital, Karen Hospital among others who came in to make the day a success.

A matching band led by Don Bosco Boys saw the procession take part in a 5 km walk from KNH to Nairobi Hospital and back. Free screening for disability, obesity/ overweight, BMI and blood pressure was offered to clients who showed up in huge numbers.

To culminate the day, the Head of Unit, Physiotherapy Mr. Kennedy Mogire and HoD Rehabilitative Services Mr. Dickson Okumu gave a talk at the KMTC auditorium whereby they appreciated the role physiotherapists play in prevention and management of osteoarthritis.