OSTEOARTHRITIS (OSTEOARTHROSIS)

• Osteoarthritis is a degenerative condition of the articular cartilage and the underlying bone as a result of wear and tear
• Usually occurs in the elderly but can be accelerated in patients with an underlying joint pathology and increased or abnormal biochemical forces on the joint, including elevated BMI
• Patient complaints of Pain which increases on activity and relieves on rest
• Swelling, stiffness of the joints along with difficulty in movements and cracking sounds during movements is seen
• It mainly affects the weight bearing and high use joints such as the hip, knee, hands, and vertebrae

Classification:

• Primary OA – it occurs in old age, mainly in the weight bearing joints (knee and hip).It is commoner than the secondary OA
• Secondary OA –There is an underlying primary disease of the joint which leads to degeneration of the joint, often many years later. it may occur at any age after adolescence and occurs commonly at the hip

• Multifactorial, sill not understood
• Causes of secondary OA - congenital mal development of a joint, irregularity of joint surfaces from previous trauma, previous disease producing a damaged articular surface, internal derangement of the knee such as loose body, mal alignment, obesity and excessive weight

• Occurs in elderly people, mostly in the major joints of the lower limb, frequently bilaterally
• Pain is the earliest symptom – it occurs intermittently in the beginning, becomes constant over months or years. Initially it is dull pain and occurs on starting an activity after a period of rest
• Crepitus on joint movement
• Swelling – inflammation of the synovial tissues
• Stiffness and restricted range of motion
• Feeling of instability of the joint
• Possible varus formation if the knee is affected
• Locking resulting from the loose bodies and frayed menisci

Late clinical finding

• Constant pain (Including at night)
• Morning joint stiffness usually lasting < 30 minutes

O/E –

• Tenderness of the joint line
• Crepitus on moving the joint
• Irregular and enlarged looking joint due to formation of peripheral osteophytes
• Deformity – Varus of the knee, flexion – adduction – external rotation of the hip
• Effusion – rare
• Terminal limitation of the joint movement
• Subluxation tested on ligament testing
• Wasting of quadriceps femoris muscle

Radiological – narrowing of joint space, subchondral sclerosis, subchondral cysts, osteophyte formation, loose bodies, deformity of the joint

Arthroscopy – if a loose body or frayed menisci is suspected

• To delay the occurrence of the disease, if the disease is not begun yet
• To stall progress of the disease and relieve symptoms, if in early stages
• To rehabilitate the patient with or without surgery, if his disabilities can be partially or completely alleviated
• Analgesics
• Chondroprotective agents
• Supportive therapy – weight reduction, avoidance of stress and strain, local heat, exercises for building up the muscles, local application of liniments and counter irritants
• Surgical – osteotomy, joint replacement, joint debridement, arthroscopic procedures

 Ayurvedic Treatment

Internal medicines

Inflammatory stage

• Amrutothara Kashaya
• Punarnavadi Kashaya
• Kaishora guggulu
• Rasna guggulu

 Non Inflammatory stage

• Rasna erandadi Kashaya
• Rasna sapthaka Kashaya
• Dhanwantara Kashaya
• Panchatikthaka Ksheera Paka
• Yogaraja guggulu
• Trayodashanga guggulu
• Laksha guggulu
• Sahacharadi/ Dhanwantara Avarthi
• Kukkudanda Twak Bhasma
• Medicated Aja mamsa rasa
• Dashamoola hareetaki

Procedure

Inflammatory stage

• Lepa – Jadamayadi, Kottamchukkadi
• Dhanyamla Dhara
• Upanaha - Kolakulathadi choorna

Non Inflammatory stage

• Kottamchukkadi Lepa
• Taila Pichu -Murivenna
• Local vasthi ( e.g. Januvasthi) - Dhanwantara Taila
• Patra Potala Sweda
• Kayaseka - Dhanwantara thaila+ Murivenna
• Matra Vasthi – Sahacharadi taila
• Vaitharana Vasthi
• Maadhu tailika vasti