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Osteoarthritis is a disease which affects the joints in the body. The surface of the joint is damaged and the surrounding bone grows thicker. 'Osteo' means bone and 'arthritis' means joint damage and swelling (inflammation).
When joints are swollen and damaged, they can be painful. They can also be difficult to move. Some other words are used to describe osteoarthritis, including 'osteoarthrosis', 'arthrosis' and 'degenerative joint disease'.
Osteoarthritis is a very common form of osteoarthritis. Other joints which are often affected include joints in the hands, the spine, the hip joint and the big toe joint.
What causes osteoarthritis of the knee?
Many factors seem to increase the risk of osteoarthritis developing in the knee joint. The risk does increase as we get older, but osteoarthritis of the knee joint is not a problem in all elderly people. It is something that runs in some families which shows that there is a gene or genes involved.
This may be linked with a gene that affects collagen, one of the main building blocks of cartillage. Osteoarthritis of the knee is twice as common in women as in men. It mainly occurs in women who are over the age of 50, and is often associated with mild arthritis of the joints at the end of the fingers (causing bony swellings called Heberden's nodes).
Osteoarthritis of the knee is also more common in some racial groups than others. For example it is more common in Afro-caribbean population. It is also more common in black people in South Africa and America in comparison with white people.
Osteoarthritis of the knee is common in people who are overweight, especially in middle-aged women. Being overweight also increases the chances of osteoarthritis getting worse once it has developed.
Putting regular stress on the knee joint can lead to osteoarthritis. For example, people who go running and jogging for a long time have a slightly increased risk of osteoarthritis of the knee.
Injuries to the knee joint often lead to osteoarthritis in later life. A common cause is a tear of the meniscal cartilage after a twisting injury. This is a common injury in footballers, who can face extra risks. The damaged can lead to osteoarthritis in later life.
Does osteoarthritis of the kneevary for different people?
Osteoarthritis of the knee affects different people in different ways. Some people have a problem only with one knee, others with both knees. Pain is the main problem for some people while others find their main problem is difficulty in walking.
Some people may stay the same for many years while the osteoarthritis in other people keeps getting worse.
As a result, it is not very helpful to compare the experience of one person with another as we cannot predict the eventual outcome for anyone with osteoarthritis.
How can I tell if I haveosteoarthritis of the knee?
People with osteoarthritis of the knee joint usually complain that the knee is painful or aching. Your knee joint may often feel stiff at certain times. You may have pain all around the joint or just in one particular place and the pain may be worse after a certain activity.
The pain is usually better when you rest. It is unusual to have pain in the knee joint which wakes you up at night, except in severe osteoarthritis. You may feel stiff for a short period after resting and first thing in the morning. Walking for a few minutes usually eases the stiffness.
You will probably find that your pain will vary. There may be good days and bad days or even good and bad months for no apparent reason. Changes in the weather may make a difference. For example, your joints may ache more just before it rains.
All joints have nerve endings which are sensitive to pressure. The nerve endings will respond to the drop in atmospheric pressure which occurs before it rains.
If you develop more severe arthritis, you movement will be restricted. Walking any distance or climbing stairs can be a problem. Some times your knee joint may give way because of weak thigh muscles or damaged ligaments.
How rheumatologist diagnose osteoarthritis of the knee?
Your rheumatologist will be looking out for the problems mentioned above. When your joints are examined, your doctor can feel the bony swelling and creaking of the joint and see any restricted movement. Your rheumatologist will also be looking for tenderness over the joint, and any extra fluid.
The thigh muscles are usually thinner and weaker than normal. With very severe osteoarthritis in the knee, the knee joint will tend to give way because of the damaged ligaments. It may even be possible to move the knee from side to side.
The tests that can showosteoarthritis?
There is currently no blood test for osteoarthritis, although blood tests are sometimes used to rule out other types of arthritis. The x-ray is the most useful test to confirm osteoarthritis.
Often it will show the space between the bones narrowing as the cartillage thins, and changes in the bone such as spurs. Calcification may also show on knee x-ray.
Although the x-ray helps the diagnosis, it cannot predict how much trouble you will have. A bad x-ray does not necessarily mean a lot of pain or disability.
What are the prospects if I haveosteoarthritis of the knee?
Osteoarthritis does not always get worse. Most people with osteoarthritis carry on a normal life and do not become severely disabled. For man people, osteoarthritis reaches a peak a few years after the symptoms start and then either stays the same or gets a little easier.
However, osteoarthritis of the knee can often worsen as the years go by, and it may become painful and disabling.
Sometimes osteoarthritis gets better on its own, but this is unusual. Rheumatologist cannot predict the outcome for individuals.
However, there are a number of treatments that can improve symptoms, and certain changes in lifestyle can greatly reduce the risks of osteoarthritis progressing.
Regular appropriate exercise, protecting the joints from further injury, and maintaining an ideal weight through healthy eating will all help. So, to a certain extent, the person with osteoarthritis is in control of the outcome in their own case.
How can osteoarthritis of the knee be treated?
There are no clues for osteoarthritis. But there are many treatments. Treatment can help to:
* Relieve the discomfort and pain.
* Reduce the stiffness.
* Stop any further damage to the joint.
Can drugs help?
At the moment, there are no drugs which affect how osteoarthritis develops. But some drugs can help you deal with the symptoms. Pain relievers (such as paracetamol) and anti-inflammatory creams to rub into the knee can help pain and stiffness. Some people find them more helpful than others.
Anti-inflammatory drugs (NSAIDs) help some people more than paracetamol but they can cause stomach ulcers. Discuss this with your rheumatologist.
Sometimes an injection might help, either into a tender spot around the knee, or even into the joint itself. Recently there has been a lot of interest in a nutritional supplement called glucosamine sulphate.
These are now referred to as disease modifying osteoarthritic drugs (DMOADs) or chondroprotective agents. Some patients seem to benefit from them and if so, its worthwhile taking them.
Can surgery help?
Most people with osteoarthritis of the knee will never need surgery. But operations are sometimes used for badly damaged joints. These include joint replacement. This will be considered for someone who is barely able to walk and who is in constant pain.
Are there any other measures which can help?
Many other measures are now being researched to help people with osteoarthritis of the knee, such as exploring new drugs to help the joint heal and using electrical nerve stimulation (a TENS machine) to relieve pain. Beware of 'miracle cures' and special diets. Sadly, there are no miracles for most people with osteoarthritis.
(The writer is a board certified specialist in Rheumatology attached to the Sri Jayawardenepura General Hospital and a visiting consultant.)
From the National Stroke Association of Sri Lanka:
Warning signals of a brain attack(stroke)
What is a stroke?
It is a disturbance of brain function due to a disruption to its blood supply. When the blood supply is disrupted the brain cells are deprived of oxygen and other nutrients, causing some cells to become damaged and others to die. A stroke is also known as a brain attack.
Most strokes occur when a blood vessel carrying blood to the brain becomes blocked resulting in inadequate blood supply to an area of the brain (ischaemic stroke). Some strokes are caused by bleeding into the brain tissue from a burst blood vessel (haemorrhagic stroke).
It may be one or more of the following:
* Sudden blurring or decrease in vision in one or both eyes.
* Numbness, weakness or paralysis of the face, or in either an arm or a leg on one or both sides of the body.
* Difficulty in speaking or understanding.
* Dizziness, loss of balance or an unexplained fall.
* Difficulty in swallowing.
* Headache (usually severe and abrupt in onset) or unexplained change in the pattern of headaches.
Sometimes such episodes may last only a few minutes to a few hours.
Such symptoms should never be ignored, as they indicate that a part of the brain is not receiving enough blood.
Such a condition, if neglected, may lead to a stroke. If you or someone you know experience any of the above warning signals, seek medical attention immediately.
What are the effects of a stroke?
Some strokes are fatal while others may cause permanent or temporary disability.
As a result of a stroke certain areas of the brain are damaged and functions normally controlled by these brain areas become impaired. The most common effects of a stroke are paralysis on one side of the body and loss of ability to speak/language skills.
How are strokes treated?
In general, treatment for people affected by stroke are of three types:
Drug treatment aims at reducing the extent of brain damage and thereby increasing the likelihood of a good recovery.
General care aims at helping with swallowing difficulties and bladder and bowel control and minimizing the complications of a stroke.
Rehabilitation aims at maximizing recovery from stroke, so that the patient could become as independent as possible and regain his/her normal lifestyle.
Can a stroke be cured?
There is no known drug that can completely eliminate the possibility of a stroke or offer a guaranteed 'cure'.
Tips for healthy fats for cooking
1. Since saturated fatty acids are associated with increase risk of cardiovascular disease, avoid using oils in cooking that are high in saturated fats, such as coconut oil, palm oil, butter, lard (pork fat) and other animal fats.
2. Choose vegetable oils with the best nutritional profiles - those with a healthy amount of monounsaturated fat and the two essential n-6 and n-3 polyunsaturated fats and low in saturated fat. Of all the vegetable oils, canola, and to some extent soybean, are the healthiest oils. Use these oils as salad oil, cooking oil and to stir-fry vegetables or saute foods.
3. Other vegetable oils such as olive oil, sunflower, safflower and corn are also low in saturated fats. However, canola and soybean oils are far superior to other vegetable oils, because they can provide both n-6 and n-3 polyunsaturated fatty acids.
Other vegetable oils contain primarily n-6 polyunsaturated fatty acids and almost no n-3 polyunsaturated fatty acids. Excess intakes of n-6 polyunsaturated fatty acids are not recommended because large levels of n-6 fatty acids in blood may have some negative effects on heart health.
On the other hand, the n-3 fatty acids counteract the negative effects of the n-6 fatty acids and provide protective effects on cardiovascular risk.
They may also improve other cardiovascular risk factors such as platelet function, blood pressure, blood flow and inflammatory processes.
Thus, it is imperative to have a good balance of n-6 and n-3 fatty acids in our diets. In this respect, canola oil is the best vegetable oil, because it provides n-6 to n-3 in a desirable ratio of 2:1. Soybean oil can also provide both n-6 and n-3 fatty acids, but the disadvantage is that it contains too much n-6.
4. Choose soft margarine that are low in saturated and trans fats instead of butter, hard margarine, lard and shortening.
5. Substitute unsaturated oils (such as liquid oils or soft margarine low in saturated fats and trans fats) in recipes that call for shortening, butter, hard margarine, lard or beef fat.
6. Use a small amount of oil to saute or stir fry foods rather than deep-frying in oil. Deep-frying uses a large amount of oil, which is soaked up by the foods, thereby increasing the overall caloric content of those foods.
7. Although deep frying is not a healthy choice, if you have to deep fry, choose a hard fat such as coconut oil, palm oil or palm kernel oil. These oils more stable than unsaturated liquid vegetable oils. Because of their high saturated fat content, they do not break down during deep frying.
Although fried foods are more tastier than non-fried foods, because of the negative effects of saturated fats on CHD, it is best to limit eating deep fried foods on a regular basis.
8. For pan frying, it is not necessary to have a highly stable oil. Oils containing high levels of monounsaturated fats have a stability intermediate to that of saturated oils and polyunsaturated oils and are healthier than saturate fats. for pan frying, use any of the very high monounsaturated oils, such as canola or olive oil.
Once you use the oil for frying, do not use it again for frying or cooking. Polyunsaturated fatty acids tend to break down when they are exposed to high temperatures for long periods. Therefore, always use fresh oil for deep frying.
In summary, oils containing large amounts of saturated fats or trans fats are considered as bad fats. Bad fats include coconut oil, palm oil, butter, various animal fats and hard margarine prepared using partially hydrogenated oils.
Polyunsaturated fat, along with monounsaturated fats are good, healthy fats and they can be found oils such as canola, soybean and olive. Polyunsaturated fats are necessary for the body and protects against illness.
(This article was sent by Dr. W. M. Nimal Ratnayake Ph.D Head Metabolism Section of Nutrition Research Division. Health Department Government of Canada).
Alcohol in moderation may extend life
Moderate drinking may lengthen your life, while too much may shorten it, researchers from Italy report.
Their conclusion is based on pooled data from 34 large studies involving more than one million people and 94,000 deaths.
According to the data, drinking a moderate amount of alcohol - up to four drinks per day in men and two drinks per day in women - reduces the risk of death from any cause by roughly 18 per cent, the team reports in the Archives of Internal Medicine.
However, "things radically change" when consumption goes beyond these levels, study leader Dr. Augusto Di Castelnuovo, from Catholic University of Campobasso, said in a statement.
Men who have more than four drinks per day and women who have more than two drinks per day not only lose the protection that alcohol affords, but they increase their risk of death, the data indicate.
The reason why men are protected at up to four drinks per day, while women lose the protection after two glasses has to do with how men and women metabolize alcohol, researchers say. It's been shown that when men and women who drink the same amount of alcohol, women experience higher blood alcohol levels than men.
Therefore, women who consume more than two glasses of alcohol per day may be at increased risk for diseases of the liver and certain types of cancer.
"Our findings, while confirming the hazards of excess drinking, indicate potential windows of alcohol intake that may confer a net beneficial effect of moderate drinking, at least in terms of survival," the Italian team concludes.
"Heavy drinkers should be urged to cut their consumption, but people who already regularly consume low to moderate amounts of alcohol should be encouraged to continue," they add.
The manner in which alcohol is consumed also appears to be important, the researchers report. "Little amounts, preferably during meals, this appears to be the right way (to drink alcohol)," said Dr. Giovanni de Gaetano of Catholic University, another author on the study.
"This is another feature of the Mediterranean diet, where alcohol, wine above all, is the ideal partner of a dinner or lunch, but that's all: the rest of the day must be absolutely alcohol-free."
"The message carried by scientific studies like ours is simple," Dr. de Gaetano continued. "Alcohol can be a respectful guest on our table, but it is good just when it goes with a healthy lifestyle, where moderation leads us toward a consumption inspired by quality not by quantity."
NEW YORK (Reuters)
Talking point
A former Deputy Director of the National Hospital Colombo has drawn the attention of the Health Ministry for the urgent need to check on the quality of nurses employed in some of the small scale private sector medical institutions that are operating in the country.
This follows a personal experience he had - according to Ministry sources in one of these institutions in Colombo, where he had gone to take an ECG where the nurse concerned appeared to have been so poorly trained that she had not known how to connect the ECG cords properly to the body. This it is alleged had resulted in a wrong reading of an impending heart attack.
The excited doctor had rushed to Apollo, where they found that there was nothing wrong with his heart. The ECG had been normal.
Nurse's ECG misconnection had cost the doctor an unnecessary Apollo bill of a substantial medical check up.
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