By: Mark Castleden
What can be done about osteoarthritis, especially since I also have scoliosis?
Osteoarthritis was formally thought to be due to wear and tear, which led to a fatalisitic attitude about management. Any understanding of the mechanism of osteoarthritis must include features such as the age association, the pattern of joint involvement, common homogenous features and a marked difference between two people affected with the same condition. Although repetitive trauma may be important, osteoarthritis is now thought to be due to a combination of systemic influences, e.g. obesity and the gender of the person (osteoarthritis is much more common in females). Hypermobility of the joint may be important, and there is some tendency for osteoarthritis to run in families. Scoliosis, or increased curvature of the spine, would be an unlikely complication of osteoarthritis alone and might suggest there are other conditions going on in the spine which should be excluded.
It is clear that the first thing is to be sure that the diagnosis is correct. The principles of management thereafter are firstly, prevention, which not only includes the better management of fractures, but also control of obesity and improving exercise and fitness. The second principle is that treatment depends on the patient's clinical condition and how they are affected by their arthritis. For example, does it impact on their leisure activities, do they have help within the home, what are they able to do for themselves, and so on.
Mildly affected people may only require a walking stick, or some appliance to help them with dressing or getting around the house. A splint to correct instability or correct a deformity may also be useful. Many people with osteoarthritis find great relief from the use of shoes with good shock absorbing insoles, which can reduce pain related to joint loading.
It is also important to correct secondary effects of a flexion deformity or muscle wasting, and exercises, including hydrotherapy, may be beneficial. Drug therapy can be given to modify pain, and this can be simple analgesics or non-steroidal anti-inflammatory agents. In certain patients, surgery may be curative.