Letting an injured joint heal helps reduce the risk of developing OA there in the future. In addition, for those who have OA, fatigue can increase pain.
Make sure you get enough sleep every night. According to the Arthritis Foundation , diabetes may be a significant risk factor for developing osteoarthritis. High glucose levels can speed up the formation of molecules that make cartilage stiff, and diabetes can also trigger inflammation that can accelerate cartilage loss. Keeping diabetes under control and regulating your glucose levels can help prevent OA.
Although there is no cure for osteoarthritis, there are many ways to prevent it and relieve and manage its symptoms. Maintaining a healthy lifestyle with low-impact exercise, getting plenty of rest and enough sleep, and maintaining a healthy diet and weight are simple ways you can reduce and manage OA symptoms so that you can live a healthy and fulfilling life. From obesity and joint injury to repetitive joint stress, we'll fill you in on the major risk factors for osteoarthritis.
If you live with osteoarthritis, you know it's a complex condition with a broad range of treatments and risk factors. Here's a detailed, top-to-bottom…. Osteoarthritis treatments include lifestyle changes, over-the-counter medications, prescription drugs, physical therapy, and even surgery. Advanced osteoarthritis OA can significantly affect your quality of life. Find out what advanced OA involves and how to manage it. Researchers say physical activity does not increase the risk of developing osteoarthritis in the knee and may actually help reduce symptoms.
Erosive osteoarthritis has many of the same symptoms as traditional osteoarthritis, though the earmarks of the disease are usually limited to the…. Find out what Healthline readers are wearing, and what you should look for the next time you go shoe shopping.
Synvisc and Hyalgan are both viscosupplements used to treat osteoarthritis. Discover their similarities and differences, including side effects and…. Learn how to manage pain, swelling, and bruising after a total knee replacement here. Learn about options such as analgesics and…. Preventing knee injury and obesity during adolescence are examples of strategies that are relevant to knee OA.
Secondary prevention includes the detection and treatment of risk factors for progression in individuals who are already at risk. Examples relevant to knee OA include the detection and monitoring of weight gain and impairments in proprioceptive acuity, dynamic joint stability and muscle function, and subsequent intervention with weight management and targeted exercise therapy in those who already have sustained a knee injury.
OA is a heterogeneous disease with several different phenotypes and a large number of risk factors, which often interact with each other Figure 1. Three important risk factors, which show promise for both primary and secondary intervention, are obesity, trauma and impaired muscle function.
Most worrying are the high—and also rising—rates of childhood obesity in industrialized countries, which occur before the skeleton is mature. Despite initial uncertainty as to whether the obesity was the cause or effect of the OA, prospective cohort studies have demonstrated that obesity precedes the onset of RKOA.
As well as being overweight or obese, weight gain is associated with the risk of receiving a total knee replacement. In a cohort of women, BMI at baseline was associated with self-reported knee pain 14 years later. Fat mass, rather than lean mass, might drive the association.
Interventions for weight reduction have been fairly ineffective at the population level, although evidence suggests that a number of successful strategies are available at an individual level. The results of clinical trials have demonstrated the ability of a number of interventions to reduce weight in the short and medium terms, and trials are now addressing the more difficult issue of maintaining weight loss over longer periods of time, as has been reviewed previously.
Dietary restriction has been shown to reduce weight, but macronutrient protein, carbohydrate and fat manipulation within the diet seems to have, at best, a minor effect on weight loss. Interventions using cognitive behavioural therapy CBT can lead to substantial weight loss and do not necessarily need to be intensive. The current gold standard of intervention to achieve weight loss is bariatric surgery.
This technique has excellent effectiveness in terms of weight reduction and long-term persistence. Others are amenable to modification, and should be taken into account when designing weight-loss strategies.
Tackling obesity in knee osteoarthritis. A considerable number of randomized, controlled trials of weight loss have reported OA and joint pain as outcomes, but these trials recruited patients with existing OA and, as such, are tertiary prevention trials, and beyond the scope of this Review, except to state their effectiveness in reducing pain and improving function.
In a study involving women, weight loss of around 5. For knee OA and arthroplasty, weight gain from normal BMI to overweight was associated with higher relative risk than persistent overweight, compared with normal weight over the same age range. The evidence suggests that obesity leads to knee OA and pain, and that weight loss will reduce both clinical OA and knee pain. Weight loss is achievable with the help of various interventions, and although maintenance of reduced weight is difficult, modifiable predictors have been identified Box 1.
In the current climate of progress towards personalized treatment of disease, interventions for weight loss should be targeted to the individual rather than enforcing homogeneous policies across the whole population. Early intervention with a focus on the prevention of knee injury in young adults has great potential to reduce the burden of knee OA in the general population. The cost of implementing prevention programmes is small compared with the potential savings from avoidance of future orthopaedic surgery.
The great majority of knee injuries occur in sport, and sport-related injuries are more frequent in women than in men, which suggests that prevention of injury can be targeted to people at high risk. Although patients are often categorized as having an injury to the anterior cruciate ligament ACL , these injuries are seldom isolated. On the contrary, concomitant injuries to the menisci, cartilage, bone or other ligaments are nearly always seen.
The highest incidence of injury was observed during adolescence, but knee injuries continued to occur throughout the adult lifespan. These mechanisms seem to involve not only the structures affected by injury, but also inflammatory responses and treatment factors relating to surgery and rehabilitation, as well as personal factors such as obesity and lifestyle, pain processing and genetics.
As in other OA phenotypes, discrepancies are seen between structural findings and symptoms in those developing OA following a prior injury.
Reports of symptoms following knee trauma including ACL injury are mostly restricted to patients who have had surgical reconstruction of the ACL. The relative contributions to the reported symptoms of the injury, the surgical reconstruction, rehabilitation and other surgical treatments are not known.
The identification of young people at risk of OA could involve screening for risk factors such as knee injuries requiring medical attention, surgery to the joint, persistent pain within the past month, overweight or obesity, physical inactivity, impaired muscle function and family history of OA. Most epidemiological studies of the incidence of OA have had a lower age limit of 50 for participants, but future studies should include people in their twenties, thirties and forties, to assess those who sustained major knee injuries as adolescents—around half of whom develop RKOA within 10—15 years of the injury.
These programmes typically take 10—20 min to perform, and commonly substitute for the regular warm-up session prior to sports practice 2—3 times weekly.
The programmes usually also involve education in the awareness of high-risk positions. This form of prevention seems to be equally effective in all subgroups of individuals analysed. As with all behavioural changes, maintaining the new behaviour—in this case, including neuromuscular training in warm-up sessions prior to sports practice—is a challenge. Both the immediate and long-term effects are highly dependent on adherence to the training. In Norway, the use of physical therapists instead of coaches to train female handball players in a neuromuscular injury-prevention programme was associated with adherence during the specified intervention period.
An information campaign was then developed, targeting team coaches and managers in major cities around the country. The incidence of ACL injury in team handball was monitored and found to decrease to levels below those seen during the initial intervention period. The current challenge is to increase uptake of such training which shows great variation across sports and countries in high-risk groups such as children and adolescent players.
In this respect, the inclusion of injury-prevention programmes during physical-education classes in schools could have a substantial public-health effect.
Guidance on well-tested interventions, along with additional information, is easily accessible on the internet, to help organizations, politicians, insurance companies, schools and other stakeholders to facilitate uptake.
Individuals who sustain a knee injury in youth sports are at increased risk of being symptomatic, having impaired physical function, and being overweight or obese 3—10 years later, compared with uninjured controls matched for age, sex and sport.
Compared with uninjured individuals, knee injuries are known to increase the risk of OA, and orthopaedic knee surgery is associated with the risk of OA and joint replacement at a younger age. For example, arthroscopic partial meniscectomy APM is the most commonly performed arthroscopic knee procedure, and is most often performed in middle-aged individuals without any prior high-impact trauma.
Although the causes of OA vary in different patients, the consensus is that OA is a mechanically driven disease, which is evident in individuals who have had injury or surgery—or both—in whom the joint structure is affected, so that the joint is less stable and more vulnerable.
As an example, relative to joints without surgery, removal of meniscal tissue increases local contact pressures and the risk of future OA. In addition to advice on achieving a healthy lifestyle, including maintaining a healthy body weight and regular physical activity, prevention strategies for those who are at risk of knee OA owing to injury or surgery should focus on biomechanical interventions with the ability to improve joint stability and decrease pain.
As with the prevention of injury, neuromuscular exercise therapy can be used for this purpose. Neuromuscular exercise therapy is based on biomechanical principles, targets the sensorimotor system, stabilizes the joint while in motion and improves the patient's trust in their knee Box 2 , Figure 3. The rationale for the use of neuromuscular training is the existence of sensorimotor deficiencies, symptoms of pain, functional instability and functional limitation.
The exercises involve multiple joints and muscle groups, closed kinetic chains, and lying, sitting and standing positions. Good movement quality with appropriate positioning of the hip, knee and foot in relation to each other is emphasized. The level of training is determined by the patient's sensorimotor control and quality of movement.
Training progresses by introducing more-challenging support surfaces, engaging more body parts simultaneously and adding external stimuli, as well as varying the type, speed and direction of movement. Examples of external stimuli include throwing a ball, catching a ball and sudden, unexpected movements.
Exercise therapy is different from physical activity with regard to definition, purpose and goal. Its purpose is to restore normal musculoskeletal function or to reduce pain caused by diseases or injuries. Access to rehabilitation differs across countries and health-care systems. In some countries, patients with surgical reconstruction of the knee are not offered any structured exercise therapy at all, but are left to perform more general physical activities on their own. The available knee-ligament registries are focused on surgical patients, so the effect of exercise alone following a knee-ligament injury cannot be determined.
The only high-quality, randomized study in young, active adults comparing individuals treated with rehabilitation and early ACL reconstruction to those treated with rehabilitation alone and optional delayed ACL reconstruction showed no difference in pain, other symptoms, function, quality of life, return to sport or RKOA at 2 years or 5 years. Exercise therapy is an active approach involving the sensorimotor system—including the muscles—to improve biomechanics; passive approaches are also available to improve joint biomechanics.
Most commonly, knee braces and shoe modifications have been studied, alone or in combination. Typically, valgus braces which force the knee in a medial direction and lateral-wedge foot orthotics which force the foot towards a more pronated position have been tested in patients with established medial knee OA.
This combination, or the brace alone, decreases pain and somewhat shifts the load in the knee from the medial to the lateral side. In a randomized study in patients with patello-femoral OA, bracing was associated with pain relief and a decreased volume of bone marrow lesions in the affected compartment. Motivation and adherence are key components in successful lifestyle changes. Ultimately, the responsibility for achieving a healthy lifestyle lies with the individual, and surveys show that large parts of the population are willing to make the required changes.
However, the role of the clinician in providing motivation and support cannot be overemphasized. Clinicians with positive attitudes and beliefs, who take time to explore the goals and barriers that patients perceive to be important, are more successful in achieving lifestyle changes in their patients than less-engaged clinicians. However, this approach is time-consuming and rarely feasible in a busy practice. Referral to patient education and self-management programmes is, therefore, an attractive option to inform patients about the disease that they are at risk of or have early symptoms of, as well as their future prospects, and the effects, advantages and disadvantages of available treatment options.
Patient education is often delivered in groups to enable interaction between participants, but is also available to individuals via the internet. Shared-decision-making tools enable patients, carers and clinicians to participate jointly in the choice of care pathway. Checklists of known barriers to change and strategies to overcome them have been developed. Although different types of exercise have similar pain-relieving effects, 74 , 95 exploratory analyses suggest potential benefits to targeting deficits in individual patients with specific exercises.
Knee OA is a common disease, which is predicted to become more prevalent as longevity and rates of obesity and physical inactivity increase. The current armoury of nonsurgical treatments for knee OA is aimed at providing relief from the symptoms of the disease, and no validated disease-modifying drugs are being marketed.
The employment of prevention strategies is, therefore, essential to prevent an epidemic of knee OA. Early identification of individuals who are at risk of developing knee pain and OA is essential, to target prevention strategies more effectively. Neuromuscular exercise programmes are successful in preventing half of the knee injuries that occur during adolescence, suggesting that primary prevention of knee OA is possible.
Appropriate prevention strategies, including weight loss and exercise programmes, should be identified for each patient by selecting interventions to correct, or at least attenuate, risk factors for OA. These interventions must also be acceptable to the patients, to maximize adherence to—and persistence with—the regimes.
Now is the time to start the era of personalized prevention for knee OA. Cross, M. The global burden of hip and knee osteoarthritis: estimates from the global burden of disease study.
Article PubMed Google Scholar. Institute for Health Metrics and Evaluation. GBD Data Visualizations [online] , Javaid, M. Individual magnetic resonance imaging and radiographic features of knee osteoarthritis in subjects with unilateral knee pain: the health, aging, and body composition study. Arthritis Rheum. Lane, N. Osteoarthritis Cartilage 19 , — Kellgren, J. Radiological assessment of osteo-arthrosis. Lawrence, J. Prevalence in the population and relationship between symptoms and x-ray changes.
Guermazi, A. Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study Framingham Osteoarthritis Study. BMJ , e Englund, M. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. Altman, R. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee.
Socialstyrelsen SoS. Soni, A. Neuropathic features of joint pain: a community-based study. Valdes, A. Kerkhof, H. Prediction model for knee osteoarthritis incidence, including clinical, genetic and biochemical risk factors. Zhang, W. Nottingham knee osteoarthritis risk prediction models. Thomas, G. Subclinical deformities of the hip are significant predictors of radiographic osteoarthritis and joint replacement in women.
A 20 year longitudinal cohort study. Osteoarthritis Cartilage 22 , — Vos, T. Years lived with disability YLDs for sequelae of diseases and injuries — a systematic analysis for the Global Burden of Disease Study Lancet , — Oliveria, S.
Incidence of symptomatic hand, hip, and knee osteoarthritis among patients in a health maintenance organization. Osteoarthritis increasingly common public disease [Swedish]. Lakartidningen , — PubMed Google Scholar. Hartvigsen, J. Self-reported musculoskeletal pain predicts long-term increase in general health care use: a population-based cohort study with year follow-up.
Regular exercise of all kinds, including aerobic activity , helps keep joints healthy. When a joint is compressed, this fluid washes over the joint, providing lubrication and nourishment.
Other tips for keeping joints healthy include not smoking , staying well hydrated water is a major component of cartilage and eating a healthy diet. One study , published in Annals of the Rheumatic Diseases , found that people who ate the highest amounts of fiber were less likely to have symptoms of knee osteoarthritis.
Advertising Policy Cleveland Clinic is a non-profit academic medical center. Policy A: Osteoarthritis may seem like something we have to put up with … Read More. Learn more about vaccine availability. Advertising Policy. You have successfully subscribed to our newsletter.
Related Articles.
0コメント