11,12 Early in the course of OA, patients experience localized joint pain that worsens with activity, is relieved by rest, and is generally worse at the end of the day than it is at the beginning of the day as the disease progresses, patients may also experience pain at rest. Pain is the predominant symptom in degenerative arthritis. Joint stress (e.g., occupation-related repetitive injury and physical trauma).Obesity, which is one of the most important modifiable risk factors and requires appropriate counseling.Gender, with women more likely to report pain in all affected joints.10 Additional risk factors for OA include: OA is rarely found in persons under 35 years of age in this population, secondary causes or other types of arthritis ( Table 1) should be strongly considered. 10 Prevalence rates for both radiographic OA and, to a lesser extent, symptomatic OA rise steeply after age 40 years in women and age 50 years in men. 9 Following destruction, progressive cartilage degradation and OA ensue.Īge is the most consistently identified risk factor for OA, regardless of the joint being studied. The primary enzymes responsible for the degradation of cartilage are the matrix metalloproteinases (MMPs) together with pro-inflammatory cytokines (e.g., interleukin -1), MMPs appear to be important mediators of cartilage destruction. 9 Another important distinction is that elevated degradative enzyme activity is found in OA, but not in cartilage undergoing normal aging. Furthermore, while found in both normally aging and osteoarthritic cartilage, denatured type II collagen is more prevalent in OA. 9 For example, the water content and the ratio of chondroitin sulfate to keratin sulfate constituents differ in normally aging and osteoarthritic cartilage. OA Pathophysiology and Risk Factorsĭifferences between normally aging cartilage and osteoarthritic cartilage have been described, suggesting that OA is truly a disease and not just a natural consequence of aging. Pharmacists need to consider that instability can arise secondary to pain, stiffness, and impaired ambulation when OA affects the MPJ furthermore, falls occurring in the elderly need to be assessed using a multidimensional approach that considers such factors as medications, functional disability, and neurologic impairment. 8 Furthermore, reduced flexibility and mobility in seniors can result in limitations affecting not only the movements and locomotion required for everyday functioning and responsibilities, but also leisure activities, vacations, and caregiving. OA of the first metatarsophalangeal joint (MPJ) of the big toe/great toe is a common condition (hallux limitus/rigidus) marked by pain, stiffness, and impaired ambulation. high heels, sandals, slippers) on a regular basis in their past were more likely to experience foot pain in their later years compared with those who wore “average” shoes. 5 Interestingly, Dufour et al examined factors associated with foot pain, including current and past shoe wear their findings revealed that women who wore “poor” shoes (e.g. Shoes and other footwear may be an important modifiable factor in foot pain, particularly as it relates to rheumatic disorders according to Riskowski et al, it is surprising that this topic has received little attention in the rheumatology community. 6 According to the Framingham Heart Study, prevalence data indicate that 29% of women and 19% of men reported foot pain on most days of the month. 5 The prevalence of foot pain among community-dwelling older adults ranges from approximately 36% to 70%, depending on definitions and populations studied. Today, arthritis and foot pain are both major public health problems. 2,3 Further, according to a North American survey, adults over age 65 years accounted for 37% of arthritis cases in 2005 and will account for 50% by 2030. 1 Musculoskeletal disease is the most common cause of chronic disability in individuals older than 65 years, and arthritis, currently a growing medical problem, is the most common cause of disability in people over 75 years of age. Osteoarthritis (OA), considered a musculoskeletal disorder ( Table 1), is the most prevalent articular disease in the elderly. The prevalence of disabling joint diseases increases with age.
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