TO ASSESS THE HEALTH RELATED QUALITY OF LIFE IN PATIENTS WITH OSTEOARTHRITIS

 

 

About Author:
Nishith Sheth
M.Sc in Clinical Research
Cranfield university
sheth10687@gmail.com

Abstract
Osteoarthritis is one type of degenerative joint disease and also known as chronic musculoskeletal disease and it occurs mainly in elderly patients with the severe cause of disability. There are approximately 30 million persons affected with severe osteoarthritis and about 26 million persons are affected with severe osteoarthritis in United States only. The approximate annual cost to the public society in medical care is expected to reach 100 billion dollars by the end of 2020. From this much of cost, most of the cost is spent only in finding out the new diagnosis and treatment for this severe disease and also for the prevention of side effects. Today till 2010, 50% of the persons with the age over 75 suffer from the knee osteoarthritis. 80% of the aged persons with knee osteoarthritis feel difficulty in daily routine activities, while 20 % of the aged persons with mild osteoarthritis feel no difficulty in their daily routine activities.
In this disorder, the joint loses the slippery cartilage those results from ‘wear and tear’ on a joint. Thus the joint becomes large, thick and painful. Thus the bone near the cartilage tries to change and produce overgrowth of the bone.  That’s why the tissue near the bone becomes inflamed and ligaments lose and joint muscle becomes weak. So the people with osteoarthritis feel pain when they are doing their normal routine activities.

REFERENCE ID: PHARMATUTOR-ART-1757

There are amounts medical and non-medical treatments obtainable for the disease and the goal behind this is to reduce the side effects and to minimize the severe disability. Non-pharmacological treatments like exercise and some beneficial nutrition, also vitamin C, D and E are used while as pharmacological management NSAIDs, glucosamine and chondritin sulfate is used. Also hyaluronic acid injection is used in severe condition.

The 30- 35 subjects within the age of greater than 40, with a mild to severe knee, hand, hip osteoarthritis pain with different sex, ethnicity and different genetic characteristics are participated. The inclusion criteria for the volunteers include suitable age, no any chronic medical conditions like severe liver and kidney disease, the agreement for the subjects regarding not start any new medication during the study. At first visit, the verbal and detailed description of the trial was provide to the subject and they have to sign the permission from regarding the participation in the study without any force and clears all doubts of the subjects regarding the participation in the study. The signed form is given to the subject. The patient was provided the questionnaire with the permission of the respective physician. They have to fill all details given in the questionnaires on their own. If any worries occur during the filling of questionnaires, then the doubts will be cleared by the respective personnel present there and the physician. Depending on the filling of the details in the questionnaire, the data will be collected and assessed for the study or for biochemical analysis.

After the 2 months of the study, various data were collected regarding the osteoarthritis patients. The data regarding the QOL before treatment and after treatment were also collected. The data like treatments used by the patients in severe condition of osteoarthritis, their pain function, their normal regular activities and the data regarding the QOL of the patients were also collected and presented on the graph individually and finally the QOL score was calculated to know the QOL of the patients.

Finally it was accomplished that the QOL of the subjects were comparatively good before the occurrence of the disease or the treatment, but when the disease precedes fast, the QOL of the patients become very severe and no treatment is available for them and they also lose their interest in any other daily routine activities.

INTRODUCTION
Osteoarthritis is one type of degenerative joint disease and also known as chronic musculoskeletal disease and it occurs mainly in elderly patients with the severe cause of disability. There are approximately 30 million persons affected with severe osteoarthritis and about 26 million persons are affected with severe osteoarthritis in United States only. The approximate annual cost to the public society in medical care is expected to reach 100 billion dollars by the end of 2020. From this much of cost, most of the cost is spent only in finding out the new diagnosis and treatment for this severe disease and also for the prevention of side effects. Today till 2010, 50% of the persons with the age over 75 suffer from the knee osteoarthritis. 80% of the aged persons with knee osteoarthritis feel difficulty in daily routine activities, while 20 % of the aged persons with mild osteoarthritis feel no difficulty in their daily routine activities.

In this disorder, the joint loses the slippery cartilage those results from ‘wear and tear’ on a joint. Thus the joint becomes large, thick and painful. Thus the bone near the cartilage tries to change and produce overgrowth of the bone.  That’s why the tissue near the bone becomes inflamed and ligaments lose and joint muscle becomes weak. So the people with osteoarthritis feel pain when they are doing their normal routine activities.

Many risk factors are responsible for the development of severe osteoarthritis. Obesity, age, genetic predisposition, joint laxity, female sex and mechanical load on the body work as a vital function for its growth. Role of subchondral bone, cytokine and proteinases also works a vital function in the pathophysiology of the disease. Assessment of the severe osteoarthritis is done with the help of biomarkers and newly diagnostic procedures like sonography technique and MRI and also other new biomedical instruments and also most reliable way by using questionnaire on person’s Quality of Life.

There are number of medical and non-medical treatments available for the disease and the goal behind this is to reduce the side effects and to minimize the severe disability. Non-pharmacological treatments like exercise and some beneficial nutrition, also vitamin C, D and E are used while as pharmacological management NSAIDs, glucosamine and chondritin sulfate is used. Also hyaluronic acid injection is used in severe condition.

In osteoarthritis patients, Quality of Life related to health and routine in daily living activities is negatively affected. Quality of Life questionnaire is used to assess the Quality of Life in patients suffering from osteoarthritis. This questionnaire shows the person’s satisfaction and current functioning in daily living activities which include physical, mental, social functioning. After the complete filled questionnaire, score is calculated based on the criteria that classify the person’s different class of the disease.

Several clinical trials were carried out in the past on patients with osteoarthritis using several drugs like NSAIDs and some COX-2 inhibitors. The results had shown that the COX-2 inhibitor Rofecoxib is more effective than the high doses of NSAIDs in osteoarthritis. But this drug may lead to severe GI events, thus the patients discontinue the treatment to improve the tolerability.

HYPOTHESIS AND OBJECTIVES:
The main hypothesis behind this thesis investigate application is to assess the health related Quality of Life in patients with osteoarthritis in Gujarat using questionnaire.

Objectives:
1) To evaluate the health related Quality of Life in osteoarthritis patients in above 40 years of ages of patients in Gujarat.
2) To determine the risk factors associated with the disease.
3) To evaluate the Quality of Life of the patients with osteoarthritis before the treatment and after the treatment.
4) To compare the rate of occurrence of the disease in both male and female patients.

LITERATURE REVIEW

EPIDEMIOLOGY AND PREVALENCE:
The most widespread form of arthritis is osteoarthritis and it is the main leading cause of chronic disability and mainly occurs due to involvement of hip and knee. All osteoarthritis is not symptomatic but the WHO estimates that osteoarthritis mainly occurs in ages above 60 years with major severe chronic disability in 20% of the total population. The prevalence of osteoarthritis is higher in American countries and it affects about 30 million people with severe chronic disability. The percentage of osteoarthritis of the knee is higher in those countries than the other severe heart and lung disorders. Current treatments for osteoarthritis can reduce the symptoms but not completely cure the disease and also not decrease the development of the disease. In severe knee osteoarthritis and hip osteoarthritis patients, the only treatment available is joint and hip replacement surgery. The surgery may take higher cost than the other treatments, so most of the patients do not take part in this type of costly surgery. [1]

The osteoarthritis of the knee and hip increases with the ages with severe symptoms. In United States, the prevalence of osteoarthritis in patients was 40 million in 1995 and it may rise to 60 million in next 25 years with severe symptoms in 2020. [1]

The knee osteoarthritis and hip osteoarthritis ranks in the top 3 wellbeing care disorders in the developing world because it takes large amount of the cost for the treatment and is also not completely curable. The osteoarthritis prevalence is not same across the individuals of different genders means it is mainly found higher in women than men. Before age of 45-50, it occurs higher. But today the trend is totally changed. The rate of prevalence of osteoarthritis is higher after age 50 and it mainly affects women than men. The highest numbers of women is suffered from hip and knee osteoarthritis as compared to men who mainly have higher rate of hip osteoarthritis. The osteoarthritis epidemiology includes symptoms, severe disability and changes in the structure associated with the bone in it. [2]

The disease is known by the failure of cartilage in the involved joints. For the diagnosis, only radiography is available to see the inflammation between the involved joints and this radiography examination show narrowing joint space and osteophyte production around the joint surface and bone reformation whether available or not. Kellgren-Lawrence grading system is used to check the severity of the radiograph. This system shows the osteophyte production in the range of 0-4 degree but it does not help to narrow the space between the joint and bone formation. [3]

There is less literature available on the prevalence and incidence of osteoarthritis. Symptomatic osteoarthritis mainly occurs in more than 60 years of age persons which include 18% women and 9.6% men. Knee osteoarthritis is forth most common disease that causes disability in females and eighth in males.

In England, 1.80 million people are suffering from symptomatic osteoarthritis that mainly includes knee and hip. In German and Canadian countries, 4 million people are suffering from some kind of autoimmune diseases that mainly affects joints.

In USA, the age of the patients suffering from knee osteoarthritis is 60-65 years and the occurrence of the symptoms lasts for 7- 8 years. The frequency of osteoarthritis is superior in white persons than the black persons. In the year of 1999, more than 4, 50, 000 patients had taken the visits of the physicians for the osteoarthritis and they have to stay for 5-7 days there. After the release, they have to go to the nursing home for further treatments for severe osteoarthritis. In that year, more than 25% of the patients with knee osteoarthritis have undergone to the major surgery like total joint replacement. [4]

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