September 2022

The elderly and osteoarthritis seem to go hand in hand. as the age increases Many older people began to slow down. Difficult to go up and down stairs with a rustling sound in the joints or sometimes having joint pain whether knee hip joint or knuckle Although this disease is not life threatening, it does not compromise on happiness and quality of life.

“Rheumatoid arthritis is a major public health problem in Thailand and around the world. affect the quality of life of Elderly people who are prone to this disease, the more Thai people are now living longer. The more there will be more patients with this disease. This disease is incurable. But if we can predict the severity of the disease, we can find a way to reduce or slow down the severity of the disease.” Prof. Dr. Sittisak Hansawek, Department of Biochemistry Faculty of Medicine Chulalongkorn University Discussed the origin of the research project “Cytokine and Biochemicals as Indicators and Targets in the Treatment of Osteoarthritis”, which received an award for outstanding research results from CU personnel. Health Sciences for the year 2021

Over 10 years of research, Prof. Dr. Sittisak and his team have studied to understand the causes of osteoarthritis. disease mechanism and indicators of the severity of the disease to set up follow-up guidelines Prevent and alleviate the severity of disease This will increase the quality of life of patients.

• cytokines and mechanisms of osteoarthritis

Prof.Dr. Sittisak According to the study of the mechanism of osteoarthritis, it was found that some cytokines contributed to osteoarthritis and its disease progression.

“Cytokines are proteins secreted by inflammatory cells in the joints. cytokines and biochemicals It stimulates the cartilage cells to secrete other substances, such as substances that help in the creation and breakdown of cartilage. An imbalance of cytokines stimulates the rapid degradation of cartilage. causing more deterioration.”Prof.Dr. Sittisak say

The knowledge that has been found can be applied to develop patients to monitor whether there is a chance of developing more severe osteoarthritis in the future. as well as find ways to reduce or inhibit the cytokines that cause osteoarthritis. Currently, cytokine levels are measured following the patient has undergone osteoarthritis surgery.

“After surgery, cytokine levels will be measured to help determine if there may be an infectious-inflammatory complication. If the cytokine level is very high Indicates that there may be an infection following surgery. Therefore, antibiotics need to be given until cytokine levels have dropped to normal.” Prof.Dr. Sittisak say

• Know regarding osteoarthritis and risk factors

Major causes of osteoarthritiscomes from the quality ofcartilagein joints that deteriorate with age Occurs in people aged 40 years and over and will be evident in those aged 60 years and older. The likelihood of developing osteoarthritis is higher. From the past statistics, it was found that more than 50 percent of people aged 70 years and over had osteoarthritis.

“Joints of various organs Throughout the body, there are two pieces of bone: hard bone and articular cartilage. when people get older The quality of cartilage formation has decreased. As a result, the function of cartilage is lost. The body stimulates cartilage cells to produce cytokines. causing inflammation of the tissues around the joints, tendons and muscles.” Prof.Dr. Sittisak Describe the mechanism of osteoarthritis in the elderly. This can happen to any joint in the body, but the most common is the knee. followed by hip and finger joints

apart from age Women are 2 to 3 times more likely to suffer from osteoarthritis than men because women when entering menopause Hormones in the body that stimulate cells are reduced, affecting the quality of cartilage. Moreover Another risk factor is body weight that contributes to more severe osteoarthritis.

• Symptoms and severity of osteoarthritis

The severity of osteoarthritis varies with the duration of the disease. In the early stages, joint pain occurs when walking, standing or going up and down stairs. Then it starts to have stiff joints, loud noises, walk for a while and have to sit and rest. Symptoms improve when the use of the joint is stopped.

If osteoarthritis is in a severe stage The patient will have pain, swelling in the joints and inflammation. Can’t bend and stretch around the joints fully. in a large number The joints are distorted, the knees are bent, the fingers are crooked. When X-rays, it is found that bone regeneration is formed around the joint to penetrate the tissue in the knee joint. causing inflammation and pain in the knee joint

“This disease is not fatal. but making it impossible to live a normal life worse quality of life Patients with this disease for a long time Muscles may atrophy due to inactivity and there is a 50 per cent chance of osteoarthritis patients in both knees.”Prof.Dr. Sittisak say

• It can be treated even if it is not completely cured.

Even though osteoarthritis is not cured But there are ways to improve quality of life and reduce pain. Prof.Dr. Sittisak said that following the patient was diagnosed by X-ray examination of the abnormalities in the joints

There are currently three approaches to treatment, depending on the severity of the disease.

• Starting from not using drugs
• drug treatment
• Surgery as a last resort

treatment without drugs Prof.Dr. Sittisak It said that 80 percent of osteoarthritis patients are overweight, so proper weight control will help reduce stress on the joints. and help improve osteoarthritis symptoms

“How to calculate overweight Look at your body mass index or Body Mass Index (BMI) using your body weight. Divided by the height in meters squared. If it is in the range of 18-23, it is considered to be in moderation. Another simple method of calculating overweight is to subtract your height by 100. If your weight is greater than the result, you are overweight.”

Prof.Dr. SittisakAdvise patients to exercise the muscles around the joints to be strong at all times. Especially knee joints. Extend your legs for 10 seconds and then lower them down. Do 20 rounds, 20 times a day. If you have a support device such as a brace or walking cane, it will help you walk better.

drug treatment such as pain relievers muscle relaxant In addition, there are injections, which are currently injected with synovial fluid. Injecting a patient’s platelet concentration into the joint to help reduce inflammation. making people with osteoarthritis in the early stages have better symptoms

“If you have joint pain in the first 24 hours, you must apply a cold compress. To cool to relieve pain from inflammation. When symptoms improve and chronic pain recurs, warm compresses should be applied. This will make the blood flow in that area better. relaxes the muscles.” Prof.Dr. Sittisak Suggest ways to deal with pain It is also suggested that acupuncture and ultrasound can help relieve joint pain.

surgical treatment This method is used for patients with severe symptoms such as deformed joints that are very painful. Affect work and life. endoscopy to clear the joint Remove broken or loose bone fragments inside the joint. Orthopedic correction surgery deformed

“The last method is knee replacement surgery. This will help improve the quality of life of patients. able to return to normal life How long will the knee prosthesis last?take care” Prof.Dr. Sittisak say

• Vitamin D and E enhance bone performance.

Prof.Dr. Sittisak He added that the study also examined the efficacy of vitamin D2 supplementation in 200 osteoarthritis patients treated at the orthopedic department. Chulalongkorn Hospital Patients with osteoarthritis aged 60 years and over and whose body vitamin D test result is less than 30 ng/ml to take vitamin D2 (Ergocalciferol, 20,000 unit/tablet) twice a week for a period of time. 6 months

“Vitamin D2 stimulates bone formation. Helps in the formation of minerals, calcium, magnesium, phosphate in the bones. Vitamin D also works with parathyroid hormone to help the intestines absorb calcium. and stimulate the reabsorption of calcium by the kidneys raises the level of calcium in the blood thus helping to build stronger bones In addition, vitamin D can help improve muscle performance. can work better.”Prof.Dr. Sittisak say

Prof.Dr. Sittisak went on to say that The research team also studied the use of vitamin E. Added to the group of patients with osteoarthritis as well The patients were given vitamin E for 2 months.

“Vitamin E helps reduce free radicals in the body. which in research We found that vitamin E reduced joint pain. The use of advantages is up.”Prof.Dr. Sittisak say

The recommended intake of vitamin D is 400 – 600 IU/day. For vitamin E, 40 – 200 IU/day is recommended, however, the recommended intake varies with age and individual physical condition. or vitamin E It should be under the supervision and advice of a doctor or pharmacist.

Who Should Get Vitamin D Supplements?

People who are at risk of vitamin D deficiency, such as the elderly, pregnant women

2. Patients with osteoporosis

3. Patients with chronic kidney disease

4. Patients with certain intestinal diseases that result in impaired intestinal absorption of vitamin D.

5. People with impaired digestion and absorption of fat (Because vitamin D is soluble in fat), the absorption of vitamin D is reduced, etc.

• Adjust behavior, slow down osteoarthritis

Prof.Dr. Sittisak Older people with osteoarthritis are advised to avoid behaviors that can accelerate osteoarthritis, such as kneeling, cross-legged, squatting, and frequent going up and down stairs. and supplemented with exercises to strengthen the muscles around the joints and exercise which the doctor recommends swimming Light walking and cycling

“It is important to control your body weight well to reduce the impact on the knee joints and slow down osteoarthritis.Prof. Dr. Sittisak concluded.

people with problemsosteoarthritis Contact orthopedic department Chulalongkorn Hospital, 5th Floor, Por Por Ror Building, Tel. 0-2256-5351 to make an appointment for a doctor during office hours and outside office hours (Orthopedic Clinic) or visit the Department of Orthopedic website for more information. Faculty of Medicine, Chulalongkorn University http://ortho.md.chula.ac.th