and

present

What to advise patientsWhat to advise patientswith osteoarthritis? with osteoarthritis?

An aerobic activity every day

Maintains joint flexibility and good muscle tone

Made easier by wearing shoes with thick, flexible soles to cushion the impact on the joints or, for patients with genu varum, with corrective insoles

During "inflammatory"* flares: avoid undue stresson the joint, standing for prolonged periods of time and carrying heavy loads

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*The joint is more painful than usual and is hot and swollen.

Chevalier X. Arthrose du genou et de la hanche. Rev Prat Med Gen 2012;21:987-91.

Fight the flab!

A risk factor for the onset and progression of osteoarthritis

Obesity is known to promote the onset of knee osteoarthritis and also, to a lesser extent, hip and hand osteoarthritis

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Even minimal weight loss of about 5% reduces osteoarthritis-induced pain, functional impairment and disability

There is no specific diet for osteoarthritis patients.A balanced, low-calorie diet is recommended for overweight patients

Chevalier X. Arthrose du genou et de la hanche. Rev Prat Med Gen 2012;21:987-91.Société française de rhumatologie. Osteoarthritis file.

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Advanced femorotibial knee osteoarthritis.

Primary osteoarthritis,CT-arthrography.

MRI of both hands: axial images in 3-D gradient echo sequences with suppression of the fat signal, with and without injection of gadolinium focussing on the metacarpophalingeal joints.

Aerobic activity and strengtheningexercice required

This will not intensify the knee or hip osteoarthritis-related pain

On the contrary, taking regular exercise can provide relief, improve range of motion and delay the need for replacement surgery

The recommended regimen is to gradually work up to30 to 60 minutes, three times a week

5Bonan I. Rôle de la rééducation dans le traitement de la gonarthrose. Rev Prat 2012;59:1246-47.

Do the right exercises

There are specific exercises recommended for each form of osteoarthritis: they are designed to maintain tendon flexibility and joint range of motion, prevent bad posture and reinforce the muscles

A few sessions of physiotherapy are required to: gradually start exercising again learn the right exercises to do regularly at home

6Bonan I. Rôle de la rééducation dans le traitement de la gonarthrose. Rev Prat 2012;59:1246-47.

Regular training is required

Don't forget home exercises for hand osteoarthritis

7 Beauvais C. Education thérapeutique en rhumatologie. Rev Prat Med Gen 2012;26:155-60.

For overweight patients, combine dietand exercise

A diet alone may not be sufficient to provide effective relief

The combination of diet and aerobic exercisein overweight patients with knee osteoarthritis:

significantly improves pain, function and muscle strength

is more beneficial than each measure applied individually

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Ghroubi S, et al. Apport de l’exercice physique et du régime dans la prise en charge de la gonarthrose chez l’obèse. Annales de réadaptation et de médecine physique vol. 51, 2008. p. 663-670.

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Choose the right sports(for the more athletic!)

Gentle, low impact sports are recommended: swimming,

cycling (on flat ground or on an exercise bike),stretching exercises, etc.

High impact sports (skipping, tennis, etc) arenot recommended for patients with establishedknee or hip osteoarthritis: they may aggravate the disorder

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Patients may continue to run as long as they wear appropriate footwear (thick, flexible rubber or air/gel type soles to cushion the impact) and run, wherever possible, on soft ground. Power walking is a good alternative

Chevalier X. Arthrose du genou et de la hanche. Rev Prat Med Gen 2012;21:987-91.Société française de rhumatologie. Osteoarthritis file.

Don't forget thermotherapy

Application of cold or heat can provide effectiveshort-lasting relief from the symptoms of hip or knee osteoarthritis (ice for inflammatory flares and heatfor joint stiffness)

Thermotherapy could be effective against the paincaused by hand osteoarthritis

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Zhang W, et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage 2008;16(2):137-62. Chevalier X. Arthrose des doigts. Rev Prat Med Gen 2010;24:162-163.

Protect your joints

There are many gadgets (long-handled shoe horn, door openers, etc.) available to help osteoarthritis sufferers in their daily lives whichcan be purchased either directly from retailers or from specialist mail order catalogues

12Société française de rhumatologie. Osteoarthritis file. Beauvais C. Education thérapeutique en rhumatologie. Rev Prat Med Gen 2012;26:155-60.

These will help reduce pain and maintain range of movement

Use walking aids

This may help reduce the pain of hip or knee osteoarthritis

During inflammatory flares, it is essential to rest the joint:use crutches if necessary

Between inflammatory flares: a walking stick will take the pressureoff the joint in daily life and will provide comfort and reassurance

Sticks or crutches should be carried on the side opposite to the damaged joint

Some patients find using a cane difficult to accept; it should be noted that,in most cases, a cane or stick will no longer be required after the hip or knee replacement procedure

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Zhang W, et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage 2008;16(2):137-62. Société française de rhumatologie. Osteoarthritis file

Envisage hydrotherapy (crenotherapy)

Proven to provide pain relief

The combination of physical treatments, physiotherapy and advice from ergotherapists and dieticians contribute to their beneficial effects

14Société française de rhumatologie. Osteoarthritis file