1.1 Background of the study
Osteoarthritis (OA) is one of the most common joint disorders worldwide and the most common type of arthritis (Vos et al., 2010; Cross et al., 2014; Cisternas et al., 2016). It typically affects knees, hips, hands, spine, and feet (Hunter and Felson 2006). Osteoarthritis (OA) is a degenerative disorder of synovial joints characterized by focal loss of articular cartilage with reactive changes in the subchondral and marginal bone, synovium, and para-articular structures (Scott, 2010). In addition, it is a whole joint disease involving structural alterations or damage and loss of articular cartilage, there is remodeling of subarticular bone, osteophyte formation, and ligamentous laxity, weakening of periarticular muscles, hyaline articular cartilage and, in some cases, capsule and synovial inflammation. The complex pathogenesis of osteoarthritis involves mechanical, inflammatory, and metabolic factors, which ultimately lead to structural destruction and failure (Hutton, 1989; Brandt et al., 2006; Martel-Pelletier et al., 2016). OA is a degenerative joint disease involving the cartilage and many of its surrounding tissues.
According to the National Institute for Health and Care Excellence (2014), OA refers to a clinical syndrome of joint pain accompanied by varying degrees of functional limitations and reduced quality of life. A number of specific risk factors have been identified including obesity and metabolic disease, age, sex, ethnicity and race, genetics, nutrition, smoking, bone density and muscle function (Neogi, 2013; Sandhar et al., 2020), exposure to these and other risk factors is unequally, and often inequitably, distributed
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