Many people with osteoarthritis lead normal and active lives. Medication and physiotherapy can help reduce pain and restore movement to stiff joints. If necessary, surgery can be used to improve function of the joints, decrease pain and discomfort and improve the quality of life. Although osteoarthritis cannot be cured, its symptoms can be managed and the patient can often enjoy a more useful and active lifestyle.
Osteoarthritis, or degenerative joint disease, is the most common type of arthritis & one of the most common causes of knee pain. A healthy knee has cartilage and lubricating joint fluid — called synovial fluid — to protect and cushion the bone ends, allowing the joint to move and bend. Cartilage is a firm, rubbery material that covers and cushions the ends of bones in normal joints. Its main function is to reduce friction in the joints and serve as a “shock absorber.”
Osteoarthritis causes the cartilage in a joint to become stiff and lose its elasticity, making it more susceptible to damage. Over time, the cartilage may wear away in some areas, greatly decreasing its ability to act as a shock absorber. As the cartilage wears away, tendons and ligaments stretch, causing pain. If the condition worsens, the bones could rub against each other, causing even more pain and loss of movement.
OA is most common in middle-aged and older people, and its symptoms can range from very mild to very severe. The disorder most often affects hands and weight-bearing joints such as knees, hips, feet and the back, but can affect almost any joint in the body. Osteoarthritic affection of spine is called as spondylosis. Women are more commonly affected than men.
SYMPTOMS OF OSTEOARTHRITIS:
1. Joint aching and soreness, especially with movement
2. Pain after overuse or after long periods of inactivity
3. Morning stiffness lasting less than 30 minutes
4. Joint instability or buckling seen in advanced cases due to ligaments degeneration and deformities.
5. Loss of function in advanced stage.
6. Bony enlargements in the middle and end joints of the fingers. These enlargements may or may not be painful.
What Causes Osteoarthritis?
There are many factors that can increase a person’s chance of developing OA, including:
1.Obesity: Maintaining an ideal weight or losing excess weight may help prevent osteoarthritis of the knees, hips, and back. Weight loss can also decrease OA rate of progression once the disease is established.
2. Injury: People with joint injuries due to sports, work-related activity, or accidents may be at increased risk of developing OA. For example, athletes with knee-related injuries may be at higher risk of developing osteoarthritis of the knee. In addition, people who have had a severe back injury may be predisposed to develop osteoarthritis of the spine. People who have had a broken bone near a joint are prone to develop osteoarthritis in that joint.
3. Heredity: Some people have an inherited defect in one of the genes responsible for making cartilage. This can cause defective cartilage, which leads to more rapid deterioration of joints. People born with joint abnormalities are more likely to develop osteoarthritis, and those born with an abnormality of the spine (such as scoliosis, a curvature of the spine) are more likely to develop osteoarthritis of the spine.
4. Joint Overuse: Overuse of certain joints increases the risk of developing OA. For example, people in jobs requiring repeated bending of the knee are at increased risk for developing OA of the knee.
5. Age: Although age is a risk factor, research has shown that OA is not an inevitable part of aging.
6.Crystal deposits in the cartilage can cause cartilage degeneration and osteoarthritis.Uric acidcrystals cause arthritis in gout, while calcium pyrophosphate crystals cause arthritis in pseudogout.
7.Hormone disturbances such as diabetes and growth hormonedisorders, are also associated with early cartilage wear and secondary osteoarthritis.
DIAGNOSIS OF Osteoarthritis
We make a diagnosis of Osteoarthritis based on a physical exam and history of symptoms. The diagnosis of osteoarthritis is based on a combination of the following factors:
1. A description of symptoms:
The location and pattern of pain
2. Certain findings in a physical examination:
A. Bony enlargement at affected joints
B. Limitation of range of motion
C. Crepitus on motion
D. Pain with motion
E. Malalignment and/or joint deformity
PATTERN OF JOINT INVOLVEMENT:
Axial: cervical and lumbar spine
Peripheral: distal interphalangeal joint, proximal interphalangeal joint, first carpometacarpal joints, knees, hips
Disease with multiple joint involvement is a subtype of osteoarthritis; most commonly, osteoarthritis affects the hands, hips, knees and/or spine.
3. X-rays may be used to confirm a diagnosis and to make sure that no other type of arthritis is present. OA has been graded according to radiological severity. More the grading, worse prognosis and more chances of intervention by your doctor in the form of injections/ operation
4. Sometimes blood tests are done. While blood tests cannot point to anything in particular that can help a doctor confirm the presence of OA, the tests can help the doctor determine the presence of a different type of arthritis.
5. If fluid has accumulated in the body’s joints, the doctor may remove some of the fluid with a process called joint aspiration and may examine the fluid under a microscope to rule out other diseases.
The treatment of OA focuses on decreasing pain and improving joint movement.
Comorbid conditions such as cardiac disease, hypertension, peptic ulcer disease or renal disease must be considered, and the patient’s needs and expectations should also be taken into account.
The following treatments are available.
1. Over-the-counter pain-relieving medications: These include paracetmol (Calpol), aspirin (Disprin) or ibuprofen (Brufen). Although over the counter medications should be strongly discouraged.
2. Topical treatments:
Some medications in the form of creams, rubs, or sprays may be applied over the skin of affected areas to relieve pain. They sometimes reduce the need of pain killer tablets.
Physical activity can improve joint movement and strengthen the muscles that surround the joints. Gentle exercises, such as swimming or walking on flat surfaces, are recommended because they create less stress on joints. Activities that increase joint pain (jogging, high-impact aerobics, etc.) should be avoided. If you have arthritis, talk to your doctor to find out the best exercise routine for you. Swimming is particularly well suited for patients with osteoarthritis because it allows patients to exercise with minimal impact stress to the joints. Other popular exercises include walking, stationary cycling, and light weight training.
4. Weight control:
Losing weight can prevent extra stress on weight-bearing joints.
5. Anti-inflammatory pain relievers:
These help reduce pain and swelling in the joints. We have many varieties to choose from in picking the right medicine for you. However these drugs should be avoided and the dose & duration should be kept minimum.
6. Mood elevators anti antidepressants:
Chronic pain is almost always associated with depression and anxiety and depression aggravates pain so to break the cycle we sometimes prescribe these medications.
7. Hot or cold compresses: These treatments may be given in the form of a hot shower or bath, or by applying heating pads or cold compresses. Recently it has been proved that cold therapy is more effective and safer than hot therapy.
8. Joint protection devices: These can prevent strain or stress on painful joints. Commonly called as braces.
9. Physiotherapy: Now a days importance of physiotherapy is established beyond controversy. We usually suggest local UST/ IFT/ SWD/ TENS or even combination therapy. Although physiotherapists are always adviced to give exercise training which the patient should continue for rest of his/ her life.
10. Supplements like Diacerin, Glucosamine and Chondroitin:
While research is conflicting, there is some evidence that they may relieve some pain in some people with osteoarthritis, especially in the knee. Several studies have shown that same may work better than prescription anti-inflammatory pain relievers in some people.
11. Steroid injections:
Sometimes we inject these potent medicines directly into the involved joint to help relieve pain. Using them too frequently can cause joint damage.
12. Hyaluronic Acid Injections: These medications can be given as injections to relieve pain in some people with osteoarthritis. Medications include Hyalgan, Synvisc, and Synvisc-One. Selection of hyaluronic acid depands on stage of OA.
Stronger pain pills, such as narcotics, may be prescribed when osteoarthritis pain is severe and other treatments are not working.
14. Surgery: Surgery is generally reserved for those patients with osteoarthritis that is particularly severe and unresponsive to the conservative treatments. Arthroscopy can be helpful when cartilage tears are suspected.Osteotomy is a bone-removal procedure that can help realign some of the deformity in selected patients, usually those with certain forms of knee disease. In some cases, severely degenerated joints are best treated by fusion (arthrodesis) or replacement with an artificial joint (arthroplasty). Total hip and total knee replacements are now commonly performed even in our country. These can bring dramatic pain relief and improved function. Here we replace articulating surfaces of your joint with metal or Polyethylene surfaces. Do not expect a new joint to perform as well as the one Mother Nature provided.
SOME OF THE COMMONLY ASKED QUESTIONS TO YOUR DOCTOR:
“If I have minimal or no symptoms with early signs of osteoarthritis, what should I do?”
The ideal steps to take should lead to a proper diagnosis and an optimal long-term treatment plan. While many steps are described here, the plan must be customized for each person affected by osteoarthritis, depending on the joints affected and the severity of symptoms.
An opinion regarding the cause or the type of the arthritis can often be adequately obtained by consulting a general family doctor. It is often unnecessary to see an orthopaedician, like myself, for this purpose. However, if the diagnosis or treatment plan is unclear, an orthopaedician might be consulted.
When we determine that a patient has a classic node formation from osteoarthritis (Heberden’s node), we may make the diagnosis solely based upon the examination, without the need for any additional tests, such as blood or X-ray testing. Sometimes, testing can be helpful to better understand the degree and character of the osteoarthritis affecting a certain joint. It can also be helpful for monitoring and to exclude other conditions.
Treatment may not be necessary for osteoarthritis of the hands with minimal or no symptoms. When symptoms are troubling and persist, however, treatment might include pain and anti-inflammatory medications, with or without food supplements, such as glucosamine and/or chondroitin. Furthermore, heat/cold applications and topical pain creams can be helpful.
Obesity has long been known to be a risk factor for osteoarthritis of the knee. I recommend weight reduction for patients who are overweight with early signs of osteoarthritis of the hands, because they are at a risk for also developing osteoarthritis of their knees.
What is the prognosis (outlook) for patients with osteoarthritis?
The prognosis of patients with osteoarthritis depends on which joints are affected and whether or not they are causing symptoms and impaired function. Some patients are unaffected by osteoarthritis while others can be severely disabled. Joint replacement surgery for some results in the best long-term outcome. Finally, if you are concerned that osteoarthritis could be lead to injury of the internal organs, don’t be. Osteoarthritis does not cause internal organ damage or blood test abnormalities.
Can osteoarthritis be prevented?
There is no prevention of osteoarthritis with the exception of avoiding joint injury.
What does the future hold for osteoarthritis?
In the future, medications may be available that protect the cartilage from the deteriorating consequences of osteoarthritis. Research into cartilage biology will eventually lead to new and exciting breakthroughs in the management of osteoarthritis.
Surgical innovation has led to a technique for the repair of isolated splits of cartilage (fissures) of the knee. In this procedure, a patient’s own cartilage is actually grown in the laboratory, then inserted into the fissure area and sealed over with a “patch” of the patient’s own bone covering the tissue. While this is not a procedure for the cartilage damage of osteoarthritis, it does open the door for future cartilage research. These and other developing areas hold promise for new approaches to an old problem.
Investigators at the National Institutes of Health have found that taking glucosamine did not significantly improve symptoms of osteoarthritis compared to placebo. Studies are underway to look at whether some glucosamine formulations may have advantages over others.
Dr. Amrish Kumar Jha
MS (ORTHO), MCH (ORTHO)
Fellow joint replacement and Arthroscopy
Asst. Professor, Calcutta Medical College, Kolkata