What is osteoarthritis?
Osteoarthritis is a very common condition that can affect any joint in the body. It usually affects the joints of your spine, hips, knees, and hands. Osteoarthritis is caused by the breakdown of cartilage.
Being active and leading a healthy lifestyle can slow down the development of this disease. Certain medications can also improve joint function and improve pain.
There are two main types of osteoarthritis:
- Primary: Most common, generalized, primarily affects the fingers, thumbs, spine, hips, knees, and the great (big) toes.
- Secondary: Occurs with a pre-existing joint abnormality, including injury or trauma, such as repetitive or sports-related; inflammatory arthritis, such as rheumatoid, psoriatic, or gout; infectious arthritis; genetic joint disorders, such as Ehler’s Danlos (also known as hypermobility or “double-jointed; congenital joint disorders; or metabolic joint disorders.
What is cartilage?
Cartilage is the main type of connective tissue throughout our body. It serves a variety of structural and functional purposes and exists in different types throughout our joints, bones, spine, lungs, ears, and nose. Cartilage is a firm, rubbery, flexible connective tissue covering the ends of bones in normal joints. It is a mixture of water and protein.
Its function is to reduce friction in the joints and serve as a “shock absorber.” The shock-absorbing quality of normal cartilage comes from its ability to change shape when compressed, because of its high water content. Although cartilage may undergo some repair when damaged, the body does not grow new cartilage after injury. Cartilage is avascular, meaning there are no blood vessels in it. Therefore, healing is a slow process.
- Chondrocytes, and the precursor form chondroblasts, are highly complex multifunctional cartilage cells. Functions include synthesizing and maintaining the extracellular matrix comprised of collagen and proteoglycans that help healthy cartilage grow and heal.
- Collagen is a structural protein found in many tissues such as skin, tendons and bone and is a key structural component of cartilage. Collagen provides cartilage with its strength and creates a framework for the other components.
- Proteoglycans are complex molecules composed of protein and sugar combinations that are interwoven in the matrix of cartilage. Their function is to trap large amounts of water in cartilage, which allows it to change shape when compressed thus acting as a shock absorber. At the same time, proteoglycans repel each other, allowing cartilage the ability to maintain its shape and resilience.
Who is more prone to osteoarthritis?
Approximately 80% of older adults, ages 55 years and older, have evidence of osteoarthritis on X-ray. Of these, an estimated 60% experience symptoms. Around 240 million adults worldwide have symptomatic osteoarthritis, including more than 30 million U.S. adults. Post-menopausal women have an increased incidence of knee osteoarthritis compared to men.
What are the risk factors for osteoarthritis?
In addition to age and secondary causes such as inflammatory arthritis and prior injury/ trauma, several other risk factors increase the chance of developing osteoarthritis including obesity, diabetes, elevated cholesterol, sex, and genetics.
- Obesity is a risk factor for osteoarthritis, particularly of the knee. In addition to overloading the weight-bearing mechanisms of the body, the metabolic and pro-inflammatory effects of obesity have been studied as contributory to osteoarthritis. Maintaining ideal body weight or losing extra weight is important for those at risk.
- Both diabetes and hyperlipidemia (elevated lipids/cholesterol) contribute to the inflammatory response within the body, increasing the risk of osteoarthritis. Oxidation of lipids can also create deposits in cartilage which affects affecting blood flow of subchondral bone. Also when the blood sugar cholesterol/lipids, increase free radicals within the body, this oxidative stress exceeds the resilience of cartilage on the cellular level. Controlling diabetes and hyperlipidemia is important for bone health in addition to general health.
- Decreased estrogen as experienced by post-menopausal women increases the risk of knee osteoarthritis as estrogen is protective of bone health specifically reducing oxidative stress to the cartilage.
- Heredity can play a role in osteoarthritis, as individuals born with other bone diseases or genetic traits may be more likely to develop osteoarthritis.
SYMPTOMS AND CAUSES
What causes osteoarthritis?
Osteoarthritis usually occurs when the cartilage (a slippery and firm tissue that allows frictionless joint motion) which cushions the bones inside your joints starts decaying. The surface beneath the cartilage starts becoming rough. When the cartilage is totally damaged and there is no protective barrier in between. This can cause immense pain and discomfort.
Risk factors that can make you susceptible to developing Osteoarthritis:
- Old age- When you start aging, your bones tend to grow weaker. This can cause Osteoarthritis.
- Sex- Studies state that women are more prone in developing Osteoarthritis.
- Obesity– Extra body weight can add more pressure and stress on the joints of your body, which can make the cartilage on your knees, hips and joints prone to more friction. Fat tissues also produce proteins which can cause chronic inflammation on your joints leading to Osteoarthritis.
- Joint injuries- Injuries which occur while playing sports or from a fatal accident can increase your chances of developing Osteoarthritis. Injuries that have occurred several years ago can also make you develop Osteoarthritis in the future.
- Some occupations- Certain jobs include tasks which put continuous stress on a particular joint. This region can easily affects Osteoarthritis.
- Genetics- If one or both parents have Osteoarthritis, the child is also prone in developing Osteoarthritis.
- Bone deformities- People who are born with a defective cartilage or malformed joint are more susceptible in developing Osteoarthritis.
Osteoarthritis can be genetic both as primary such as nodular OA of the hands as well as secondary related to other genetic disorders, such as hypermobility of joints. Inflammatory and infectious arthritis can contribute to the development of secondary osteoarthritis due to chronic inflammation and joint destruction. Previous injuries or traumas including sports-related and repetitive motions can also contribute to osteoarthritis.
DIAGNOSIS AND TESTS
How do I know if I have osteoarthritis?
Magnetic resonance imaging (MRI) or X-rays helps in the diagnosis of osteoarthritis by the specialist. These tests confirm the cartilage loss and bone spurs surrounding the affected joint. Sometimes, lab tests like blood tests and Joint fluid analysis can analyze joint or blood fluid levels in your bone. These tests also confirm whether or not you have Osteoarthritis. Sometimes symptoms of Osteoarthritis can be similar to a joint infection, gout, or rheumatoid arthritis.
Your healthcare provider (MD, DO, NP, PA) can typically diagnose osteoarthritis by obtaining a complete history of your symptoms and examining your joints. X-rays may be helpful to make sure there is no other reason for the pain. Magnetic resonance imaging (MRI) is generally not necessary except in unusual circumstances. There are no blood tests that diagnose osteoarthritis. If there is a swelling in a particular joint, your doctor may drain fluid from that joint. Testing of this fluid to look for clues for other types of arthritis, such as gout.
MANAGEMENT AND TREATMENT
What is the treatment of osteoarthritis?
The main treatments for the symptoms of osteoarthritis include lifestyle measures – such as maintaining a healthy weight and exercising regularly. medication – to relieve your pain. supportive therapies – to help make everyday activities easier. There is no cure for osteoarthritis. Medical treatments and recommendations include:
- Medications (topical pain medicines and oral analgesics including nonsteroidal anti-inflammatory medications, NSAIDs).
- Exercise (land- and water-based).
- Intermittent hot and cold packs (local modalities).
- Physical occupational and excercise therapy.
- Weight loss (if overweight).
- Healthy eating, managing diabetes and cholesterol.
- Supportive devices such as braces, orthotics, shoe inserts, cane, or walker.
- Intra-articular injection therapies (steroid, hyaluronic acid “gel”).
- Complementary and alternative medicine strategies, including vitamins and supplements.
Surgery may be helpful to relieve pain and restore function when other medical treatments are ineffective. Especially with advanced OA.
The goals of treatment are to:
- Decrease joint pain and stiffness and delay further progression.
- Improve mobility and function.
- Increase patients’ quality of life.
The type of treatment regimen prescribed depends on many factors, including the patient’s age, overall health, activities, occupation, and severity of the condition.
There are no medications yet available that have been shown to reverse or slow the progression of osteoarthritis. The doctors mainly focus on the medications on decreasing symptoms of the disease. Pain-relieving medications include acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs). There is a restriction on Narcotic pain medications due to the chronic nature of the disease and the possibility of tolerance and addiction. Topical medications in the form of analgesic patches, creams, rubs, or sprays might help in the areas to relieve pain.
Although many of these medications are available in over-the-counter preparations, individuals with osteoarthritis should talk to a health care provider before taking the medications. Some medications may have dangerous or unwanted side effects and/or may interfere with other medications which you are using. Some over-the-counter medications still require routine laboratory testing.
The antidepressant duloxetine hydrochloride (Cymbalta®) was approved by the FDA in 2010 to treat the pain of osteoarthritis, such as lower back pain. That has been a big help for people who can’t tolerate NSAIDs or other treatments.
Supportive or assistive devices help decrease stress on affected joints. Braces and orthotics help to support and stabilize painful, damaged joints. Medical devices should be used as instructed and under the direction of a health professional such as a physical/ occupational therapist or your licensed healthcare provider. Shoe lifts/ inserts, a cane, or a walker may be helpful to take pressure off certain joints and improve body and gait mechanics.
Exercise is important to improve flexibility, joint stability, and muscle strength. Regimens such as swimming, water aerobics, and low-impact strength training are essential. These activities decrease the amount of pain and disability that osteoarthritis sufferers experience. Avoid excessively vigorous exercise programs, as they may increase arthritis symptoms and potentially hasten the progression of the disease. Physical therapists or occupational therapists can provide appropriate and tailored exercise regimens for individuals with osteoarthritis.
Hot and cold therapies
Intermittent hot and cold treatments may provide temporary relief of pain and stiffness. Such treatments include a hot shower or bath and the careful application of heating or cooling pads or packs.
Since obesity is a known risk factor for osteoarthritis, working to better manage weight may help prevent and improve osteoarthritis. Weight loss in overweight persons who have osteoarthritis has been shown to reduce stress and the amount of pain in weight-bearing joints as well as moderate the inflammatory processes that contribute to OA.
When osteoarthritis pain cannot be controlled with medical management and it interferes with normal activities, surgery may be an option. Surgery is usually reserved for those people who have significant osteoarthritis. Several types of techniques can be employed, including minimally invasive joint replacement techniques. Although it has risks, joint surgery today can be very effective at restoring some function and reducing pain for appropriate individuals.
Supplements and alternative medicine nutraceuticals, a term derived from “nutrition” and “pharmaceutical”, are compounds that are available in pharmacies and health food stores without a prescription and are not licensed by the FDA as drugs. They include nutritional supplements, vitamins, minerals, and other compounds sometimes referred to as “natural,” “homeopathic,” or “alternative” therapies. As this market is less regulated than the food and drug companies – many preparations exist, the actual quantity of active ingredients may vary, and there is no guarantee as to the accuracy of the label and the product.
Glucosamine and chondroitin are components of normal cartilage. As a supplement, they are most widely available as sulfate compounds. Clinical research results on glucosamine and chondroitin seem to vary, however, some trials indicate possible pain-relieving properties, particularly in osteoarthritis of the knee. Exactly how they work remains unclear and there is no strong scientific evidence supporting the claim that they build bone and cartilage. In general, glucosamine and chondroitin appear to be safe and well-tolerated however should first be discussed with your healthcare provider.
Fish oils have some anti-inflammatory activity, but these oils have been studied more extensively for rheumatoid arthritis. Supplements can potentially interact with prescription medicines and can have side effects, they should always first be reviewed with your healthcare provider.