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What is osteoarthritis?
Osteoarthritis, also known as degenerative arthritis, is a leading cause of disability worldwide. It is characterized by progressive functional joint failure that is usually precipitated by injury.
How does osteoarthritis develop?
The joint is normally protected by the joint capsule, muscles, ligaments, and the underlying bone. The joint capsule and ligaments protect the joint by limiting the extent of movements a joint may undertake, thus establishing the normal range of motion. In addition, the ligaments contain nerves that detect the joint’s position as it moves, enabling the other muscles and tendons to contract or relax appropriately in order to further protect the joint.
Other components that preserve joint function include synovial fluid, the underlying bone, and the cartilage. Synovial fluid within the joint space serves as a lubricant to reduce the friction between articulating cartilage surfaces. The underlying bone may serve as subtle shock absorbers to decrease stress delivered to the joint. The cartilage is a stiff but compressible tissue that forms a smooth cap over articulating surfaces of the bone, cushioning the effect of impact on the joint. Its ability to reduce both friction and impact serves as another protective mechanism for the joint.
Failure of any or all of the protective mechanisms increases the risk for joint injury, and consequently, osteoarthritis. The amount of stress a joint is subjected to, both acutely or chronically, also plays a pivotal role in the development of osteoarthritis. Eventually, there is uneven and progressive cartilage loss, translating to the loss of its cushioning effect. This is accompanied by the thickening and irregularity of the underlying bony plate, stretching of the articular capsule, and muscle weakness. equal
What are the symptoms of osteoarthritis?
Osteoarthritis commonly affects the spine, hip, knee, and fingers. It usually presents with activity-related joint pain that is initially intermittent, but then later becomes constant as the disease progresses. Affected individuals may also complain of early morning joint stiffness that usually lasts less than thirty minutes. Buckling of the knees can occasionally occur in individuals with osteoarthritis of the knee.
How is osteoarthritis diagnosed?
Osteoarthritis is diagnosed based on the clinical presentation with or without the aid of radiographs. Sometimes, osteoarthritis can be diagnosed via x-rays even if the person is asymptomatic. Other laboratories workup may be requested to rule out other possible diagnoses if warranted, such as examinations of blood and aspirated synovial fluid.
What increases the risk of developing osteoarthritis?
Age is the most potent risk factor for developing osteoarthritis, due to the natural breakdown of the protective joint mechanisms. Normal reactive cartilage synthesis in response to joint loading is impaired, resulting in thinner and weaker cartilage. Muscles also become weaker, ligaments lengthen, and nerves become slower to respond.
Genes also play a role in its development, although it usually osteoarthritis of the hand and the hip that are inheritable.
Any anatomic abnormalities of the joint, either congenital (e.g. bowlegged individuals), or acquired (e.g. traumatic injury), will predispose one to develop osteoarthritis in the joint involved.
Obesity is another well-recognized risk factor in developing osteoarthritis. The weight-bearing joints of an obese person undergo more long-term overloading when compared to that of normal-weight individuals.
Repetitive joint movements, either as a result of occupational or recreational activities, are another contributory risk factor to osteoarthritis development.
How do you treat osteoarthritis?
Although there is no non-surgical cure for osteoarthritis available, there are many treatment options to relieve pain and preserve remaining joint function.
The simplest effective treatment for most individuals is to avoid the activities that precipitate pain. A cane may be recommended to reduce the load of weight-bearing joints such as the hip and knee joints. For obese individuals, weight loss is crucial to achieving maximal improvement. Measures to strengthen the muscles that serve as joint protectors are recommended, if feasible. Exercise has been shown to reduce pain and improve joint function in patients with knee osteoarthritis. Low-impact exercises, such as swimming and water resistance training, are better tolerated than high-impact activities such as jogging. Correction of any present malalignment via surgery, braces, or orthotic footwear, can help alleviate pain. Acupuncture constitutes one possible adjunct to standard therapy and has been shown to be more effective than placebo in patients with osteoarthritis of the knee.
Pharmacologic therapy remains a valuable adjunct in the treatment of osteoarthritis. The most commonly used drugs are acetaminophen (also known as paracetamol), and non-steroidal anti-inflammatory drugs or NSAIDs. They include mefenamic acid, ketorolac, ibuprofen, celecoxib, naproxen, and piroxicam among others. If acetaminophen fails to provide adequate pain relief, NSAIDs are then prescribed. Despite their effectiveness, care must be taken with chronic use, which is associated with significant gastrointestinal side effects. They include nausea, abdominal pain, bloating, ulcers, and even gastrointestinal bleeding. Consequently, NSAIDs are usually taken after meals.
Steroids injected into the joint space may ameliorate pain for the next one to two weeks. On the other, the efficacy of injection of hyaluronic acid into the joint space remains questionable.
Surgical interventions are usually reserved for severe osteoarthritis. They are performed either to correct malalignments or to replace the entire joint with a prosthetic one.
Despite the various treatment options available, all affected individuals still suffer differing degrees of disability. Delaying its onset and progression by correcting modifiable risk factors is advisable.
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