Osteoarthritis: Everything You Need To Know
Osteoarthritis is not a singular problem but a disease resulting from multiple joint failures like articular cartilage degeneration and proliferation of connective tissues, bones, and cartilage. Although people assume that the inflammatory changes and pain are the primary issues, the disease causes focal erosion, which would, over time, cause articular cartilage destruction.
Who needs to worry about osteoarthritis?
Osteoarthritis is expected after 40 years in both genders. However, it is more severe in senior females. It usually affects weight-bearing joints and small joints in the limbs.
Other causes are
- Developmental problems like Perthes disease, hip dysplasia, slipped femoral epiphysis, intra-articular acetabular labrum, and more.
- Traumatic problems like occupational stress, meniscectomy, and intra-articular fracture
- Metabolic problems like Wilson’s Disease, chondrocalcinosis, ochronosis, and hemochromatosis
- Inflammatory problems like rheumatoid arthritis, haemophilia, septic arthritis, and gout
- Aseptic necrosis like neuropathy, SLE, sickle cell disease, tabes dorsalis, diabetes, peripheral nerve lesion, decompression sickness, and more
Types of osteoarthritis
Based on the cause, osteoarthritis is segregated as primary and secondary. In the primary, osteoarthritis has no predisposing cause and is usually assumed to be due to chondrocyte metabolism abnormality. Secondary osteoarthritis is caused due to joint abnormalities like injury to the articular surface, obesity-incurred joint stress, rheumatoid, sepsis, and more.
As mentioned, it is not a single problem in a particular tissue. Instead, it is a combination of issues affecting the synovial joint. In the initial osteoarthritis stages, there is a cartilaginous matrix loss, leading to loosening and flaking of the cartilage. Over time, it leads to cartilage breaking, thereby exposing the subchondral bones. In the next stage, you can see bone changes as the joints create spurs in response to the cartilage damage. These spurs later ossify.
In the initial stages of osteoarthritis, you will not identify any synovium changes. However, in later stages, there is a chronic synovial effusion.
Based on the osteoarthritis Xray, there are four osteoarthritis grades.
- Grade 1: the possibility of joint space narrowing and osteophytic lipping
- Grade 2: confirmed osteophytes and joint space narrowing
- Grade 3: multiple osteophytes (moderate), joint space narrowing, sclerosis, and the possibility of bone contour deformity
- Grade 4: Definite marked joint space narrowing, large osteophytes, severe sclerosis, and confirmed bone contour deformity.
It is not an acute disease developing overnight. The gradual onset of this disease starts with deep intermittent pain during the initial stages of osteoarthritis and then gradually becomes persistent joint pain during movement and relief during rest. In the later osteoarthritis stages, the patients even experience discomfort during sleep.
The leading causes of pain are
- Inflammation of synovial and capsule
- Subchondral bones microfracture
- Stretching of ligament or periosteal nerves
- Muscle spasm
- Periarticular muscles atrophy
- Bony crepitus of joints
In the later osteoarthritis stages, the patients experience bone hypertrophy, subluxation, gross deformity, and substantial loss of joint movement.
The first stage of diagnosis is osteoarthritis Xray in which the doctor can detect the problem and the affected joints. According to a study, by the age of 40, it is possible to have evidence of osteoarthritis on your X-ray. Early diagnosis is essential for easy management; thus, it is best to have a screening test when you reach 40.
Xray cannot identify cartilage abnormality during the initial stages of osteoarthritis and can sometimes identify severe osteoarthritis as mild. The best alternative for this is MRI; however, most diagnosticians rarely use MRI as a part of routine osteoarthritis diagnosis.
Osteoarthritis Xray can identify
- Subchondral sclerosis
Unfortunately, no pill can reverse, prevent, or cure osteoarthritis. The treatment usually focuses on pain management, mobility maintenance, and reducing disability by improving joint function. Any change already caused by the disease is irreversible; however, the proper treatment can reduce the speed of prognosis.
Common recommendations offered to patients are
- Correcting posture and increasing support for lumbar lordosis
- No stress or loading on the damaged joints
- Wedge insole is recommended for those with knee osteoarthritisAvoid prolonged squatting, standing, or kneeling
- Cushioned running shoes
- Physical therapy and exercise
- Walking stick for those with an affected knee or hip
- Protecting the affected joint by using rubber heels, change in occupation, and modifying lifestyle.
- Change in diet – reducing salt, sugar, and fried foods and increasing items that contain omega-3 fatty acids
Physical therapy for osteoarthritis includes heat application, ice packs, hot baths, and more. Standard exercises that patients should follow are
- Isometric exercises
- Quadricep and hamstring exercises for those with knee osteoarthritis
- Hydrotherapy to improve stiff joint movements
Obesity is an important factor that increases the severity of the problem. Thus, obese patients are recommended to lose weight to reduce the lesion severity and speed of progression. According to a study, a 28% weight loss in obese osteoarthritis patients can lead to a 40% decrease in lesion severity.
As mentioned, you cannot stop or slow down the progress of the disease. However, you can improve the quality of life with painkillers like acetaminophen, duloxetine, Tramadol, and more. However, remember that any analgesic, no matter how minimal dose you take, can have severe side effects, habit-formation, and others. Thus, most doctors recommend topical medications like sprays and ointments with capsaicin, diclofenac, salicylates, and more.
Corticosteroids can reduce inflammation, and quick relief of pain and hyaluronic acid can help to improve joint fluid viscosity. However, these two are not yet FDA-approved, and it is best to avoid them.
If you wish to reduce pain without medication, you can try acupuncture, radiofrequency ablation, braces, massage, relaxation technique, hot/cold application, and more.
Suppose you are looking for a cure to the problem; the only option available is joint surgery. There are three options for surgical treatment.
- Arthroplasty – This procedure involves replacing the affected joint with an artificial one
- Arthrodesis – This procedure involves joint fusion to reduce pain. However, this procedure can make mobility difficult. Most doctors recommend this when Arthroplasty cannot be done for any reason.
- Osteotomy – In this case of knee replacement, a small segment can be added or removed instead of replacing the whole knee. This method is not as effective as Arthroplasty.
- Arthroscopy – A less-invasive treatment with a small pen-sized scope to remove damaged cartilage, fragments, and cysts. However, it is not quite recommended for all.
Surgeries generally come with a long list of problems like anaesthesia complications, nerve injury, infection, etc. Beyond these, there is a chance of allergic reaction to the artificial joint, secondary surgery in case of ineffective outcomes after the first, etc. However, remember that these complications have less probability of occurrence.
Always start with consulting an orthopedician and get started with diagnosis and treatment. Self-medication and some random alternative options you found on YouTube will be ineffective and dangerous.
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