Osteoarthritis also called a degenerative joint disease is characterized by serious abnormalities in certain very specific areas of the body like the hands, feet and spine and, large weight bearing joints like the knees and the hips.
It occurs mainly due to the breakdown and the eventual loss of cartilage which finally leads to degradation of one or more joints in the body. Cartilage is a strong protein material that forms a lining at the end of bones thus acting as a “cushion” or a “shock absorber” between the bones of the joints.
The main function of cartilage is to prevent the joints from rubbing against each other which is attributed to the shock absorbing quality of the cartilage. This quality enables the cartilage to change shape when flattened or pressed together.
However, in patients suffering from osteoarthritis the cartilage between the joints becomes rigid and less flexible which further makes it vulnerable to damage. Gradually the cartilage may wear off totally in certain areas, largely diminishing its quality of acting as a cushion between the joints.
The worsening condition of the cartilage causes the ligaments and tendons to stretch, leading to acute pain and in an extreme situation — there could be friction in the joints due to the rubbing of the bones against each other.
Symptoms of osteoarthritis
The most important symptom of osteoarthritis is acute pain or a burning sensation experienced in the affected muscles and tendons, associated with loss of ability and stiffness. Osteoarthritis causes a sharp noise, whenever the affected joints are moved or touched along with spasms and contractions of the muscles and tendons.
Sometimes the joints may also be filled with fluid. These conditions aggravate in humid and cold weather. With the progress of the disease the joints may look to be swollen accompanied with stiffness and pain. The joint pains could increase with excessive activity, and also, due to complete inactivity.
Osteoarthritis in fingers causes hard bony enlargements called Heberden’s nodes and Bouchard’s nodes, which may or may not be painful even though they consistently limit the movement of the fingers.
Causes of osteoarthritis
Age seems to be a major cause that leads to the outbreak of primary osteoarthritis. With age the fluid content called the proteoglycans of the cartilage reduces, thus making it less flexible. Without the protection of the proteoglycans the cartilage loses its strength and hence easily yields to damage, which in turn enhances the degeneration process.
Repeated usage of the worn joints finally results in the disappearance of the cartilage cushion altogether. This leads to a direct friction between the bones of the joints. Under these circumstances an osteoarthritis patient experiences tremendous pain and lack of joint mobility.
Heredity also plays a major role in the development of osteoarthritis. Genes that is solely responsible for the formation of cartilage could have an inherent defect. These defective genes lead to the making of defective cartilage thus exacerbating the degeneration process. The presence of joint abnormalities from birth only doubles the chances of developing osteoarthritis.
Second to aging, obesity is an important factor that can cause osteoarthritis. The excessive weight of the body increases the intensity of mechanical stress on the cartilage. However, the progress of the disease can be easily checked if people work to shed off the extra weight.
Injury of the joints can also contribute to the development of osteoarthritis. Repeated injuries to the knee increase the risk of osteoarthritis of the knee. For example, soccer players who are always exposed to injuries become victims of early osteoarthritis of the knee due to continuous trauma to the joint tissues. Similarly people who have had severe back injuries are prone to develop osteoarthritis of the spine.
Overuse of a particular joint can ultimately lead to osteoarthritis of that joint. Certain jobs may demand continuous bending of the knee. In such cases osteoarthritis of knees are inevitable. This also involves other joints too. Crystal deposits like uric acid crystals and calcium pyrophosphate crystals causes cartilage degeneration which leads to arthritis of the gout and pseudogout respectively.
Diagnosis of osteoarthritis
The diagnosis of osteoarthritis is done on the basis of certain factors. These factors include – Description of the symptoms, Area where the pain is centralized and the type of pain, Physical examination.
An x ray of the affected joints can detect osteoarthritis. X ray findings could display loss of cartilage in the joints, narrowing of the space between the joint bones and formation of bone spurs. An x ray is necessary to rule out any other causes for joint pain and at the same time it helps to understand whether surgical intervention is required or not.
Sometimes blood tests are also suggested by doctors to determine the type of arthritis. If there is accumulation of fluid in the joints, the doctor may remove some of the fluid for a thorough examination under the microscope to exclude any other causes.
Treatments for osteoarthritis
There is no specific treatment for osteoarthritis that can stop the deterioration of the cartilage or for that matter repair the damage done to the cartilage of the joints. A healthy lifestyle and analgesics are the only recommended treatments for osteoarthritis.
Physiotherapy has proved to be an effective mode of treatment for chronic joint diseases like osteoarthritis. It has contributed significantly in improving the function of the joints, minimizing the intensity of pain and has also successfully stalled the requirement of surgical intervention in most advanced cases of osteoarthritis.
Exercises recommended by physiotherapists have proved to be much more useful than medications for osteoarthritis of the knees. Physiotherapists can also provide devices like splints, canes, walkers and braces to support the affected areas of the joints.
Education can increase awareness about the importance of self management of arthritis. Moderate exercise on a regular basis can go a long way in improving the mobility of the joints and also reduce pain consistently. For overweight people, losing weight should be an absolute priority if they want to keep osteoarthritis under control.
Analgesics and other medications are used to lower the effects of osteoarthritis. An analgesic called asetaminophen can be used for mild and moderate symptoms of osteoarthritis whose effectiveness is almost equal to NSAIDs.
Non-steroidal anti-inflammatory drugs or NSAIDs are required in severe cases of osteoarthritis even though they are associated with several side effects. NSAIDs like ibrufen and COX-2 selective inhibitors can work wonders for osteoarthritis pain relief.
However, they are associated with harmful side effects. NSAIDs like diclophenac that are mainly used topically have very less side effects and also contain at least some therapeutic quality. Oral steroids have displayed increased adverse effects and very few benefits when used for the treatment of osteoarthritis.
Topical medicines like capsaicin and joint injections of hyaluronic acid have not proved significantly effective. Tanezumab is a monoclonal antibody, whose function is to bind and restrain the nerve growth factor has shown positive results in relieving joint pains so much so that osteoarthritis patients of the knees have even displayed functional improvement of the joints.
However, this is a recent development and it is yet to be proved whether it can play an important role in relieving osteoarthritis pain. Surgery is the last option if the patient does not respond to any kind of treatment. Anthroscopy is generally performed when cartilage tears are suspected.
Osteotomy is a procedure that involves bone removal and it is thus used to realign the deformed areas of the bone. In some very severe cases wherein the joints are totally degenerated, replacement with an artificial joint is the only solution.
These are the facts and figures of osteoarthritis which largely proves that it is a non curable disease even though it can be said to be a preventable disease to a certain extent. So, once again the bottom-line is to maintain a healthy lifestyle and to keep your-self informed about the dos and don’ts of osteoarthritis. This will save you a lot of trouble which comes as an extra baggage along with this disease.
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