Arthritis is a term used to describe biomechanical changes in a joint. Osteoarthritis (OA) is by far the most frequent type of arthritis. There are several contributors to osteoarthritis such as the aging process.
What is osteoarthritis?
Osteoarthritis is also known as degenerative joint disorder (DJD) is the most frequent form of arthritis. Osteoarthritis will more often become a problem as we age. The changes associated with osteoarthritis generally happen slowly over the course of many years although there are a few occasions when it is not the case. Inflammation and trauma to the joint can cause changes in the bones, degeneration of ligaments and tendons as well as the breakdown of cartilage leading to swelling, pain, and joint deformity.
There are two main types of osteoarthritis:
- Primary: Most commonly generalized, mostly is affecting the thumbs, fingers and spine, as well as knees, hips and the big (big) toes.
- Secondary: Occurs in conjunction with an already-existing joint problem such as trauma or injury that is sporting or repetitive arthritis, including Rheumatoid, psoriatic or Gout and infectious arthritis. genetic joint disorders like Ehlers-Danlos(also called hypermobility or “double-jointed congenital joint disorder as well as metabolic joints disorders
What is cartilage?
Cartilage is a hard and flexible, rubbery connective tissue that is found at the end of bones in joints that are normal. It is made up of proteins and water whose principal function is to decrease friction in joints as well as act as an “shock absorber.” The shock-absorbing property of normal cartilage stems from its ability to alter its shape when compressed because due to its high content in water. While cartilage is subject to some repairs when damaged however, the body doesn’t develop new cartilage following injuries. Cartilage is avascular. This means there aren’t blood vessels inside it. This means that healing can take a long time.
Cartilage is comprised of two primary elements that are cells inside it referred to as chondrocytes as well as an emulsion-like substance known as matrix made up of mainly water and two kinds of protein (collagen as well as proteoglycans).
- Chondrocytes, as well as the precursor form of chondroblasts are multifunctional cartilage cells that are complex and multi-functional. Their main function is to synthesize and maintain the extracellular matrix composed of collagen and proteoglycans which aid healthy cartilage to grow and recover.
- Collagen is a structural protein present in various tissues like the skin, tendons, and bone and is a crucial cartilage’s main structural component. Collagen gives cartilage its durability and also provides a framework for other components.
- Proteoglycans are intricate molecules made of sugar and protein that are interspersed within cartilage’s matrix. They are used to hold huge amounts of water within cartilage, allowing it to alter shape when compressed, thereby acting as an absorber of shock. Additionally, proteoglycans repel each other and allow cartilage to retain its form and its strength.
Who is affected by osteoarthritis?
Around 80% of older adults, aged 55 years and over, exhibit signs of osteoarthritis in X-ray. From these, approximately 60% suffer from symptoms. There is a chance that as many as 240 million people around the world suffer from osteoarthritis that is symptomatic and the more than thirty millions U.S. adults. Women who are postmenopausal have a higher rate of knee osteoarthritis when than males.
What are the risk factors for osteoarthritis?
Alongside the effects of age and other causes like inflammatory arthritis, prior injuries or trauma, other risk factors also increase the risk of developing osteoarthritis, including diabetes, obesity, high levels of cholesterol and sex as well as genetics.
- Obesity has been identified as an important risk factor for osteoarthritis, especially in the knee. Along with putting stress on the mechanisms that support weight bearing within the body, metabolic and pro-inflammatory consequences of obesity are being studied as contributing factors to osteoarthritis. The goal of maintaining a healthy body weight or losing excess weight is crucial for people who are at risk.
- It is believed that both the conditions of diabetes along with hyperlipidemia (elevated cholesterol/lipids) can trigger an inflammation in the body and increase the chance of developing osteoarthritis. The oxidation of lipids may cause cartilage to develop a layer of deposits that can affect blood flow in subchondral bone the same way as blood vessels get affected due to atherosclerosis. The elevated blood sugars and high cholesterol or lipids, cause an increase in free radicals inside the body and this stress on the body exceeds the strength of cartilage on the level of the cell. The control of hyperlipidemia and diabetes is crucial to ensure bone health and to general well-being.
- The decrease in estrogen is experienced by post-menopausal females increases the chance of developing knee osteoarthritis because estrogen protects bone health and specifically reduces the oxidative stress on cartilage.
- The genetics of our family can play a part in osteoarthritis, since people born with bone diseases or genetic characteristics may become more prone to developing osteoarthritis. For instance, Ehlers-Danlos that is characterised by joint hypermobility or laxity, may cause osteoarthritis.
What causes osteoarthritis?
Primary osteoarthritis is a heterogeneous condition which means it has a variety of reasons, and isn’t just “wear and tear” arthritis. A few of the causes of OA can be changed (can be altered) and some aren’t (cannot be altered, such as being the fact that you were born with it or are now permanently). The age of an individual is a major element, but there are a few older adults who have osteoarthritis. For the ones who have, only a small percentage suffer from discomfort. As we’ve discussed there are also metabolic and inflammation dangers that could cause an increase in the rate of osteoarthritis. This is especially true when it is associated with hypercholesterolemia and diabetes.
Osteoarthritis is a genetic condition that can manifest as a primary condition, such as nodular OA in the hands and as secondary to other genetic diseases including joint hypermobility. Inflammatory and infectious arthritis could be a contributing factor to the development of secondary osteoarthritis as a result of chronic joint inflammation and destruction. Traumas or injuries that have occurred prior to repetitive or sports-related injuries can be a contributing factor to osteoarthritis.
While the precise mechanisms behind the loss of cartilage and changes in bone are not known, advances have been made over the last few years. It is believed that complex signaling pathways, triggered by joint inflammation and ineffective repair mechanisms that respond to injury, degrade cartilage inside the joints. Other changes can cause joints to lose its mobility and function which causes joint pain during activity.
How do I know if I have osteoarthritis?
In contrast to other forms of arthritis, arthritis pain usually manifests slowly over a period of months or even years. It is often triggered by the activities that stress the joint, like running or walking for long periods. Joint swelling and pain tend to decrease slowly as time passes. In some cases, particularly in advanced conditions, a feeling of grinding or crunching can be felt in joints affected by the disease. The stiffness that is experienced in the morning isn’t an obtrusive symptom of OA in comparison to arthritis that is inflammatory, like the psoriatic arthritis or rheumatoid. Osteoarthritis typically does not cause weight loss, fevers or extremely red and hot joints. These signs suggest an alternative form of arthritis or condition.
Your doctor (MD Do, MD or NP PA) is able to typically identify osteoarthritis after taking a thorough list of your symptoms and looking at your joints. X-rays can be useful to confirm that there is no any other cause for your discomfort. Magnet Resonance Imaging (MRI) can be usually not necessary, except in exceptional circumstances or where the cartilage or tears in the ligament are suspected. It is the sole blood test to detect osteoarthritis. If a joint appears to be particularly swelling, a physician may have to drain the fluid from the joint. It is possible to test the fluid to find clues to other forms of arthritis, for instance Gout.
How is osteoarthritis treated?
There is no treatment for osteoarthritis. Moderate to mild symptoms are typically treated with a mix of non-pharmacologic and pharmacologic treatments. The medical treatments and suggestions comprise:
- Medicines (topical pain medications and oral analgesics that include nonsteroidal anti-inflammatory medicines, NSAIDs).
- Workout (landand water based).
- Intermittent cold and hot packs (local modality).
- Occupational, Physical as well as exercise therapy.
- Weight loss (if overweight).
- Healthy eating, controlling cholesterol and diabetes.
- Braces are supportive devices that include braces or orthotics and cane, shoe inserts or the walker.
- Intra-articular injection treatments ( steroid, the hyaluronic acid “gel”).
- Alternative and complementary medicine strategies include vitamins and supplements.
Surgery is a possibility in relieving pain and restoring function after other medical treatment options aren’t working or exhausted particularly for advanced OA.
The main goals of treatment are:
- Reduce stiffness and joint pain and stop further progression.
- Improve your mobility and improve your function.
- Improve the living quality.
The kind of treatment plan recommended is determined by a number of variables, including your age and general health, activity, occupation and the extent of the disease.
As opposed to other forms of arthritis, where significant progress has been made in the last few years however, progress has been slower with osteoarthritis. There are no drugs in the market that have been demonstrated to slow or reverse the progress of osteoarthritis. At present, the focus of medications is on reducing the symptoms of the condition. For pain relief, medications include acetaminophen and non-steroidal anti-inflammatory medications (NSAIDs). These medications are not advised due to the long-lasting nature of the condition and the potential for tolerance and dependence. Topical medicines consisting of analgesic patches creams, rubs or sprays could be applied on the skin of the areas affected to ease the pain.
While many of these medicines are available over-the counter patients suffering from osteoarthritis must consult a medical doctor prior to taking any medications. Certain medications could cause dangerous or unwelcome side effects, or could interact with other medications that are taken. Certain over-the-counter medicines still require regular lab tests.
The antidepressant duloxetine Hydrochloride (Cymbalta(r)) is approved by FDA on October 10, 2010 for relieve osteoarthritis-related pain, for example, low back discomfort. This has been a huge aid for those who cannot take the NSAIDs or other treatments.
The use of assistive or supportive devices helps relieve joint pain. Orthotics and braces help assist and stabilize joint pain and damage. The use of medical devices is according to the guidance of a health professional, such as a physicalor occupational therapy therapist or authorized healthcare provider. Inserts and shoe lifts, a cane , or walker could be beneficial to relieve the pressure off joints and help improve gait and body mechanics.
Exercise is essential to increase the flexibility of joints, their stability, and the strength of muscles. Exercises like water aerobics, swimming and low-impact strength exercises are highly recommended. They have been proven to lessen the degree of disability and pain sufferers with osteoarthritis feel. Exercise programs that are too vigorous should be avoided since they can increase the severity of arthritis and may accelerate the progress of the condition. Therapists, occupational or physical therapy can offer appropriate and individualized workout regimens for those suffering from osteoarthritis.
Hot and cold therapies
The use of intermittent cold and hot treatments could provide temporary relief from stiffness and pain. These treatments may can include a hot bath or bath, as well as the cautious application of cooling or heating pad or pack.
As obesity is a well-known danger factor in osteoarthritis trying to manage weight can help to in preventing and easing osteoarthritis. Weight loss for overweight individuals with osteoarthritis has been proven to decrease stress and joint pain that occurs due to weight bearing and also to reduce the inflammation processes that lead to OA.
When the pain of osteoarthritis isn’t controlled by medical treatment and interferes with routine activities, surgery might be an alternative. Surgery is generally reserved for those with significant osteoarthritis. Different types of procedures are available to treat joint problems, including minimally-invasive replacement methods. While it’s not without risks but joint surgery in the present can be extremely effective in improving some functions and reducing the pain of those who need it.
Nutraceuticals, supplements and other alternative medicines (a term that is derived in “nutrition” and “pharmaceutical” is a term used to describe compounds that can be purchased from shops for health foods and pharmacies, without prescriptions and are not approved from the FDA for use as medicines. They are nutritional supplements such as vitamins, minerals, and other substances that are sometimes called “natural,” “homeopathic,” or “alternative” therapies. Because this market isn’t as controlled than drug and food industry there are many different preparations available and the amount of active ingredients can vary however there’s not a assurance that the product is accurate. the label or the product.
The chondroitin and glucosamine components are part that make up normal cartilage. As supplements, they are available in the form of compounds made of sulfate. The results of clinical research on chondroitin and glucosamine appear to differ, but some studies have suggested pain-reducing properties, especially for knee osteoarthritis. The exact mechanism of their action is undetermined and there isn’t solid scientific evidence to support the assertion that they help make cartilage and bone. In general, glucosamine as well as chondroitin are healthy and safe, however they must first be discussed with your doctor.
Fish oils may have anti-inflammatory effects, but they’ve been examined in greater detail for rheumatoid arthritis. Supplements may interact with prescription drugs and may cause adverse effects They should first be discussed with your physician.
Other alternative therapies include the use of acupuncture Acupressure, acupressure and mediation.