Osteoarthritis

If you or your loved ones suffer from joint pain due to osteoarthritis, you are not alone. More than 30 million people in the United States suffer from osteoarthritis, making it the leading cause of chronic disability in older adults. It is the most common form of arthritis affecting joints. It is also known as degenerative arthritis or degenerative joint disease. It affects all components of joints like cartilage, joint lining, ligaments, and muscles. It makes joint cartilages soft and pitted, leading to loss of cartilage from both ends of bones. Joint lining can be sensitive, leading to inflammation and thickening. Muscular tension is lost to hold the joint in place, and nerves are over-sensitized. As a result, restricted movement or complete immobility because of the pain occur. The most frequently affected joint by osteoarthritis is the knee joint, the hip joint, and other joints of the hand and spine.

Some common types of osteoarthritis are:

• Hip osteoarthritis.
• Foot and ankle osteoarthritis.
• Osteoarthritis of the knee or degenerative arthritis of the knee
• Hand osteoarthritis
• Spinal osteoarthritis.
• Shoulder osteoarthritis
• Cervical osteoarthritis is also called cervical Spondylosis.

Osteoarthritis was previously thought to result from an imbalance between mechanical forces and joint strength, leading to excessive wear and tear of the joints. However, new research studies yield increasing evidence that points to the contributions of inflammation in the pathogenesis of osteoarthritis. Some inflammatory chemicals called cytokines and metalloproteinases have been found in the joints that are responsible for inflammation and excessive matrix degeneration, which is the pathognomic of osteoarthritis.

The most important causative factor in developing osteoarthritis is the daily stresses on the joints, especially the weight-bearing joints (e.g., ankle, knee, and hip). Excessive weight and pressure of the normal joint or normal stress on a previously disturbed joint can lead to degenerative alterations and inflammation in the joints, causing osteoarthritis. Some of the risk factors like obesity, diabetes, poor posture may accelerate the process of degeneration. 

Osteoarthritis affects about 237 million people globally, around 3.3% of the world's population, making it the most common form of arthritis. 30 to 53 million people are affected by osteoarthritis in the United States. It is a common disorder in older people, affecting around 80-90% of people older than 65 years. The frequency of the disease increases with increasing age.

It is found more in women. Women are notably susceptible to knee joint arthritis and distal small joints of hands. Osteoarthritis is found more in Native Americans. 

Some common risk factors include:

• Old age
• Sex; Women more than men
• Joint injuries
• Genetics
• Metabolic disorders. For example, hemochromatosis.
• Obesity
• Repeated stress on joints
• Bone deformity
• Menopause
• Poor posture
• Underlying diseases like diabetes or Rheumatoid arthritis
• Occupation related to kneeling, Climbing, heavy weight lifting

Some common symptoms include: 

• Pain and stiffness: Pain in the joint increases with mobility, whereas stiffness occurs when the joint is on rest.
• Swelling: When there is extra joint fluid due to inflammation, the synovial membrane of the joint gets irritated, and this outpouring of excess fluid causes swelling. The knee joint is most commonly affected.
• Cracking, Crepitus, clicking, or popping sounds with joint mobility: Loss of cartilage and restricted Gliding joint movement produce creaking sensations in the joint.
• Due to changes in joint mobility, bones can alter their shape. These altered bony shapes are called osteophytes.
• Bone swellings
• Change in bone shape called Bony spurs.
• Reduction in joint movement.
• Muscle weakness.
• Bone deformation  

These symptoms of osteoarthritis can affect the everyday life of an individual, causing fatigue, anxiety, depression, insomnia, and tiredness. Mobility can be maintained without aggravating the damage to joints if early treatment is taken.

Red flags: You must consult a doctor if you develop the following:

• Sudden, severe redness, swelling, and tenderness in the joint.
• Severe pain after an injury.
• Pain continues even after rest.
• Difficulty in standing and walking due to pain.

There is no particular blood test to diagnose osteoarthritis, but some blood tests will help to rule out other diseases closely related to osteoarthritis, like rheumatoid arthritis. And detailed close physical examination can help point out the diagnosis of joint pain.

• Imaging: X-rays cannot reveal cartilage, but they can show low joint spaces and bone spurs around joints, which will aid in diagnosis.
• MRI: It helps further understand the cartilage pathology as detailed bone and cartilage images are produced by a strong magnetic field in MRI.
• Synovial Joint fluid analysis: The fluid analysis will not exactly diagnose the case of osteoarthritis, but it helps to rule out infections and pain that could be due to gout or any other cause rather than osteoarthritis.

A lot many disorders can look like arthritis, for example:

• Rheumatoid Arthritis (RA)
• Gout and Pseudogout
• Psoriatic Arthritis
• Lyme Disease
• Septic arthritis
• Fibromyalgia
• Avascular Necrosis

The signs and symptoms associated with arthritis can be managed with medications, and the deteriorated lifestyle due to the disease could be improved. The management includes:

1. Medicines

• Acetaminophen (It is used for mild to moderate pain of osteoarthritis)
• Non-steroidal anti-inflammatory drugs (NSAIDs) are very effective for a flare-up.
• Duloxetine is used to get rid of chronic pain. Cymbalta is an antidepressant approved by FDA used for chronic musculoskeletal pain.

2. Therapy

• Physical exercise:  With certain exercises, the joint’s flexibility is improved, and in turn, the pain is relieved.
• Occupational therapy: Managing pain with certain forms of disability.
• Transcutaneous electrical nerve stimulation.
• Massage therapy

3. Surgery

• Realigning bones (Osteotomy)
• Joint replacement: Damaged joint surfaces are removed surgically. It includes knee replacement and hip replacement.
• Hyaluronic acid injections provide a cushion around the knee and act as a lubricant.
• Corticosteroid injections are used for the relief of pain.

4. Topical agents include ibuprofen gel, capsaicin cream, diclofenac spray, or gel.

5. Complementary Medicine

Alternative medicine includes:

•  Acupuncture
• Supplements containing glucosamine, chondroitin, and fish oils. Chondroitin has a role in reducing pain. Glucosamine and chondroitin have a drug interaction with blood-thinning medications like warfarin.
• Hot bath.
• Cool packs on the affected joint.
• Omega-three fatty acids, green tea, and ginger help improve motility and joint function.
• Avocado and soybean oils act as an anti-inflammatory to relieve joint and hip pain.
• Epsom salt baths also remove Inflammation and relief pain.
• Using athletic support Like knee braces and shoes.

The outcome is related to the joints involved and the presence or absence of risk factors. The presence of older age, obesity, and previous deformity results in more severe disease. Untreated disease can lead to complications like:

• Heme arthrosis
• Bone death
• Osteonecrosis
• Erosion of ligaments
• Erosion of tendons
• Hairline fractures (also called stress fractures)
• Weight gain due to poor mobility

 Some people suffer from other consequences like poor sleep due to pain, anxiety, and depression.

Joint replacement procedures have been successful in patients with multiple joint involvements. But the joint prosthesis needs a proper follow-up and may require revision after 10-15 years, depending on the patient’s activity. 

Adopting some habits may improve life with osteoarthritis.

• Weight management: If weight is maintained, pressure doesn’t arise on the weight-bearing joints like knees, hips, and ankles.
• Adequate sleep.
• Heat and cold therapy.
• Physical exercise.
• Gentle stretching has a tremendous effect on osteoarthritis as it relieves pain in the knees, hips, and back stretching. Increase the range of motion of restricted joints.
• Using flavonoids: Flavonoids present in fruits and vegetables have a good effect on the osteoarthritis of the knee.
• Consuming foods high in vitamin C, vitamin D, and beta carotene.