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Osteoarthritis

Osteoarthritis

Osteoarthritis is not a single disease but rather the end result of a variety of disorders leading to the structural or functional failure of 1 or more of your joints.

 

Osteoarthritis involves the entire joint including the nearby muscles, underlying bone, ligaments, joint lining (synovium), and the joint cover (capsule). 

 

Osteoarthritis also involves an advancing loss of cartilage. The cartilage tries to repair itself, the bone remodels, the underlying (subchondral) bone hardens, and bone cyst form. This process has several phases. 

 

  • The stationary phase of disease progression in osteoarthritis involves the formation of osteophytes or joint space narrowing. 

 

  • Osteoarthritis progresses further with obliteration of the joint space. 

 

  • The appearance of subchondral cysts (cysts in the bone underneath the cartilage) indicates the erosive phase of disease progression in osteoarthritis.

 

  • The last phase in the disease progression involves bone repair and remodeling.

 

Definitions 

 

  • Joint cartilage is a layer of tissue present at the joint surfaces that sustains joint loading and allows motion. It is gel-like, porous, and elastic. Normal cartilage provides a durable, low-friction, load-bearing surface for joints. 

 

  • Articular surface is the area of the joint where the ends of the bones meet, or articulate, and function like a ball bearing. 

 

  • Bone remodeling is a process in which damaged bone attempts to repair itself. The damage may occur from either an acute injury or as the result of chronic irritation such as that found in osteoarthritis. 

 

  • Collagen is the main supportive protein found in bone tendon, cartilage, skin, and connective tissue. 

 

  • Osteophytes are bony outgrowths or lumps, especially at the joint margins. They are thought to develop in order to offload the pressure on the joint by increasing the surface area on which your weight is distributed. 

 

  • Synovium is a membrane found within the joints that secretes a fluid that lubricates tissues where friction would otherwise occur. 

 

  • Subchondral bone is the part of bone under the cartilage.

Symptoms

The following signs and symptoms may be seen: 

 

  • Pain: Aching pain, stiffness, or difficulty moving the joint may develop in 1 or more joints. The pain may get worse with overuse and may occur at night. With progression of this arthritis, the pain can occur at rest. 
  • Specific joints are affected. 
  1. Fingers: Bone enlargements in the fingertips (first joint) are common. These are called Heberden nodes. They are usually not painful. Sometimes they can develop suddenly and are painful, swollen, and red. This is known as nodal osteoarthritis and occurs in women older than 45 years. 
  2. Hip: The hips are major weight-bearing joints. Involvement of the hips may be seen more in men. Farmers, construction workers, and firefighters have been found to have an increasedincidence of hip osteoarthritis. Researchers think that a heavy physical workload contributes to OA of the hip and knee. 
  3. Knees: The knees are also major weight-bearing joints. Repetitive squatting and kneeling may promote osteoarthritis. 
  4. Spine: Osteoarthritis of the spine can cause bone spurs or osteophytes, which can pinch or crowd nerves and cause pain and potentially weakness in the arms or legs.

Causes

The causes of osteoarthritis are varied:

 

  • Endocrine: People with diabetes may be prone to osteoarthritis. Other endocrine problems also may promote development, including acromegaly, hypothyroidism,hyperparathyroidism, and obesity. 
  • Posttraumatic: Traumatic causes can be further divided into macrotrauma or microtrauma. An example of macrotrauma is an injury to the joint such as a bone break causing the bones to line up improperly (malalignment), lose stability, or damage cartilage. Microtrauma may occur over time (chronically). An example of this would be repetitive movements or the overuse noted in several occupations. 
  • Inflammatory joint diseases: This category would include infected joints, chronic goutyarthritis, and rheumatoid disease. 
  • Metabolic: Diseases causing errors ofmetabolism may cause osteoarthritis. Examples include Paget's disease andWilson disease. 
  • Congenital or developmental: Abnormal anatomy such as unequal leg length may be a cause of osteoarthritis. 
  • Genetic: A genetic defect may promote breakdown of the protective architecture of cartilage. Examples include collagen disturbances such asEhlers-Danlos syndrome. 
  • Neuropathic: Diseases such as diabetes can cause nerve problems. The loss of sensation may affect how the body knows the position and condition of the joints or limbs. In other words, the body can't tell when it is injured. 
  • Other: Nutritional problems may cause osteoarthritis. Other diseases such ashemophilia and sickle cell are further examples.

Treatment

Self-Care at Home

 

Lifestyle changes may delay or limit osteoarthritis symptoms.

 

  • Weight loss: One study suggested that, for women, weight loss may reduce the risk for osteoarthritis in the knee. 
  • Exercise: Regular exercise may help to strengthen the muscles and potentially stimulate cartilage growth. Avoid high-impact sports. The following types of exercise are recommended: range of motion, strengthening, and aerobic. 
  • Diet: Antioxidant vitamins C and E may provide some protection. Vitamin D andcalcium are recommended for strong bones. The recommended daily dose of calcium is 1000-1200 mg. The current guideline for vitamin D is 400 IU per day. Avoid more than 1200 IU of vitamin D per day. 
  • Heat: Hot soaks and warm wax (paraffin) application may relieve pain. 
  • Orthoses: These assistive devices are used to improve function of moveable parts of the body or to support, align, prevent, or correct deformities. Splints or braces help with joint alignment and weight redistribution. Other examples include walkers, crutches or canes, and orthopedic footwear. 
  • Over-the-counter (OTC) medications 
  1. Acetaminophen (Tylenol) is the first drug recommended for osteoarthritis. 
  2. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for arthritis pain. These include aspirin, ibuprofen (Motrin or Advil), naproxen(Aleve), and ketoprofen (Orudis). 
  3. Newer OTC preparations include chondroitin and glucosamine sulfate, which are natural substances found in the joint fluid. Chondroitin is thought to promote an increase in the making of the building blocks of cartilage (collagen and proteoglycans) as well as having an anti-inflammatory effect. Glucosamine may also stimulate production of the building blocks of cartilage as well as being an anti-inflammation agent. Glucosamine was found to increase blood sugar in animal studies, so people with diabetes should consult their doctor first. A recent study showed that glucosamine slowed progression of osteoarthritis in the knee.
  • Arthritis self-help course: The Arthritis Foundation offers an educational program on the causes and treatment of arthritis. Exercise, nutrition, relaxation, and pain management programs are covered as well as ways to communicate with your doctor. Completion of the program reduced pain by 20% and doctor visits by 40%.
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