All You Need To Know About Osteoarthritis
Osteoarthritis (OA) is the most prevalent form of arthritis. As a matter of fact, over 75 per cent of people above the age of 55 show the joint deformations of OA on X-rays. However, most of these people do not experience any symptoms. OA can be a crippling disease for those experiencing the joint pain and stiffness that comes with it. Some people have OA in only one joint, whereas others suffer from it in multiple joints. Majority of OA patients are above the age of 45 and women.
In this article, we will cover:
- The development of OA
- The diagnosis of OA
- The treatment of OA
Which part of the body does it concern?
Typically, OA can occur in the small joints of the hands, the spine, the knees, the hips and some joints in the toe. It mainly affects the articular cartilage. Articular cartilage is the slippery, cushioned surface that covers the ends of the bones in most joints and allows the bones to slide without rubbing. In addition, it also functions as a shock absorber.
In OA, the articular cartilage becomes worn away or damaged. As this happens, the joint no longer moves smoothly or fits together well. In the initial stages of OA, the cartilage becomes thicker as the body attempts to repair the damage. However, these repaired areas are more brittle than the original cartilage and they start to thin and wear away. They may even wear away completely. Eventually, this leads to a condition known as eburnation. In eburnation, the bones become thick and polished as they rub together. These changes in the cartilage and bones can be seen through X-rays.
However, OA is not simply a disease of the cartilage. The damage to the cartilage seems to start some kind of chain reaction involving all parts of the joint. Often, bone spurs or outgrowths start to form around the edges of the joint. The joint capsule, which is the watertight sack around the joint, can become thickened and lose its stretch. On the other hand, the synovial membrane lining the inside of the joint capsule may become inflamed, meaning it is swollen, red, hot and painful. In addition, crystals may form in the synovial fluid. On top of that, the tendons and ligaments around the joint can also become inflamed.
Furthermore, the muscles around the joint can weaken. Typically, this occurs because of under-use of the muscles due to pain in the joint. Whenever a part of the body hurts, we subconsciously alter the way we use the joint to avoid the pain. As a result, the muscles are weakened. The cartilage itself does not have any nerves to feel pain. Thus, the pain of OA probably comes from these other changes in and around the joint.
What causes osteoarthritis?
Unfortunately, the specific cause of OA is unknown. The causes may differ according to each individual. Usually, doctors categorise OA into two types, primary OA and secondary OA. Primary OA is where there is a breakdown of the joint from a disease process. Secondary OA, on the other hand, means that a problem, such as a fracture or an infection, caused damage to the joint. Even when the original problem heals, the chain reaction of OA can still cause the disease to progress.
Another possible cause of OA is major injuries and repetitive stress. Someone who breaks their ankle is likely to develop OA in that same ankle. Similar to machines, a damaged and unbalanced joint wears out quicker. As such, those who consistently place heavy stress on the same joint, such as baseball pitches or jackhammer operators, are at risk of developing OA in that joint.
In addition, severely overweight people have a higher risk of developing OA of the hip and knees. A study following overweight young adults for thirty-six years showed that obesity during youth was closely linked to the development of OA later in life. The same study also found that just losing small amounts of weight can decrease one’s chances of developing OA.
Especially in women, genes may play a role in the development of OA. OA in the fingers, for example, affects ten times more women than men. It has been proven to occur more frequently among women of the same family line. Furthermore, genes are known to cause issues with cartilage formation.
In certain cases, rare metabolic disorders or other issues with the bones or joints can cause OA. However, the main factor in most OA patients still seems to be age. People who are older have a higher risk of developing OA.
What are the symptoms of osteoarthritis?
Patients suffering from OA have one or more joints that are stiff and painful. The pain is a deep, dull ache that is typically gradual. This pain is worsened when the joint is used but gets better upon resting. Usually, the joint may feel stiff after waking up or not being used for some time. However, this stiffness normally disappears within a short amount of time. Over time, pain and stiffness may become almost constant.
Regardless of the affected joint, people with OA usually experience similar symptoms:
- Pain that worsens in cool, damp weather or during and after movement
- Swelling, enlargement or change in the shape of the joints, with tenderness in the enlarged areas
- A grating sensation, crackling or popping when the affected joints are used (called crepitus), most commonly in the knees
- Inability to move the affected joints through a normal range of motion
- The affected joints being able to move too much or in the wrong direction (in more severe, unstable cases)
Certain symptoms may also depend on the affected joint. Patients with OA in the knee may experience issues with the joint locking up, especially when stepping up or down. Patients with OA of the hip usually walk with a limp. As for patients with OA of the hands, the strength and movement of the fingers can be affected, making it difficult to perform simple tasks such as getting dressed. Lastly, patients with OA of the spine may experience pain, weakness and numbness in the neck and lower back.
How is osteoarthritis diagnosed?
A few X-rays may seem like all that is needed to diagnose OA. However, it is crucial for other forms of arthritis to be ruled out. The doctor will also need to figure out if it is a case of secondary OA, where the OA was caused by another issue. Even for primary OA cases, the doctor will have to check for problems in other areas of the joint that may have been caused by the breakdown of cartilage.
The patient may be asked several detailed questions regarding their health history. It is important to explain the nature of the pain. Afterwards, the affected joints will undergo a careful examination. X-rays will probably be taken. In addition, blood samples and samples of the synovial fluid in the joint may be taken to check for any other issues.
How can osteoarthritis be treated?
Although OA is a chronic disease and there is no known cure for it yet, it is very treatable. In treatment for OA, the goal is to relieve pain and improve or maintain the movement of the joint.
A large portion of the treatment for OA does not require any prescriptions. The doctor will recommend some of these steps to help manage symptoms:
- Use heat and cold packs.
- Tape the knee, if it is affected.
- Wear wedged insoles in shoes, if the hip or knee is affected.
- Participate in aerobic exercises.
- Do strengthening and range of motion exercises. These are commonly taught and monitored by physical or occupational therapists.
- Lose some weight.
- Go for massages.
- Use equipment to reduce pressure on the joints, such as a cane or special gadget to open jars.
- Join education programs or support groups.
There are drugs available to help with alleviating the pain. The doctor may first recommend an over-the-counter pain reliever such as acetaminophen (also known as Tylenol). If this is not effective, nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, may be prescribed. Unfortunately, the main issue with NSAIDs is that they can be very hard on the stomach and kidneys over time. Furthermore, OA patients may have to take these drugs over the course of many years. In unusual cases of severe pain, stronger pain medications may be prescribed. However, these can be addictive and must thus be used with caution.
All these medications may interact with other drugs. As such, it is important to inform the doctor of other medications one is taking and work together to set up dose amounts and schedules.
In recent years, OA patients have used two unique compounds, glucosamine and chondroitin sulfate, which are gaining more acceptance among many doctors. These two compounds are dietary supplements in pill form that have proven benefits of reduced pain and increased joint mobility. Although these treatments are controversial, some doctors feel there are sufficient benefits to recommend them as supplements for patients.
In some cases, steroid injections into the joint have proven to ease the pain. Rubbing capsaicin cream into the joint can also provide pain relief. At times, doctors may also recommend tidal joint lavage, which involves rinsing the joint with saline. Alternatively, there are also approaches such as electrical nerve stimulation and pulsed electromagnetic fields.
For cases where pain fails to be relieved and joint function is unable to be maintained, surgery may be recommended. Although this option may sound daunting, surgery has proven to be very effective in treating OA.
Several kinds of surgical procedures have been designed to treat OA of different joints. Artificial joint replacement is possibly the most widely-known treatment. It is used as the last resort in treating OA after the joint is completely destroyed. However, other surgical procedures exist to treat OA in the initial stages to reduce symptoms and slow the progression of the disease.
Although managing OA takes some work, it is not impossible. It is good to note that OA does not always worsen over time. In many cases, the condition stabilises. In fact, in some cases, especially in OA of the knee, the disease may actually reverse itself. Even if OA continues to progress, it usually does so very slowly.