OSTEOARTHRITIS

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What is osteoarthritis ?
A joint is a place in the body where two bones connect .The most complex connections occur when the two bones must be able to move without rubbing against each other (very little friction).These are known as articular (moveable) joints.

OsteoarthritisCartilage is a smooth, lubricated substance located at the ends of bones within moveable joints. It allows the bones to move easily against each other. This surface also protects the bone by cushioning and spreading the force of impact , especially in large joints like the knees and hips. In Arthritis, the shock- distributing cartilage pad becomes damaged, changing the ability of the joint to move freely and without pain.


There are several types of Arthritis. Two keys groups are Osteoarthritis and Rheumatoid Arthritis.

Osteoarthritis is the most common type of arthritis, effecting over 20 million Americans. It is normally associated with age or “wear – and- tear” of the joints, but many factors contribut to its development. Osteoarthritis usually affects weight- bearing joints (knees, hips,feet and back)in middle aged or older adults.

Rheumatoid Arthritis is a condition where the body’s immune system attacks and damages the joint, causing inflammation in tissues which line space surrounding the joint (synovium)

What Causes Osteoarthritis?
In Osteoarthritis, the joint is often damaged by direct injury or trauma. Though osteoarthritis may be the result of a single injury, it is more commonly caused by repeated impact (such as in sports or occupational situations).The repeated impact can damage the smooth surface of the cartilage. This increases the friction between joint surfaces and damages the structure of the joint.

The breakdown of the cartilage may be increased by factors beyond wear and tear. For example, genetic abnormalities of cartilage (type II collagen mutation) have been identified. An abnormal component of cartilage reduces the smooth, friction- reducing qualities of the cartilage surface.

Immune responses, as well as accumulation of some forms of crystals (uric acid or hydroxypatite) within the joint, may also contribute to cartilage breakdown in some patients.

Additional factors that increase the risk of Osteoarthritis include obesity, advancing age, trauma and instability of the joint. Women are more commonly affected than men.

Recognizing the symptoms

Up to two thirds of individual over age 60 have signs of Osteoarthritis. In Osteoarthritis, the lining of joint space (synovium) is not highly inflamed (the limited swelling and tenderness). However, the bone surfaces beneath the cartilage often show signs of injury, which may include microscopic fractures.

Osteoarthritis is characterized by:

  • Joint stiffness: Often worsen with activity and may be noted to be worst on the day after increased activity involving the affected joint.
  • Pain: May be derived from surroundings structures (tendon, muscle) and generally decreases with rest.
  • A tendency to affect certain joints more frequently-particularly the hip, knee, the portion of the spine in the neck (cervical), and specific joints in the hands (distal and proximal interphalangeal joints).
  • Limited deformity of the joint. In early stages, Osteoarthritis is uncomfortable and may limit activity.

Diagnosing Osteoarthritis

A health care provider makes the diagnosis of Osteoarthritis by interviewing the patient and completing a full physical examination. X-rays may be helpful in evaluating the degree of joint damage.

A Number of laboratory tests may be used to analyze blood or joint fluid.These may tell the difference between Osteoarthritis and other causes of joint problems (such as Rheumatoid Arthritis)

How an arthritic joint may appear on an x-ray.

Treatment
Treatment of Osteoarthritis depends on the extent and severity of the disease.

Management involves pain reduction and efforts to avoid activities or situations which worsen the symptoms

Medication
All drugs can be grouped together by how they work (ie, their specific mode of action) The list below includes all the different types of drugs approved for use in the treatment of this condition at the time of publication (Updated information is also available online at: www.diseases-expalined.com

Always consult your healthcare provider if you have any questions or concerns about the medication you have been prescribed.

Drug Type Effect
Acetaminophen Blocks the body production of pain signals
Capsacin Applied to the skin, this agent may reduce the formation of chemical signal for pain
Corticosteroids (Prednisone) Decrease production of chemicals (prostaglandins and leukotrienes )as well as some activity of Inflammatory cells may be taken orally or given by injection (in some cases directly into an affected joint).
Nonsteroidal Anti- inflammatory Drugs(NSAIDs) NONSELECTIVE : Decrease production of chemical (prostaglandins)and some protective products involved in inflammation and the production of pain signals selective (cox-2 inhibitors): A specific group of NSAIDs which selectively decrease production of some specific chemicals (prostaglandins)invloved in inflammation and production of pain signals.
Other drugs Effect
Glucosamine and or chondroitin These dietary supplements have been shown to improve symptoms in some people with Osteoarthritis.

Risk factors:

  • Sports injury(particularly a repetitive injury to an individual , or group of joints)
  • occupational hazards(eg.repetitive actions)
  • obesity
  • Specific medical conditions(eg,sickle cell disease)
  • Advancing age
  • Women have a higher risk than men
  • Genetic inheritance
  • Immune system abnormalities

Self help
Many self help and support are available for patients and their families.

Exercise programs may improve well being and preserve movement. These should be carefully tailored to an individual’s needs and physical condition by a healthcare provider.

Physical therapy and specific exercises may be recommended to maintain the fullest possible range of joint movement, and to strengthen supportive muscles.

A number of devices are available to assist individuals with tasks (such as opening jars which may be more difficult when joint movement is impaired.

Braces or assist devices may provide joint stability to protect the joint from stress or strain.

Application of heat or cold packs may provide temporary pain relief

Weight control/loss may limit stress on the joints.

The effects of Arthritis on the joints of the body
In a nomal healthy joint, the fibrous(articular)capsule contains synovial fluid which lubricates and reduces friction in the joint.It also supplies nutrients and remove waste products from the articular cartilage.

In the articular cartilage deteriorates causing the bones to wear against each other.This can result in pain when pressure is exerted on the joint.

In RHEUMATOID ARTHRITIS the individual’s antibodies attack the joint tissue causing inflammation of the synovial membrane.

Prof. Kisan Rajaramji Patond, MS Ortho
Professor of Orthopedics
GMC Hospital Ajman

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