What is Osteoarthritis ?

It is the most common form of arthritis, usually seen in old people. It is called as degenerative joint disease or as osteoarthritis. “Arthron” is a greek word which means joint and “it is” means inflammation. In general it is joint disease that affects the cartilage. Cartilage is nothing but a tissue or a protein substance that covers the end of the bone in a joint and acts like a cushion. In osteoarthritis, the surface layer of the cartilage breaks and wears away. Due to this the bones under the cartilage rub against each other causing severe pain, swelling and the joint cannot be moved. Osteophytes (bone spurs) may be formed at the edges of the joint and the joint can also loose its shape. It is seen commonly in aged people and unlike other type of arthritis it affects only the joints and not the internal organs. It can affect any in the body including knees, hips, spine, feet, lower back and fingers.

Types
Osteoarthritis can be distinguished by two types. They are:
• Primary osteoarthritis.
• Secondary osteoarthritis.

If the cause for arthritis is not known then it is Primary osteoarthritis.
If the cause for arthritis is known then it is secondary osteoarthritis.

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Causes The exact cause for osteoarthritis is not known. But based on the research data it is suspected that it is a combination of factors such as excess weight, ageing process, muscle weakness and heredity. Primary osteoarthritis is mostly due to ageing. Overtime, the smooth surface of the cartilage roughens and starts deteriorating. The cartilage will completely wear out and the bone starts rubbing against each other. This will damage the end of the bone and the joints will start paining. Some researches have believed that the cartilage damage may be due to the mechanical stress. These stresses causes the enzymes released from the cartilage cells to get imbalanced. The exact cause for the enzyme imbalance is not known. Secondary osteoarthritis is caused due to any other disease or condition. The other disease or conditions include • Diabetes. • Obesity. • Surgery to any joints. • Congenital abnormalities. • Hormone disorders. • Gout.
Diabetes is associated with early cartilage wear. Obesity can cause osteoarthritis by increasing the mechanical stress on the cartilage. It mainly affects the knees. Repeated surgeries to joint tissues such as bones, cartilage and ligaments can lead to early osteoarthritis of the knees especially in football players and long distance runners. People with congenital abnormalities tend to suffer with early degeneration and loss of joint cartilage. It is found that certain crystal deposits also can lead to cartilage degeneration such as white calcium pyrophosphate crystals cause arthritis in pseudo gout and uric acid crystals can cause arthritis in gout. Symptoms This disease usually develops slowly and everybody who had osteoarthritis may not have sign or symptoms. The symptoms can vary between patients to patients. However, it can cause the following symptoms: • Pain in the affected joint after continuous use or after period of inactivity. The pain can get worsen during the end of the day. • Swelling and stiffness in the joint. • Warm sensation and creaking of the affected joints. • Discomfort in the joints during the changes in the weather. • Deformation or outward curvature of the knees due to cartilage degeneration. This condition is referred to as the “bow legged”. • Pain in the neck or lower back due to osteoarthritis of the spine. • Bony lumps at the end or middle of fingers and at the base of the thumb. Bony lumps at the end are called as Heberden’s node named after a British doctor. Similarly, one that occurs in the middle is called as Bouchard’s node. • Flexibility in the joints is lost. • Numbness and tingling sensation of the affected parts of the body. Diagnosis Generally, a careful examination of the duration, location, character of the joint symptoms will help the doctor to analyse osteoarthritis easily. Usually a combination of methods are used to diagnose osteoarthritis which includes the following: • Physical examination. • X-rays. • Other tests like Arthroscopy and Arthrocentesis.
Physical Examination: Some diagnosis is done looking at the patient’s physical appearance such as Bouchard’s node, Herberden’s node etc. Sometimes the doctors check the patient’s ability of bending, walking, performing daily activities etc. It is important for the patient to describe to the doctor the symptoms such as stiffness, joint pain and function. X-rays: X-rays do not show how much the joint has been damaged instead it gives a picture of bone spur formation, cartilage loss, narrowing of the joint space between adjacent bones, bone damage etc. These tests may not show early osteoarthritis damage i.e. until enough cartilage is lost. Other tests: Usually blood test is not done for osteoarthritis. It is done only to rule out secondary osteoarthritis and other conditions that mimic osteoarthritis. Other than blood tests, there are some other tests that include:

• Arthroscopy Here the abnormalities and damage of the cartilage and ligaments can be detected by inserting a viewing tube into the joint space. It deformities can also be repaired using arthroscopy. It is more comfortable in the sense patients can recover faster in this method compared to open joint surgery.
• Arthrocentesis In this method of diagnoses, fluid in the joint is removed using a sterile needle. It is done to prevent further infection, to exclude other conditions such as gout. Removing the fluid and injecting the corticosteroids can help the patient getting relieved from swelling, pain and inflammation.

Treatments
Depending on the patients need, health and lifestyle a combination of treatments can be given. The treatments suggested includes the following:
• Medicines.
• Pain relief techniques.
• Exercises.
• Weight control methods.
• Surgery.
• Rest and joint care.

Medicines

The main goal of giving medicines is to reduce pain and improve functioning. Pain relievers such as Acetaminophen and Aspirin are given. Even pain relieving creams such as menthol, methyl salicylate, capsaicin etc are used over the joints to reduce the pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, apirin etc are used to reduce pain and inflammation in the joints. But these drugs include side effects such as diarrhea, gastrointestinal distress, ulcers and even bleeding. With improved research new NSAIDs known as Cox-2 inhibitors have come to market that reduce these side effects. Generally, cortisone injections are not used to treat osteoarthritis but when given directly to the affected joints reduces the pain and restores the function. Apart from these, certain food supplements such ad chondroitin and glucosamine have shown to relieve the symptoms and stiffness of osteoarthritis.

Pain relief techniques: Techniques such as using hot bags or towels on the affected joints and taking hot shower may help in reducing the pain up to certain extent.

Exercises: It is supposed to be the best treatment for osteoarthritis. It strengthens the muscles around the joints and improves heart and blood flow. It helps in weight reduction and the movements of joints are made easy. Exercises suggested include swimming, walking, cycling etc. These exercises allow the patient to exercise with minimal impact stress to the joints.

Weight control methods: Exercise can help in reducing the weight. Reduction in weight puts less pressure or stress on the joints.

Surgery: Surgery is done for people with extreme case of osteoarthritis. Surgeries done are osteotomy, arthroscopy etc.

Rest and joint care: Regularly scheduled rest is important such as taking breaks during exercises or while doing some continuous works.

Article Contributed By: Shilpa V


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