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Osteoarthritis

What is Osteoarthritis

Osteoarthritis most commonly known as wear and tear arthritis, is a form of joint inflammation that is associated with cartilage degeneration [2]. It can occur at any joint, but mostly affects the weight bearing joints such as knees, spine, hips and hands [1]. It also includes the narrowing of space between joints and the loss of joint cartilage.


image of osteoarthritis pathology

 picture:pathology of osteoarthritis

Source: tsdcentral.com

Cartilage and Osteoarthritis

Cartilage is a protein substance that plays the role of reducing friction between joints and acts as a shock absorber of movements. When this material starts to degrade or has become thin, friction between bones increase, causing pain. Osteoarthritis causes this cartilage to lose its function and on worse conditions, completely tear away.

Age and Osteoarthritis

People ages 60 and above may have some form of osteoarthritis because naturally, cartilage degrade with age. At age 50 and above, more women suffer from osteoarthritis than men. Younger people may also have osteoarthritis, but it mostly occurs on the fingers.

Signs and Symptoms

Due to the degradation of cartilage, people with osteoarthritis have pain on the affected joint after repetitive use, as the bones had lost its cushion, which in turn causes friction. Pain on the affected joint is also experienced during long periods of inactivity and this also cause stiffness of the joint. Swelling and aching of affected joints is also experienced. However, there are some people that do not exhibit outward symptoms despite what is seen on X-ray tests. Unlike other diseases, osteoarthritis does not affect other organs of the body.

Finger joints

  • May have pain-free intervals between symptoms
  • Herberden’s and Bouchard’s nodes—bony enlargements on the middle and end joints of the finger caused by bone spurs or bone outgrowth. This may cause limitation of joint movement but not pain
  • Bunion- bony deformity on the big toe

Knee joint

  • Deformity and outward curvature of the knees (bowlegged)
  • Limping
  • Pain and swelling of the knee

 

Osteoarthritis Causes

Primary osteoarthritis

A form of osteoarthritis that is not caused by another disease.

  • natural aging of the joint– as the water content of cartilages increases with age, the protein make up of the cartilage degenerates, which results to weaker cartilages.
  • Complete loss of cartilage—advanced osteoarthritis
  • Repetitive use of the joints over the years– causes inflammation of the cartilage, which leads to pain and swelling of the joint.

 Secondary osteoarthritis

A form of osteoarthritis that is caused by another disease or condition.

  • Obesity–Obesity is the number one factor that increases risk of osteoarthritis on the knees. Greater body weight causes greater stress on the joints, and therefore on the cartilage.
  • Injury or repeated trauma— A broken bone near a joint may cause early osteoarthritis. Certain athletes, such as soccer players, have shown to have early knee osteoarthritis because of repeated trauma.
  • Heredity — some people have osteoarthritis because of a genetic defect that involves the development of cartilages (congenital abnormalities), and also scoliosis [3].
  • Hormone disturbances (diabetes, growth hormone disorders)—associated with early cartilage wear [2].
    Rheumatoid arthritis—people that have this has higher risk of having osteoarthritis

 

Diagnosis Of Osteoarthritis

A proper diagnosis always requires first a good description of the symptoms, the location and pattern of pain. After which, the doctor will proceed to physical examination. These are important because osteoarthritis is selective or occurs in any joint of the body.

Thereafter, certain laboratory tests may be performed to further reach a proper diagnosis.

  • X-ray –tests the affected joint is done to see the degree of damage.
  • Blood tests— are done to know if osteoarthritis is secondary or may be caused by another condition [2].
  • Joint fluid analysis—used to rule out gout and other underlying diseases [2].
  • Arthroscopy—insertion of viewing tube to assess damage of the cartilage and ligaments

Treatment of Osteoarthritis

There is no treatment to stop the degeneration of a cartilage or repair the damaged cartilage in osteoarthritis [2]. The general treatment for osteoarthritis is reduction.

Reduction of weight

Diet

Reduction of activities that cause stress in the joint cartilage

  • Although a patient is asked to reduce or avoid activities that aggravate pain in the joint, exercise is still encouraged. It must be performed on levels that do not cause pain. Exercise is beneficial because it develops muscle mass that supports the joints. It also helps in the reduction of weight and develops endurance. Swimming, walking and light weight lifting are encouraged.

Physical/Occupational therapy, Mechanical devices for support

  • Splints, walkers, knee braces, neck collar and lumbar corset for the spine
  • Consult an occupational therapist for issues of everyday living adjustments

Reduction of pain and inflammation.

  1. For hand symptoms, paraffin wax dips, warm water soaks and night time cotton gloves can help.
  2. Pain relievers
  • NSAIDS (Non Steroidal Anti-Inflammatory drugs)—drugs such as aspirin, ibuprofen and naproxen. It is known to have side effects in the gastro-intestinal tract especially in the elderly such as ulcers, bleeding and diarrhea.
  • Acetaminophen (Tylenol)—is much preferred than NSAIDS because it has fewer gastrointestinal side effects.
  • Pain relieving creams (Arthricare, Ben-gay)

Food supplements

  • Glucosamine and chondroitin—some studies showed improvement of osteoarthritis but further studies must yet be made to bring more knowledge to its effectiveness and administration( proper dosage, new formulations)
  • Fish-oil supplements—omega 3 capsules that is known to reduce inflammation

Note that before taking above mentioned medication, you must consult first your doctor because these medications do not apply on all cases of osteoarthritis. Every patient is unique and must be dealt with separately.

Hyaluronic acid injections

If pain is persistent and the patient does not respond to exercise, weight reduction, medications and does not consider surgery, a series of hyaluronic acid injections can be administered in the joint to temporarily thicken joint fluid, restore function and relieve pain.

Surgery

If the disease had already taken the patient’s function and quality of life, surgery may be considered. Patients that may need surgery are those not responsive to conservative treatment and is already severe [3].

  • Arthroscopy

A viewing scope is inserted between joints and instrument is inserted to clean out damaged tissues and repair tissues.

  • Osteotomy

Bone outgrowth is removed and is used to realign some deformities.

  • Arthrodesis (Joint fusion)

Joint fusion surgery is done when the patient’s joint has completely eroded. Joint is eliminated and the two bones on each end of a joint are fused.

  • Arthroplasty (Joint replacement)

The damaged joint is replaced by an artificial one.

Diet for Osteoarthritis

A good diet is essential to gaining the proper weight and to maintain good body function which will eventually help defeat the disease. But what does a good diet mean? It is said that as people get older, they must eat less to maintain a good weight. So first and foremost, diet means eating the right amount. Everything in excess will absolutely not benefit you.

Here are some nutritional guidelines for people with osteoarthritis:

  • Vitamin C

Vitamin C is a coenzyme that is involved in the formation of collagen and proteoglycans which are the main components of cartilage. People with osteoarthritis must consume at least 200mg of vitamin C daily [4].

  • Omega-3 fatty acids

Omega-3 fatty acids are known to prevent inflammation. Omega-6 fatty acids, which are commonly found on corn, cottonseed oil, saturated and trans fatty acids, should be avoided. Among omega-3 rich food are salmon, tuna, pecan, walnuts, halibut, soy food and olive oil. 3 grams of omega-3 fatty acids is encouraged for people with osteoarthritis.
It is known to reduce intake of NSAIDS because of it good effects to treat inflammation. It was even said that 3 ½ cups of olive oil is equivalent to 200mg of ibuprofen [5]. Though this does not mean you should just drink olive oil, all these says is that food with omega-3 fatty acids is a must on your diet. What you can do it to always cook with olive oil.

  • Vitamin D

Low vitamin D in the body increases cartilage loss. Vitamin D is known as the sunshine vitamin because it is produced through ultraviolet ray exposure from the sun. 15 minutes of sun exposure three to four times a week, without sunscreen, is suggested [4]. However, go when daylight is light. We can also get vitamin D in fortified milk, eggs, fish-liver oils, milk and cereals.

  • Anti-oxidants

Anti-oxidants protect us from inflammation and free radicals that damage tissues in our bodies. Anti oxidants such as beta-carotene rich foods which are found in red, yellow and orange fruits and vegetables should be part of the diet [4].

To really have a good diet, people suffering from osteoarthritis must have 2/3 of their food coming from plants such as fruits, vegetables and whole grains, and 1/3 for protein source. You must also cut your extra calories and avoid food cooked on high temperatures (grilled foods, processed foods) [6, 7]. All is possible with discipline and good lifestyle; always stick to the good ones.

References:

  1.  http://www.nlm.nih.gov/medlineplus/osteoarthritis.html
  2.  http://www.medicinenet.com/osteoarthritis/article.htm
  3.  http://www.webmd.com/osteoarthritis/guide/osteoarthritis-basics
  4.  http://www.sparkpeople.com/resource/nutrition_articles.asp?id=862
  5.  http://www.webmd.com/osteoarthritis/guide/osteoarthritis-diet
  6.  http://preventarthritis.org/10-super-foods-to-fight-osteoarthritis/
  7.  http://www.arthritistoday.org/about-arthritis/types-of-arthritis/osteoarthritis/daily-life/osteoarthritis-diet.php

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