Osteoarthritis is type of Arthritis where there is damage caused to the joints of the body. Arthritis may be the leading cause of disability in quickly age 55.
History and Physical Examinaton
All arthritides feature pain. Patterns of pain differ among the arthritides and also the location. Osteoarthritis is classically worse during the night or following rest. In elderly people and youngsters, pain may not be the main feature, and also the patient simply moves less (elderly) or refuses to use the affected limb (children).
Elements of the history of the pain sensation (onset, number of joints and which involved, duration, aggravating and relieving factors) all guide diagnosis. Physical examination typically confirms diagnosis. Radiographs are often used to follow progression or assess severity in a more quantitative manner.
Blood tests and X-rays from the affected joints often are carried out to make diagnosing.
Screening blood tests might be indicated if certain arthritides are suspected. This may include: rheumatoid factor, antinuclear factor (ANF), extractable nuclear antigen and specific antibodies.
Osteoarthritis
Osteoarthritis (also known as degenerative arthritis, degenerative osteo-arthritis, or perhaps in more colloquial terms “wear and tear”), is really a condition in which low-grade inflammation leads to pain in the joints, brought on by wearing from the cartilage that covers and acts as a cushion inside joints.
As the bone surfaces become less properly protected by cartilage, the patient experiences pain upon standing and walking, including walking and standing. Because of decreased movement because of the pain, regional muscles may atrophy, and ligaments may become more lax.
There has been no cure for osteoarthritis, as cartilage has not been induced to regenerate. However, when the disease is caused by cartilage damage (for example as a result of a personal injury) Autologous Chondrocyte Implantation can be a possible treatment. Treatment is with NSAIDs, local injections of glucocorticoid or hyaluronan, as well as in severe cases, with joint replacement surgery.
Signs and symptoms
The main symptom is chronic pain, causing loss of mobility and frequently stiffness. “Pain” is usually described as a clear, crisp ache, or perhaps a burning sensation in the associated muscles and tendons. Osteoathritis may cause a crackling noise (called “crepitus”) once the affected joint is moved or touched, and patients may feel muscle spasm and contractions within the tendons. Occasionally, the joints can also be filled with fluid. Humid weather boosts the pain in several patients.
Osteoarthritis commonly affects the hands, feet, spine, and the large weight-bearing joints, such as the hips and knees, although in theory, any joint in the body can be affected. As the disease progresses, the affected joints appear larger, are stiff and painful, and usually feel worse, the more they are utilised throughout the day, thus distinguishing it from rheumatoid arthritis symptoms.
In smaller joints, such as at the fingers, hard bony enlargements, called Heberden’s nodes (about the distal interphalangeal joints) and/or Bouchard’s nodes (about the proximal interphalangeal joints), may form, and though they are not necessarily painful, they are doing limit the movement of the fingers significantly. When the disease affects the toes it often results in the development of bunions, rendering them red or swollen.
Osteoarthritis is the most standard reason for “water on the knee”, an accumulation of excess fluid in or around your knee joint.
Causes
Osteoarthritis often affects multiple members of the same family, suggesting that there’s hereditary susceptiblity to this condition. Numerous research indicates that there’s a greater prevalence of the disease between siblings and especially identical twins, indicating a hereditary basis. Up to 60% of cases are believed to derive from genetic factors. Researchers are also investigating the potential of allergies, infections, or fungi as a cause. There is some evidence that allergies, whether fungal, infectious or systemically induced, can be a significant contributing step to the appearance of the disease in a synovial sac.
Two kinds of Osteoarthitis
Primary Osteoarthritis
This kind of the condition is really a chronic degenerative disorder related to but not brought on by aging, as there are people well into their nineties who have no clinical or functional signs and symptoms of the disease.
As an individual ages, the water content of the cartilage decreases as a result of reduced proteoglycan content, thus causing the cartilage to be less resilient. Without the protective effects of the proteoglycans, the collagen fibers from the cartilage can become susceptible to degradation and thus exacerbate the degeneration.
Inflammation from the surrounding joint capsule can also occur, though often mild (compared to that which occurs in rheumatoid arthritis symptoms). This could happen as breakdown products in the cartilage are released into the synovial space, and also the cells lining the joint make an effort to take them off.
New bone outgrowths, called “spurs” or osteophytes, can form on the margins from the joints, possibly so that they can improve the congruence of the articular cartilage surfaces. These bone changes, with the inflammation, can be both painful and debilitating.
Secondary Osteoarthitis
This type of arthritis is caused by additional factors or diseases however the resulting pathology is the same as for primary osteoarthritis:
Congenital disorders, for example:
- Congenital hip luxation
- People with abnormally-formed joints (e.g. hip dysplasia) are more vulnerable to osteoarthritis, as added stress is specifically positioned on the joints every time they move. [However, recent reports have shown that double-jointedness may actually protect the fingers and hand from osteoarthritis.]
- Cracking joints-the evidence is weak at best that this has any connection to arthritis
- Diabetes.
- Inflammatory diseases (such as Perthes’ disease), (Lyme disease), and all sorts of chronic forms of arthritis (e.g. costochondritis, gout, and rheumatoid arthritis). In gout, the crystals crystals make the cartilage to degenerate at a faster pace.
- Problems for joints, as a result of an accident
- A joint infection, e.g. from an injury.
- Hormonal disorders.
- Ligamentous deterioration or instability may be a factor
- Obesity. Obesity puts added weight about the joints, particularly the knees.
- Osteoperosis (High bone strength and density).
- Workplace injuires, or similar injuries from exercise or work. Certain sports, for example running or football, put undue pressure on the knee joints. Injuries resulting in broken ligaments can result in instability of the joint and over time for you to wear on the cartilage and eventually osteoarthritis.
- Pregnancy
- Alkaptonuria
- Hemochromatosis and Wilson’s disease
Diagnosis
Diagnosis is normally carried out by x-rays. This is possible because loss of cartilage, subchondral (“below cartilage”) sclerosis, subchondral cysts, narrowing from the joint space between the articulating bones, and bone spur formation (osteophytes) show up clearly on x-rays. Plain films, however, often don’t correlate well using the findings of physical study of the affected joints.
With or without other techniques, for example MRI (magnetic resonance imaging), arthrocentesis and arthroscopy, diagnosis can be created by a careful study from the duration, location, the smoothness from the joint symptoms, and also the appearance from the joints themselves. As yet, there are no methods available to detect the condition in the early and potentially treatable stages.
Treatment
Generally speaking, the process of clinically detectable osteoarthritis is irreversible, and typical treatment includes medication or other interventions that may lessen the pain from the disease and thereby enhance the function from the joint.
Application of heat – often moist heat – eases inflammation and swelling in the joints, and can help improve circulation, with a healing impact on the local area.
No matter what the severity, or in which the disease lies, conservative measures, for example weight control, appropriate rest and exercise, and the use of mechanical support devices are usually good for sufferers. Regarding osteoarthritis from the knees, knee braces, a cane, or perhaps a walker can be a helpful aid for walking and support. Regular exercise, if at all possible, in the form of walking or swimming, is encouraged. Applying local heat before, and cold packs after exercise, might help relieve pain and inflammation, just like relaxation techniques.
Weight loss can relieve joint stress and may delay progression . Proper advice and guidance with a health care provider is important in management of the disease , enabling individuals with this problem to enhance their quality of life.
Dealing with chronic pain can be difficult and lead to depression.
Communicating with other patients and caregivers can be helpful, as can maintaining a positive attitude. Individuals who take control of their treatment, communicate with their health care provider, and actively manage their arthritis experience can help to eliminate pain and improve function.
Dietary
Supplements which can be useful for treating osteoarthritis include:
- Glucosamine
- Chondroitin
- Other supplements :
- Omega-3 Fish oils,a vitamin supplement comprised of important oils based on fish to alleviate symptoms naturally.
- Boswellia, a natural supplement known in Aryuvedic medicine. It’s accessible in health food stores an internet-based.
- Antioxidants, including vitamins C and E both in foods and supplements, provide pain relief.
- Hydrolyzed collagen (hydrolysate) (a gelatin product) could also prove beneficial in the relief of symptoms, as substantiated inside a German study by Beuker F. et al. and Seeligmuller et al. In their 6-month placebo-controlled study of 100 elderly patients, the verum group showed significant improvement in joint mobility.
- Ginger (rhizome) extract – has improved knee symptoms moderately.
- Methylsulfonylmethane (MSM): A small study by Kim et al. suggested that MSM significantly reduced pain and improved physical functioning in osteoarthtitis patients without major adverse events (Kim et al). The authors cautioned that even though this short pilot study did not address the long-term safety and usefulness of MSM, they claim that physicians should consider its use for several patients.
- S-adenosyl methionine: small scale studies have shown so that it is as effective as NSAIDs in reducing pain, although it takes about four weeks for the effect to occur.
- Selenium deficiency has been correlated having a higher risk and severity of the condition, therefore selenium supplementation may reduce this risk.
- Vitamins B9 (folate) and B12 (cobalamin) drawn in large doses significantly reduced hand pain, presumably by reducing systemic inflammation.
- Vtamin D deficiency has been reported in patients with osteoarthritis, and the use of Vitamin D3 is suitable for pain relief.
- Bone Morphogenetic Protein 6 (BMP-6) has recently been proven to possess a functional role within the maintenance of joint integrity and it is now being produced in an orally ingested form.
Other nutritional changes proven to assisted in the treatment of the condition include decreasing saturated fat intake and using a low energy diet to decrease excess fat. Life-style change may be required for effective symptomatic relief, especially for arthritis of the knee. Reducing sugar, processed foods, fatty foods and nightshade vegetables within the diet helps many. According to Dr. John McDougall, a minimal fat vegetarian diet can help to eliminate symptoms. A macrobiotic diet has been recognized to reduce symptoms as well.
Medications
These drugs need to be determined by a doctor.
Acetaminophen. A mild pain reliever.
Non-steroidal anti-in flammatory drugs. In more severe cases may reduce both pain and inflammation.
Corticosteroids. Their effect is modest and also the adverse effects may outweigh the advantages.
Narcotics. Reserved for severe pain, and are rarely medically necessary for chronic pain.
Topical treatments”designed for local application and action. Creams and lotions. (can be purchased in the pharmacy).
Severe pain in specific joints may be treatable with local lidocaine injections and could temporarily reduce the pain.
Acupuncture
Treatment is by insertion of very tiny needles in to the number of channels called meridians situated beneath the skin. Said to treat the entire person along with the affected region.