Osteoarthritis: Disease of Wear and Tear

Osteoarthritis,is a progressive disease of the joints. Its also known as “wear and tear arthritis”

Cause

• The articular cartilage that covers the ends of bones in the joints gradually wears away.
• Thus the smooth articular cartilage is now a frayed, rough surface leading to painful joint movements.
• Usually OA develops after many years of use, especially in middle-aged or older.
• Other risk factors- obesity, previous injury to the affected joint, and family history of osteoarthritis.

Anatomy

• A joint is a place where the ends of two or more bones meet.

For example, in knee joint the bones of the lower leg (the tibia and the fibula) and the thigh bone (the femur) constitutes the joint.

• In hip joint the top of the thigh bone (femoral head) meets a concave portion of the pelvis (the acetabulum).
• Articular cartilage is an elastic tissue which covers the ends of the bones that make up the joint and makes painless and smooth movement of healthy joint

Symptoms

• joints affected: any joint in the body, with symptoms ranging from mild to disabling.
• The joint will be painful and inflamed.
• Without cartilage, bones rub directly against each other when the joint moves,causes the pain and inflammation.
• Pain or a dull ache usually develops gradually over time.
• Diurnal variation of pain: worse in the morning and feel better with activity.
• Relation to activities: Vigorous activity – pain may flare up.

For example, in a case of OA-hand: Bone growths on the little finger are typical of osteoarthritis.Joint is Stiff swollen, enlarged or “out of joint.”

A bump over the joint.

• Motion will be limited because bending of joint is difficult, and also if loose fragments of cartilage and other tissue can interfere with the smooth motion of joints.
• The joint may lock or “stick” when used. It may creak, click, snap, or make a grinding noise (crepitus). The joint may become weak and buckle.
• Although osteoarthritis cannot be cured, early identification and treatment can slow progression of the disease, relieve pain and restore function.

Diagnosis

1. Complete medical history
2. Physical examination
3. X-rays
4. Possibly laboratory tests

History

• Any past history of injuries to the joint.
• When did the joint pain began and what the pain feels like.
• Is the pain continuous, or does it come and go? Does it occur in other parts of the body?
• When the pain occurs: Is it worse at night?
• Does it occur with walking, running or at rest?

Physical examination of affected joint:

• It is done to know if there is pain or restricted motion.
• Done keeping the joint in various positions
• Looked for: any cracking or grinding noises (crepitus) that indicate bone-on-bone friction.
• Muscle loss (atrophy)
• Signs that other joints are involved.
• Signs of injury to muscles, tendons, and ligaments.

X-rays

• Helps the doctor to distinguish various forms of arthritis.

It can show

•  The extent of joint deterioration, including narrowing of joint space,
•  Thinning or erosion of bone,
•  Excess fluid in the joint,
•  Any bone spurs or other abnormalities. They can help the doctor to identify stage of the disease

Laboratory tests

To rule out other diseases that cause symptoms similar to osteoarthritis.

Treatment

1. Nonsurgical Treatment
2. Early nonsurgical treatment-reduces the progression of osteoarthritis, increase motion, and improve strength.
3. Treatment programs combine lifestyle modifications, medication, and physical therapy.

Lifestyle Modifications

• Rest or a change in activities to avoid provoking osteoarthritis pain which can include modifications in work or sports activities.
• It may mean switching from high-impact activities (such as aerobics, running, jumping, or competitive sports) to low-impact exercises (such as stretching, walking, swimming, or cycling).
• A weight loss program may be recommended, if needed, particularly if osteoarthritis affects weight-bearing joints (such as the knee, hip, spine, or ankle)

Medications

• Non-steroidal anti-inflammatory drugs (NSAIDS) – reduce inflammation.
• The doctor may recommend strong anti-inflammatory agents called corticosteroids, which are injected directly into the joint.
• This will provide temporary relief of pain and swelling.
• Dietary supplements: glucosamine and chondroitin sulfate may help relieve pain from osteoarthritis
• (should be taken only after consulting the doctor)

Physical Therapy

• A balanced fitness program, physical therapy, and/or occupational therapy
• This will improve joint flexibility, increase range of motion, reduce pain, and strengthen muscle, bone, and cartilage tissues.
• Supportive or assistive devices (such as a brace, splint, elastic bandage, cane, crutches, or walker) may be needed.
• Ice or heat may need to be applied to the affected joint for short periods, several times a day.

2) Surgical Treatment

• Indicated if early treatments do not stop the pain or if they lose their effectiveness.
• This decision depends upon 1)the age and activity level of the patient,
• The condition of the affected joint,
• The extent to which osteoarthritis has progressed.

The options are

1. Arthroscopy
2. Osteotomy
3. joint fusion
4. joint replacement

Arthroscopy

A surgeon uses a pencil-sized, flexible, fiberoptic instrument (arthroscope) to make two or three small incisions
Any bone spurs, cysts, damaged lining, or loose fragments if present in the joint are removed.

Osteotomy

The long bones of the arm or leg are realigned to take pressure off of the joint.

Joint fusion

A surgeon eliminates the joint by fastening together the ends of bone (fusion).
Pins, plates, screws, or rods may hold bones in place while they heal.
The joint’s flexibility is eliminated by this procedure.

Joint replacement

A surgeon removes parts of the bones and creates an artificial joint with metal or plastic components (total joint replacement or arthroplasty).

Dr Hitesh Gopalan U, Orthopaedic Surgeon working at MOSC Medical College, Kolenchery. He is actively involved in treating patients from the following locales; Kolenchery, Tripunithura, Thiruvankulam, Thodupuzha, Kothamangalam, Ernakulam and Idukki