Osteoarthritis (Joint Cartilage and Bone Degeneration)

What is osteoarthritis?

Osteoarthritis is a condition that affects the cartilage and bones of a joint. Although the word arthritis means inflamed joint, osteoarthritis is not an inflammatory joint disease. Instead it is a degenerative condition involving the cartilages that cap the ends of bones that form a joint. Osteoarthritis is the most common type of arthritis, followed by rheumatoid arthritis (RA) which is an inflammatory joint disease due to immune dysfunction. Almost every person will experience some degree of osteoarthritis by the age of 70 years but it often starts up earlier in life.

Causes and Risk Factors

There are different types of joints in the human body. One such type are the synovial joints which comprises the large joints such as the knee, hip and shoulder joints. Here two bones articulate with each other but to prevent friction, the end of each bone involved in the joint is lined with cartilage. Since cartilage is a flexible yet strong tissue it can bear the strain put on the joints and protects the underlying bone.

It quickly regenerates and acts as a shock absorber in the event of impact on the joint. A lining known as the synovium produces a lubricant fluid within the joint space. This synovial fluid also acts as a shock absorber. The entire joint is then surrounded by a capsule and supported by ligaments and muscles.

In osteoarthritis, the cartilage starts to degenerate either because the body does not produce it fast enough or because there is excessive wear and tear on the joint beyond the body’s regenerative rate. It is a condition that develops over long periods of time and may only become symptomatic when there is significant erosion of the cartilage.

Eventually the underlying bone may become exposed and also begin to wear down with use of the joint. Pieces of cartilage and bone may break off and float within the joint. As time passes the smooth end of the bone (subchondral bone) may be rough and jagged with bony outgrowths forming that further hampers the joint movement.

Almost every person will develop osteoarthritis to some degree after the age of 65 years. People who are more likely to develop osteoarthritis :

• Advancing age.
• Women are at a greater risk than men.
• Overweight or obese.
• Being physically inactive.
• Severe bone or joint injuries in the past.
• Repetive stress to the joints with certain occupations.

Signs and Symptoms

The type of symptoms that may be present in osteoarthritis and the intensity may vary to some degree. At the outset you may only experience one or two symptoms which are mild. The main symptoms seen in osteoarthritis includes:

• Joint pain (arthralgia) which may start or worsen while there is joint movement or even after activity. It is most likely to occur when you stand, walk or run especially for long periods of time or distances. At first the joint may only be tender which means that there is no pain unless you press on it firmly. Eventually pain develops even without pressure.
• Joint stiffness that is worse when you are resting for a while. Patients may find that there is pronounced stiffness of the joint when they wake up in the morning. This is similar to the other very common type of arthritis – rheumatoid arthritis. Understandably the stiffness reduces the flexibility of the joint and limbs over time.
• Rubbing or grating sensation or sound when moving the joints may be felt or heard by some patients. This is more likely to occur with severe osteoarthritis or in the late stages. It should not be mistaken with a clicking of the joint that can happen once off in any person. Instead the ends of the bone start rubbing together in osteoarthritis.
• Bony protrusions known as spurs form in and around the joint as the bone wears down. These abnormalities may be felt under the skin and sometimes can form protrusions that are visible on the skin surface.

Tests and Diagnosis

Your doctor will conduct a variety of tests to confirm a diagnosis of osteoarthritis after the initial physical examination and assessment. These tests will also help to assess the severity of the condition and determine the approach to treatment. These tests and diagnosis will include :

• Plain x-rays
• Magnetic resonance imagine (MRI) scans
• Joint fluid aspiration and laboratory testing

Sometimes other joint conditions can cause a similar collection of signs and symptoms. In the early stages when there is no clear differentiation between these conditions, blood tests may be conducted to isolate the most likely cause.

Treatment

Since osteoarthritis is incurable, it has to be managed with conservative measures, medication and at times surgery. These measures help reduce the pain and stiffness to some degree but more importantly it can slow down the progression of osteoarthritis.

Medication

Medication helps the patient with managing the pain. Acute bouts of inflammation may arise in osteoarthritis and drugs can reduce the inflammation during these episodes. Some of the drugs used include:

• Non-steroidal anti-inflammatory drugs like ibuprofen to reduce pain and inflammation.
• Analgesics (painkillers) from milder varieties such as paracetamol to opioid analgesics in severe cases.
• Injections of steroids and lubricant fluid to ease inflammation and reduce strain on the joint.

The use of medication should not detract from the fact that other treatment measures need to be employed at the same time. Regular treatment by a physiotherapist along with orthotic braces and shoe inserts can be helpful. The key of these measures is to reduce strain on the joint, improve flexibility, ease the pain and prevent further joint damage.

Surgery

In patients who are not responding very well to medication and conservative measures, surgery may be needed. The two main procedures that are conducted include:

• Osteotomy to realign bones and fuse the joints.
• Arthroplasty, commonly known as joint replacement, where prosthetic caps are inserted over the ends of the bone in the joint.

Remedies

Sometimes the best remedy is to rest the joint, lose weight and not undertake any activities that can be physically straining. Patients may also seek alternative remedies in the form of herbal, homeopathic and other traditional medicine remedies. These remedies should be prescribed by a qualified practitioner in the relevant discipline who can advise you on the potential side effects when used with drugs.

Acupuncture may be helpful in pain management. Nutritional supplements like glucosamine and chondroitin may be useful in reducing the severity of osteoarthritis and slowing down its progression. However, these remedies should not replace drugs and surgery. People living with osteoarthritis should undertake exercise programs that do place to much impact on the joint like yoga.