osteoarthritis

Osteoarthritis

Osteoarthritis, also known as degenerative arthritis, degenerative joint disease, OA, or osteoarthrosis, is a form of arthritis caused by inflammation, breakdown, and the eventual loss of cartilage in the joints –  cartilage wears down slowly over time.

Osteoarthritis is the most common type of arthritis.

The progression, or stages of osteoarthritis extends over several years, to decades. Often the disease is not detected until it reaches an advanced stage. This is usually when there are the first signs of movement restrictions or pain.

The severity of arthritic disease is assessed according to four defined stages of osteoarthritis.

SUMMARY

Learn how osteoarthritis develops and progresses. The sooner symptoms of arthrosis are identified, the easier it is to protect the joint.

Consultation, X-rays, MRI scans, blood plasma amino acid levels & genetic screening and arthroscopy can all be used as diagnostic tools to determine whether an individuals is developing osteoarthritis.

Taking measures early on to protect cartilage is essential for preventing or slowing down the onset of osteoarthritis. This may be enough to avoid joint surgery and joint replacements.

In OA, the fibre damage in articular cartilage plays an equally important role as the degree of involvement of the underlying bone.

What Causes Osteoarthritis? 

On the one hand, An increased risk of osteoarthritis partly lays in genetic factors, increasing age, female sex, and nutrition1.

On the other hand, risk from osteoarthritis is increased by large mechanical load. Other causes are joint misalignment, reduction of strength and coordination of the muscles responsible for joint movements, and injuries of ligaments and menisci2.

Work-related kneeling activities, such as permanent, improper loading of the lower extremities, increase the risk of osteoarthritis, especially among craftsmen, farmers and workers3.

Sport: Prevention & Risk

Sport has generally a protective effect. Subjects who do not participate in any sport suffer from osteoarthritis significantly more often than people who practice sport regularly4.

Considering the intensity and duration of a particular sport, recurrent shock loads and rotational loads can significantly increase the risk of osteoarthritis in individual cases56.

In essence, injuries suffered in sports may still encourage early osteoarthritis development.

The anamnestic data of knee injuries suffered in athletes, significantly increased the risk of early osteoarthritis of the knee during the follow-up period of 36 years (relative risk 5.17)7.

In meniscus injuries, radiological changes grade 2 or higher (according to the Kellgren u. Lawrence classification system) were found in 43% of patients 16 years after partial resection of the meniscus affected, while 59% of them had symptoms8.

After the rupture of the anterior cruciate ligament in male football players, radiological osteoarthritic changes in the knee joint can still be detected 14 years after the injury in 41% of cases9. In a study which included female football players, radiological changes of the knee joint degree 2 or higher (according to the Kellgren u. Lawrence classification system) were found 12 years after front cruciate ligament rupture in 51% of cases10. Knee pain and functional limitations which produced limitations in leisure and work, were present in 30% of men (mean age 38 years) and 50% of women (mean age 31 years). The results were independent of whether an anterior cruciate ligament reconstruction was performed, or it was treated conservatively.

Obesity is Top OA Accelerator

The greatest modifiable risk factor for appearance and development of osteoarthritis is obesity. It has been shown that osteoarthritis incidence increases linearly with increasing BMI11. The severity of gonarthrosis and coxarthrosis also correlates with increased BMI12. Initially, these effects were explained solely by overload of the articular cartilage by increased body weight. However, metabolic factors are increasingly becoming the focus. Being an endocrine organ, adipose tissue produces, inter alia, pro-inflammatory cytokines that act catabolically on chondrocytes (IL-1, TNF-α), promote synovitis (IL-6, IL-8, IL-18), and influence subchondral bone (IL 6)13.

Stages of Osteoarthritis

Stage 1

Shows only a slight fraying of the articular cartilage mostly due to falls, blows or other injuries. This is caused by slightly roughened articular cartilage surfaces rubbing against each. Particles can detach that reinforce this friction.

Treatment options

If the patient is not predisposed to OA, orthopedic physicians may not recommend any special treatment for stage 1. However, food supplements such as glucosamine and chondroitin may be recommended. Lifestyle considerations like regular exercise and a dedicated diet may also prove to be helpful.

Stage 2

Characterised by significant fibre damage in articular cartilage. The surface is rough and covered with indentations and raised portions. This has a further negative impact on joint structure.

Treatment options

If OA is detected and diagnosed at this stage, it is possible to follow a plan to stop the progression of this joint disease. There are different nonpharmacologic therapies to help relieve the pain and discomfort caused in this early stage. Many patients are recommended a strict regimen of diet, supplements and exercise / strength training for increased joint stability. Additionally, braces, knee supports or shoe inserts may be used to protect the knee from stress.

Stage 3

This is the transition stage and where deep cartilage destruction starts. It’s often associated with pain and restricted mobility. Joint inflammation is common.

Treatment options

At this stage over the counter NSAIDs or other pain-relief therapies such as codeine and oxycodone may be prescribed.

Patients that have not responded positively to physical therapy, weight loss program, use of NSAIDs may require viscosupplementation, which are intra-articular injections of hyaluronic acid into the knee joint. Moderate knee arthritis can be treated aggressively with three to five injections of hyaluronic acid over 3-5 weeks’ time, which may take several weeks for the treatment to start showing results, but pain relief typically lasts six months.

Stage 4

This is the final stage of the disease with a complete loss of joint cartilage. This is associated with more serious deformation and disruption of the underlying bone. The pain is typically severe and pain relief ineffective. Movement is so restricted that the only option is a prosthetic replacement of the joint.

Treatment options

In cases of severe OA joint replacement may be considered. For example in knee OA, an option is performing osteotomy or bone realignment surgery, wherein the orthopedic surgeon cuts the bone above or below the knee to shorten the length and help realign it for less stress on the knee joint. This surgery helps protect the knee by shifting the weight of the body away from the site of the bone spur growth and bone damage.

Another surgical option is total knee replacement, or arthroplasty. During this surgical procedure, the damaged joint is removed and replaced with a plastic or metal prosthesis device. Recovery from surgery may take several weeks and requires patience and discipline, with continuous physical and occupational therapy to regain full mobility.

Symptoms of Osteoarthritis

Each of the above-mentioned stages is characterised by a range of symptoms. As the disease progresses, the symptoms also become more prevalent. The problem with osteoarthritis is that the initial defect is very common in childhood or early adolescence. A bruised knee or a twisted wrist heals quickly again and all is forgotten.

However, these minor injuries can directly impact the cartilage or affect the nutrient supply to the cartilage. This can result in increased friction of the joint surfaces. Over time, this friction continues to damage the joint and osteoarthritis develops. Recognising the onset of osteoarthritis early on is the key to effective treatment.

The symptoms are initially very diverse and specific. Usually it starts with pain in the affected joint after periods of immobility. This is most obvious in the morning or after prolonged sitting. The joints feel stiff and take a few minutes to loosen up. As the joints start to move more freely, the joint surfaces become lubricated by the synovial fluid. This lubrication reduces the friction and the joints don’t feel stiff anymore.

As the disease progresses, pain increases as the joints become further stresses. Walking long distances can lead to aches in the affected knee or hip joints. After a break, it’s possible to continue to move relatively pain-free again. That is until a certain distance has been covered and then the cycle is repeated.

With the progressive destruction of the cartilage the pain becomes more permanently. Joint mobility is also reduced to the point of stiffness. Now the previously relatively “silent” disease transforms into an activated form of arthrosis. Ligaments and tendons next to the joints also become inflamed. This can lead to scaring and further exacerbate athrosis symptoms.

The sooner symptoms of arthrosis are identified; the easier it is to protect the joint. Taking measures early on to protect cartilage is essential for preventing or slowing down the onset of osteoarthritis. This may be enough to avoid joint surgery and joint replacements.

Initial Consultation

During an initial consultation, the patient will be asked about their medical history and a function joint test is performed. This can provide the doctor with an indication of the possible cause of joint disease.

However, this alone is not sufficient to make a definitive diagnosis. Imaging techniques are used to further examine joint health14

X-Rays

X-rays remain a popular means to assess bone structure. However, cartilage and soft tissue remain invisible. An x-ray will reveal any narrowing of the joint space or bone deformities in advanced osteoarthritis.

Unfortunately, early damage to the cartilage cannot be determined using x-rays15.

Specialists point out that the joint space in the X-ray can be measured correctly only under load. In other words: the radiograph should always be preformed standing to determine the correct joint space of the knee, foot, or hip joints.

Magnetic Resonance Imaging

Other imaging techniques such as magnetic resonance imaging (MRI) and ultrasounds can also be used to detect joint diseases. The advantage of these methods is that they don’t release radiation and they capture visible soft tissue and cartilage.

The problem with this technique is that it can be difficult to distinguish between arthritis and osteoarthritis. Inflammatory processes and conditions within the synovial fluid cannot be properly diagnosed by imaging techniques alone.

Plasma amino acid levels & genetic screening

Several studies have identified variations in plasma amino acid profiles between patients suffering from rheumatoid arthritis compared with healthy individuals. In one study, researchers investigated 28 plasma amino acids and found that rheumatoid arthritis patients showed statistically significant differences in 19 amino acid profiles compared with healthy individuals16. Of these amino acids, 18 were in significantly lower concentrations in rheumatoid arthritis patients.

Another study found a correlation between high concentrations of excitatory amino acids aspartate and glutamate in the synovial fluid and active arthritis17. Researchers concluded that high levels of glutamate within the synovial fluid may promote the pathogenesis of arthritic conditions in humans.

Some research indicates a genetic predisposition to rheumatoid arthritis characterised by five specific amino acid positions located in peptide-binding groves18. However, more research is necessary before conclusive genetic screening may be a possibility.

Arthroscopy

The most decisive way to determine the possible onset of osteoarthritis is an arthroscopy. This is a minor surgical procedure. It involves a small incision made at the joint and a camera inserted to assess the condition of the joint. The synovial fluid can then be tested for inflammatory markers and autoantibodies. The results can help to determine if the patent is suffering from osteoarthritis or arthritis.

Arthroscopy also offers the advantage of performing joint-preserving measures during the procedure. For example, the cartilage surfaces can be smoothed over and bone fragments may be removed. However, this methodology is not without controversy, as it exposes the joint to the risk of infection192021.

Product guide: joint food supplements

Several good combination preparations for joints contain joint foods such as glucosamine, chondroitin and MSM. As the health of the joint cartilage depends on many factors, combination preparations are usually superior to individual active ingredients.

Provide your joints with all nutrients they need. Read the overview of the best joint supplements here.

Bibliography

  1. Felson DT. An update on the pathogenesis and epidemiology of osteoarthritis. Radio Clin North Am 2004; 42: 1–9p
  2. Felson DT. Risk factors for osteoarthritis: understanding joint vulnerability. Clin Orthop Relat Res 2004; 427 (Suppl): S16–21
  3. Schneider S et al. Prävalenz und Korrelate der Osteoarthrose in der BRD. Repräsentative Ergebnisse der ersten Bundesgesundheitssurvey. Orthopädie 2005; 34(8): 782–790
  4. Schneider S et al. Prävalenz und Korrelate der Osteoarthrose in der BRD. Repräsentative Ergebnisse der ersten Bundesgesundheitssurvey. Orthopädie 2005; 34(8): 782–790
  5. Schmitt H. Degenerative Gelenkerkrankungen nach Leistungssport. Deutsche Z Sportmed 2006; 57(10): 248–254
  6. Buckwalter JA, Lane NE. Athletics and Osteoarthritis. Am J Sports Med 1997; 25: 873–881
  7. Gelber AC et al. Joint injury in young adults and risk for subsequent knee and hip osteoarthritis. Ann Intern Med 2000; 133: 321–328
  8. Englund M et al. Impact type of meniscal tear on radiographic and symptomatic knee osteoarthritis: a sixteen-year follow up of meniscectomy with matched controls. Arthritis Rheum 2003; 48: 2178–2187
  9. von Porat A et al. High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players – a study of radiographic and patient-relevant outcomes. Ann Rheum Dis 2004; 63: 269–273
  10. Lohmander LS et al. High Prevalence of Knee Osteoarthritis, Pain and Functional Limitations in Female Soccer Players Twelve Years after Anterior Cruciate Ligament Injury. Arthritis Rheum (2004); 50(10): 3145–3152
  11. Schneider S et al. Prävalenz und Korrelate der Osteoarthrose in der BRD. Repräsentative Ergebnisse der ersten Bundesgesundheitssurvey. Orthopädie 2005; 34(8): 782–790
  12. Iannone F, Lapadula G. Obesity and inflammation – targets for osteoarthritis therapy. Current Drug Targets 2010; 11: 586–598
  13. Iannone F, Lapadula G. Obesity and inflammation – targets for osteoarthritis therapy. Current Drug Targets 2010; 11: 586–598
  14. Sankowski, A. et al. (2013). Psoriatic Arthritis. Polish Journal of Radiology. Volume 78, Issue 1, (pp. 7-17)
  15. Sutter, R. et. al. (2012). New developments in hip imaging. Radiology. Volume 264 , Issue 3, (pp. 651-67)
  16. Partsch, G. et.al. (1978). Plasma amino acid level in rheumatoid arthritis and ankylosing spondylitis and its variation during age. Z Rheumatol. Volume 37, Issues 3-4. (pp 105-11).
  17. McNearney, T. et.al. (2000). Excitatory amino acid profiles of synovial fluid from patients with arthritis. The Journal of Rheumatology. Volume 37, Issue 3, (pp. 739-45).
  18. Raychaudhuri, S. et.al. (2012). Five amino acids in three HLA proteins explain most of the association between MHC and seropositive rheumatoid arthritis. Nature Genetics. Volume 44, Issue 3, (pp. 291-6).
  19. Elfeddali, R. et al. (2013). Arthroscopic elbow surgery, is it safe? Journal of Shoulder and Elbow Surgery. Volume 22, Issue 5, (pp. 647-52)
  20. Bert, J. and Bert, T. (2013). Management of infections after arthroscopy. Sport Medicine & Arthroscopy Review. Volume 21, Issue 2, (pp.75-9)
  21. Noud, P. and Esch, J. (2013). Complications of arthroscopic shoulder surgery. Sport Medicine & Arthroscopy Review. Volume 21, Issue 2, (pp.89-96)

About the author

Relative Posts

Leave a Reply

Leave a Reply

Your email address will not be published.