- Published on Tuesday, 10 September 2013 22:35
- Written by tebyan.net
Osteoarthritis (OA, also known as degenerative arthritis, degenerative joint disease), is a clinical syndrome in which low-grade inflammation results in pain in the joints, caused by abnormal wearing of the cartilage that covers and acts as a cushion inside joints and destruction or decrease of synovial fluid that lubricates those joints. As the bone surfaces become less well protected by cartilage, the patient experiences pain upon weight bearing, including walking and standing. Due to decreased movement because of the pain, regional muscles may atrophy, and ligaments may become more lax. OA is the most common form of arthritis.
"Osteoarthritis" is derived from the Greek word "osteo", meaning "of the bone", "arthro", meaning "joint", and "itis", meaning inflammation, although many sufferers have little or no inflammation. A common misconception is that OA is due solely to wear and tear, due to the fact that OA typically is not present in younger people. However, while age is correlated with OA incidence, this merely illustrates that OA is a process that takes time to develop. There is usually an underlying cause for OA, in which case it is described as secondary OA. If no underlying cause can be identified, it is described as primary OA. "Degenerative arthritis", often used as a synonym for OA, but the latter involves both degenerative and regenerative changes.
Treatment of Osteoarthritis
One of the most common conservative treatments is chiropractic care. This safe and moderate treatment reduces uneven joint alignment and helps to prevent future progression of degenerative joint disorders. No matter the severity or location of OA, measures such as weight control, appropriate rest, exercise and the use of mechanical support devices are usually beneficial. In OA of the knees, knee braces, a cane or a walker can be helpful for walking and support. Regular exercise in the form of walking or swimming, if possible, is encouraged.
Applying local heat before””and cold packs after””exercise, can help relieve pain and inflammation, as can relaxation techniques. Heat, often moist heat, eases inflammation and swelling, and may improve circulation, which has a healing effect on the local area. Weight loss can relieve joint stress and may delay progression. Proper advice and guidance by a healthcare provider is important in OA management, enabling people with this condition to improve their quality of life.
In 2002, a randomized, blinded assessor trial was published showing a positive effect on hand function with patients who practiced home joint protection exercises (JPE). Grip strength, the primary outcome parameter, increased by 25% in the exercise group versus no improvement in the control group. Global hand function improved by 65% for those undertaking JPE.
Medical treatment includes NSAIDs, local injections of glucocorticoid or hyaluronan, and in severe cases, with joint replacement surgery. There has been no cure for OA, as cartilage has not been induced to regenerate. However, if OA is caused by cartilage damage (for example as a result of an injury), Autologous Chondrocyte Implantation may be a possible treatment.
Clinical trials employing tissue-engineering methods have demonstrated regeneration of cartilage in damaged knees, including those that had progressed to osteoarthritis. Further, in January 2007, Johns Hopkins University was offering to license a technology of this kind, listing several clinical competitors in its market analysis.
Complications: Dealing with chronic pain can be difficult and result in depression. Communicating with other patients and caregivers can be helpful, as can maintaining a positive attitude. People who take control of their treatment, communicate with their healthcare provider and actively manage their arthritis experience can reduce pain and improve function.
Surgery: If the above management is ineffective, joint replacement surgery may be required. Individuals with very painful OA joints may require surgery such as fragment removal, repositioning bones or fusing bone to increase stability and reduce pain.
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Paracetamol: A mild pain reliever may be sufficiently efficacious. Paracetamol (tylenol/acetaminophen), is commonly used to treat the pain from OA, although unlike NSAIDs, acetaminophen doesn't treat the inflammation. A randomized controlled trial comparing paracetamol with ibuprofen in x-ray-proven mild to moderate osteoarthritis of the hip or knee found equal benefit. However, acetaminophen at a dose of 4 grams per day can increase liver function tests.
Nonsteroidal anti-inflammatory drugs: In more severe cases, non-steroidal anti-inflammatory drugs (NSAID) may reduce both the pain and inflammation. These include medications such as diclofenac, ibuprofen and naproxen. High doses are often required. All NSAIDs act by inhibiting the formation of prostaglandins, which play a central role in inflammation and pain. However, these drugs are rather taxing on the gastrointestinal tract, and may cause stomach upset, cramping, diarrhea and peptic ulcer. Diclofenac has also been found to cause damage to the articular cartilage.
COX-2 selective inhibitors: Another type of NSAID, COX-2 selective inhibitors (such as celecoxib, the withdrawn rofecoxib and valdecoxib) reduce this risk substantially. These latter NSAIDs carry an elevated risk for cardiovascular disease, and some have now been withdrawn from the market.
Corticosteroids: Most doctors nowadays avoid the use of steroids in the treatment of OA as their effect is modest and the adverse effects may outweigh the benefits.
Narcotics: For moderate to severe pain, narcotic pain relievers such as tramadol””and eventually opioids (hydrocodone, oxycodone or morphine)””may be necessary.
Topical Treatments: Topical treatments are treatments designed for local application and action. Some NSAIDs are available for topical use (e.g. ibuprofen and diclofenac) and may improve symptoms without having systemic side effects. Creams and lotions containing capsaicin are effective in treating pain associated with OA if they are applied with sufficient frequency.Severe pain in specific joints can be treated with local lidocaine injections or similar local anaesthetics, and glucocorticoids (such as hydrocortisone). Corticosteroids (cortisone and similar agents) may temporarily reduce the pain.
Supplements that may be useful for treating OA include:
Glucosamine: A molecule derived from glucosamine is used by the body to make some of the components of cartilage and synovial fluid. Supplemental glucosamine may improve symptoms of OA and delay its progression. However, a large study suggests that glucosamine is not effective in treating OA of the knee. A subsequent meta-analysis that includes this trial concluded that glucosamine hydrochloride is not effective and that the effect of glucosamine sulfate is uncertain.
Chondroitin: Along with glucosamine, chondroitin sulfate has become a widely used dietary supplement for treatment of osteoarthritis. A meta-analysis of randomized controlled trials found no benefit from chondroitin. The Osteoarthritis Research Society International is in support of the use of chondroitin sulfate for OA.
Omega-3 fatty acid: A vitamin supplement comprised of important oils derived from fish.
Boswellia: A herbal supplement known in Ayurvedic medicine. It is widely available in health food stores and online.
Bromelain: A protease enzymes extracted from the plant family Bromeliaceae, blocks some pro-inflammatory metabolites.
Antioxidants: Including vitamins C and E in both foods and supplements, provide pain relief from OA.
Hydrolyzed collagen (hydrolysate): A gelatin product that may also prove beneficial in the relief of OA symptoms, as substantiated in 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.
Other nutritional changes shown to aid in the treatment of OA include decreasing saturated fat intake and using a low energy diet to decrease body fat. Lifestyle change may be needed for effective symptomatic relief, especially for knee OA.
Acupuncture: A meta-analysis of randomized controlled trials of acupuncture for knee osteoarthritis concluded "clinically relevant benefits, some of which may be due to placebo or expectation effects."
Low-level laser therapy: Low-level laser therapy is a light-wave-based treatment that may reduce pain. The treatment is painless, inexpensive and without risks or side effects. Unfortunately, it may not actually have any real benefits.
Prolotherapy: Prolotherapy (proliferative therapy) is the injection of an irritant substance (such as dextrose) to create an acute inflammatory reaction. It's claimed to strengthen and heal damaged tissues including ligaments, tendons and cartilage as part of this reaction. The injection is painful (like corticosteroids or hyaluronic acid) and may cause an increase in pain for a few days afterwards. The only other significant risk is the rare possibility of infection.
Radiosynoviorthesis: A radioactive isotope (a beta-ray emitter with a brief half-life) is injected into the joint to soften the tissue. Due to the involvement of radioactive material, this is an elaborate and costly procedure, but it has a success rate of around 80%.
Causes of Osteoarthritis
Although it commonly arises from trauma, osteoarthritis often affects multiple members of the same family, suggesting that there's hereditary susceptibility to this condition. A number of studies have shown that there's a greater prevalence of the disease between siblings and especially identical twins, indicating a hereditary basis.
Up to 60% of OA cases are thought to result from genetic factors. Researchers are also investigating the possibility of allergies, infections or fungi as a cause. There's some evidence that allergies, whether fungal, infectious or systemically induced, may be a significant contributing factor to the appearance of osteoarthritis in a synovial sac.
A single prognosis is difficult to establish because of the variety of factors influencing the disease. It also may be important to look at the particular joint involved rather than lumping all the joints together to predict the outcome. Symptoms may not be be predicted based on X-rays, but a few studies may predict joint deterioration.