Osteoarthritis Overview:

Osteoarthritis, Arthritis is a basic or general term which means joint inflammation. There are many types of arthritis-like Rheumatoid arthritis, Gouty arthritis, septic arthritis, and psoriatic arthritis but the most common type of arthritis is Osteoarthritis. It affects millions of people worldwide and affects many joints in the body.

What is Osteoarthritis?

OSTEOARTHRITIS
OSTEOARTHRITIS

Osteoarthritis is an age-related joint disease also called a chronic inflammatory degenerative joint disease or wear and tear arthritis characterized by remodeling of bone and damage of articular cartilage as a result there is the formation of bony spurs or osteophytes. There are also loose bodies within the joints like small fragments of articular cartilage and bone. The ultimate result of osteoarthritis is pain, stiffness, and joint effusion. Also causes participation restrictions and limits the activities of daily living. So that person is unable to perform his or her functional task.

Joints involved:

Osteoarthritis involves many joints of the body but the most commonly involved joints are weight-bearing joints of the body like hips, knees, and spine and the spine most commonly affects the cervical and lumbar spine. Other small joints are also involved which are the Distal and proximal interphalangeal joints of fingers and thumb. 

Age of Onset:

OA most commonly starts in old age in people above 50s but it can occur at any age due to some underlying cause, such as trauma to the joint, post-op immobilization, and repetitive stress in sports activities. Because of all these reason, people can get OA in their 20s and 30s

What is the pathophysiology of Osteoarthritis?


In our body when two or more bones meet they form a joint. In normal healthy joints, there is a substance that is tough, smooth, slippery, and shiny called articular cartilage that covers the joints and acts as a cushion to absorb shock and stress over the joint. Over time and with increasing age this articular cartilage becomes thin and rough so that it can easily damage with little stress over the joint. With  OA this articular cartilage damages and starts wear and tear in the involved joints.

In the beginning, an inflammatory response starts and our body tries to repair damage as it is the natural mechanism of the body in response to any type of injury or damage so all the cells of the body become more active like chondrocytes and inflammatory cells. These cells don't always work normally and cause changes to joint structure like cartilage degradation and remodeling of bone. Due to articular cartilage destruction, there is exposure to underlying bone which causes hardening or sclerosis of bone and leads to osteophytes formation.

Sometimes the joint loses all the cartilage and there are small fragments of bone and articular cartilage within the joints which cause more pain and inflammation in the joints. Due to inflammatory response blood vessels become more permeable as a result joint effusion occurs.

What are the causes/risk factors of Osteoarthritis?

There is not a single exact known cause of  OA. Many factors are involved in developing osteoarthritis. Some causes are given below;

Age.

OA usually starts at an older age from the 40s onward due to some age-related changes in the body like a decrease in muscular strength, as a result, there is more stress to joints and articular cartilage also becomes thin and rough with age so more rubbing of bones occurs. But it can occur at any age due to some underlying causes like joint injury or immobilization 

Gender.

The prevalence of OA is more in women than men. Women have severe knee arthritis because of some risk factors like changes in the anatomy of joints, genetics, weight, prior knee injury, and landing mechanism in sports.

Genetics.

The inheritance pattern for OA is not known but some defective genes cause defects in articular cartilage so people born with any type of joint abnormality have more chances to develop Osteoarthritis. So family history must be taken while examining joints for OA. 

Obesity.

Obesity is a major factor causing osteoarthritis of the weight-bearing joints like the hip, knee, and spine as an increase in weight causes more stress to joints so reducing excess weight and maintaining a normal weight can prevent progression in this disease.

Injuries to the joints.

Injuries to the joints as in sports activities lead to joint malformation, ligament instabilities, cartilage degeneration, and sometimes joint dislocation so all these factors contribute to Osteoarthritis later in life.

Joint overuse.

Repetitive activities in some professions which require more bending at joints and squatting is a major risk factor contributing to developing OA.

Other abnormalities.

People having some other form of arthritis like rheumatoid arthritis are more prone to develop osteoarthritis some other risk factors are excessive iron in the blood or excess growth hormone.

What are the signs and symptoms of Osteoarthritis?

Symptoms of Osteoarthritis worsen gradually. Sign and symptoms include:

  • Pain. affected joints have no or little pain at rest but pain increases with movements worse pain are felt at the end of the day.
  • Stiffness. Stiffness occurs when a patient awakens in the morning or after being inactive for a long duration.
  • Tenderness. There is tenderness on touching or applying pressure over the affected joint.  
  • Popping or cracking sensation. While using or moving affected joints pop or cracking sensation is felt.
  • Bony spurs. Extra bone growth or hard lumps can form at the margins of bones called bony spurs also known as osteophytes.
  • Joint effusion and inflammation. Due to damage of joints structures, an inflammatory response starts which can lead to joint effusion.
  • Decrease flexibility of joints. Movement of joints through their full range of motion is not possible because of muscle weakness and joint stiffness.

What are Complications in Osteoarthritis?

As osteoarthritis is a chronic degenerative joint disease so its symptoms worsen over time which leads to disability. Because of this disability and functional limitations, the patient develops depression and sleep disturbance.

What are the four stages of Osteoarthritis?

OA is divided into four stages based on signs and symptoms and joint space.

  • Stage 0 - Normal. When there is a healthy joint and x-ray shows no signs the joint is classified at stage 0.
  • Stage 1 - Minor. There are little to no signs and symptoms and doubtful narrowing of joint space on the x-ray.
  • Stage 2 - Mild. joints feel stiff and uncomfortable and there are more osteophytes on x-ray although joint space appears normal on x-ray.
  • Stage 3 - Moderate. When there is more pain, stiffness, and obvious joint swelling with definite narrowing of joint space then the joint is graded as stage 3. Popping and snapping sounds may be felt on movements.
  • Stage 4 - Severe.  On walking and moving joints there is greater pain and stiffness and discomfort. All the joint cartilage wears off and joint space is considerably reduced. Severe joint damage occurs in this stage.What is OSTEOARTHRITIS

How is Osteoarthritis diagnosed?

The diagnosis depends on the following factors:

  1. Clinical history (including all the signs and symptom description and the type, location, and pattern of pain).
  2. Physical examination
  3. X-ray. It is the main component to confirm diagnoses based on joint space narrowing and bone spurs formation.
  4. Needle aspiration. Joint fluid is taken through needles which examine to rule out other types of arthritis.

How is Osteoarthritis treated?

There is a different treatment option for OA:

1.Medical treatment

2.physiotherapy management

3.surgical treatment

1.Medical treatment:

Following medications can be used to reduced or overcome  the symptoms of Osteoarthritis;

Pain relief medicines:

a.Paracetamol:

Paracetamol is an analgesic and antipyretic agent used for the treatment of mild to moderate pain and it is also preferred over aspirin for those patients having a history of stomach ulcer and coagulation disorders where aspirin is contraindicated. 

b. NSAIDs:

  • Over-the-counter medicine such as Acetaminophen should be used as 1st line treatment for mild OA.
  • Other Non Steroidal Anti Inflammatory (NSAIDs) Drugs such as ibuprofen or naproxen should be used for the treatment of moderate to severe osteoarthritis.
  • Diclofenac is also the best pain killer. 
  • NSAIDs have many side effects so these medicines should be used with caution and are not suitable for patients having gastric ulcers and heart-related problems like Angina, Myocardial infarction, or CVA.

c.Opioids:

Opioids are strong painkillers and used to treat severe pain where paracetamol is not sufficient to relieve pain. But constipation is a major side effect caused by it so your doctor prescribes a laxative alongside these medicines to prevent constipation. Patients can also develop drowsiness and nausea after long-term usage of opioids.

d.Steroids injections:

cortisol( hydrocortisone) injections are used to reduce swelling and inflammation. It is a naturally occurring corticosteroid having anti-inflammatory and immunosuppressive actions.

Steroid injections are directly inserted into the affected joint and are used where other treatment options to relieve pain and inflammation don't work.

Adverse effects: 
  • Pain and bruising around the injection site. This type of pain ranges from minor to intense and is called a steroid flare.
  • Flushing of the face which remains for a few hours. And skin becomes pale and thin around the injection site.
  • Some patients develop disturbances of sleep such as insomnia.

2.Physiotherapy Management:

Your Physical therapist does the complete physical examination first and then starts different types of exercise to reduce pain, stiffness, inflammation, and then improve your quality of life by strengthening muscles, increasing the range of motion and flexibility of joints.

Principles of management: Osteoarthritis

There are different management guidelines that a physical therapist follows to manage OA.

  • Instruct/educate the patient: 1st of all a Physical therapist educates the patient about the progression and characteristics of the disease and then instructs the patient how to protect joints while remaining active and how to decrease your pain and stiffness while staying at home. Also helps the patient to perform exercises at home.
  • Decrease pain and stiffness:  At the early stage of disease pain and stiffness are common complaints. Pain starts after moving joints like walking and increases at the end of the day and stiffness for a short duration occurs in the morning and after a period of prolonged inactivity. There is no pain at rest during the early stage so patients should have to keep the balance between activity and rest so that the pain and stiffness reduce. At the later stage, pain occurs at rest because of secondary involvements of other joint structures like subchondral bone, joint capsule, and synovial fluid. So at later stage pain can be managed by changing lifestyle and modifying activities of daily living. Splints can also be used to decrease joint stress so that pain is minimized.
  • Stretching exercises: To increase range of motion and flexibility stretching and joint mobilization techniques can be performed. There are different types of stretching like passive stretching and self-stretching. Patients should learn self-stretching exercises so that they can perform at home.
  • Strength training exercises: weakening in the muscles develops due to inactivity and pain factor and these weak muscles may add to further joint problems and pain also increases and the joint is protracted through strong muscles. So resisted exercises are performed to strengthen the joint. These resisted exercises include static and multiple angle isometric exercises performed within a pain-free range. functional status is improved by these strengthening programs. 
  • Swimming/Pool exercises: Exercises within a pool are used to increase the functional capacity of the patient.
  • Balance training: to improve balance different types of balance exercises are there like Tai Chi.
  • Cardio workout: aerobic conditioning programs are used to improve the cardiopulmonary fitness of the patient with OA. low-intensity aerobic exercises are best for the patient such as;

1.walking

2.elliptical machine and Bicycle 

3. Low resistance circuit training

Jogging, jumping, and other activities putting repetitive stress on joints.

Use of orthotic and assistive devices:

Different varieties of assistive devices are used to minimize stress on joints. but be sure each assistive device should be prescribed by a healthcare professional. Some commonly used devices are given below :

  • Braces
  • Canes
  • Crutches
  • Walkers
  • Splints 

3.Surgical treatment of Osteoarthritis: 

The surgical treatment option is used when patients have no more choice to treat the problem conservatively. Two main surgical options for OA patients are given below;

  1. Arthroscopy is a minimally invasive procedure where an arthroscope and an endoscope are used to replace the damaged cartilage within the joints.
  2.  Arthroplasty is a second main surgical procedure used to restore the function of a joint by resurfacing the bones.

Which diet is worse for Osteoarthritis?

The high-calorie diet which is full of fats and carbs such as trans fats, refined carbs, and fried foods should not be used when you have osteoarthritis because it makes the symptoms worse and weight is also increased.

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