Osteoarthritis: Causes, Diagnosis and Treatment


Osteoarthritis (OA) is the most common chronic joint inflammation that results from cartilage degeneration.

March 30, 2018

Osteoarthritis (OA) is the most common chronic joint inflammation that results from cartilage degeneration. It is also called as degenerative joint disease, degenerative arthritis, and wear-and-tear arthritis. A joint is where two bones come together. Cartilage is a protective tissue which covers the ends of these bones. This cartilage breaks down in OA, causing the bones within the joint to rub together resulting in pain, stiffness, and other symptoms.
Although it can occur in adults of any age, mostly seen in older people. Osteoarthritis is the most common form of arthritis, and is a leading cause of disability in millions of people worldwide. Most commonly it affects joints in your hands, knees, hips and spine, typically at the neck or lower back . Although the underlying process cannot be reversed, the symptoms can be effectively managed. Staying active, maintaining a healthy weight and other treatments may slow progression of the disease and help improve pain and joint function.The goal of treatment in osteoarthritis is to reduce joint pain and inflammation while improving and maintaining joint function.

Causes of Osteoarthritis:

Joint damage is the main cause of OA. The older you are, the more wear and tear you have had on your joints. Therefore age is one of the main causes of the joint damage leading to osteoarthritis as this damage get advanced over time. Past injury like torn cartilage, dislocated joints and ligament injuries can be other causes of joint damage. Joint malformation, obesity, and poor posture can also be a factor associated with OA. Certain risk factors, such as family history and gender, increase your risk of osteoarthritis.
Osteoarthritis that is caused by another disease or condition is known as secondary osteoarthritis. Conditions that can lead to secondary osteoarthritis include obesity, repeated trauma or surgery to the joint structures, abnormal joints at birth (congenital abnormalities), gout, diabetes, and other hormone disorders.The mechanical stress on the joint can be increased due to obesity affecting the cartilage. When cartilage breaks down, bone surfaces become pitted and rough causing pain within the joint, and irritation in surrounding tissues. As cartilage doesn't contain any blood vessels, damaged cartilage can't repair itself.
When cartilage wears away completely, it can no more provide protection to the ends of bones within a joint. This does not allow the bones to move easily against each other causing bone-on-bone contact resulting in intense pain and other symptoms associated with OA. Therefore obesity is the most significant risk factor for osteoarthritis of the knees. Repeated trauma to joint tissues such as ligaments, bones, and cartilage can to lead to early osteoarthritis of the knees in soccer players and army military personnel.
Congenital abnormalities is a birth defect that are vulnerable to mechanical wear, causing early degeneration and loss of joint cartilage. Structural abnormalities of these joints that had been present since birth is the main cause of osteoarthritis of the hip joints.

Osteoarthritis vs. rheumatoid arthritis:

Although osteoarthritis(OA) and rheumatoid arthritis (RA) share the same symptoms but are very different conditions. OA is a degenerative condition, where the severity increases over time where as RA is an autoimmune disorder.
Misdirected immune system that attacks body tissues particularly the joint lining tissue called synovium in RA. While rheumatoid arthritis is a systemic disease, OA is not . Therefore, rheumatoid arthritis can attack tissues throughout the body beyond affected joints, including the lungs, eyes, and skin.

Diagnosis of Osteoarthritis:

As OA develops very slowly it can be hard to diagnose until it starts to cause painful or debilitating symptoms. The diagnosis include:

Physical examination:

Your doctor will closely examine your affected joint, checking for tenderness, swelling or redness, and for range of motion in the joint in this test.

Imaging tests:

Imaging tests such as X-ray and MRI can be done to obtain a detail pictures of the affected joint.

X-rays:

Cartilage doesn't show up on X-ray images, but cartilage loss is revealed by X-rays when it shows a narrowing of the space between the bones in your joint. An X-ray may also show bone spurs around a joint. In some cases X-ray shows the evidence of osteoarthritis even before people experience any symptoms.

Magnetic resonance imaging (MRI):

An MRI uses radio waves and a strong magnetic field to produce detailed images of bone and soft tissues, including cartilage. An MRI isn't commonly needed to diagnose osteoarthritis but may help provide more information in complex cases.

Lab tests:

Blood or joint fluid analysis can help confirm the diagnosis.

Blood tests:

Although there is no blood test for osteoarthritis, certain tests may help rule out other causes of joint pain, such as rheumatoid arthritis. It is performed to exclude diseases that can cause secondary osteoarthritis, as well as to exclude other arthritis conditions that can mimic osteoarthritis.

Joint fluid analysis:

Arthrocentesis is a procedure to remove joint fluid for analysis. A sterile needle is used to remove joint fluid for analysis during this procedure. Joint fluid analysis is useful in detecting inflammation and excluding gout, infection, and other causes of arthritis.
During arthrocentesis removal of joint fluid and injection of corticosteroids into the joints can help relieve pain, swelling, and inflammation. Analysis of the location, duration, and character of the joint symptoms and the appearance of the joints helps the doctor in diagnosing osteoarthritis.
The presence of Heberden's nodes, Bouchard's nodes, and bunions of the feet can be an indication of osteoarthritis as bony enlargement of the joints from spur formations is characteristic of osteoarthritis.

Treatment of Osteoarthritis:

The process underlying osteoarthritis cannot be reversed, but symptoms can usually be effectively managed with lifestyle changes, medications, surgery, physical and other therapies. Exercising, achieving a healthy weight and and avoiding activities that exert excessive stress on the joint cartilage, can help slow down cartilage degeneration and manage osteoarthritis.
The goal of treatment in osteoarthritis is to reduce joint pain and inflammation while improving and maintaining joint function. Some patients with osteoarthritis have minimal or no pain and may not require any treatment. Others can reduce the symptoms by rest, exercise, diet control with weight reduction, physical therapy and/or occupational therapy, and mechanical support devices, such as knee braces. When large, weight-bearing joints such as the hips or knees are involved, these things can be taken in to consideration. In fact, even modest weight reduction can help to decrease symptoms of osteoarthritis of the large joints, such as the knees and hips. Resting sore joints decreases stress on the joints and relieves pain and swelling. Simply decreasing the intensity and/or frequency of the activities that consistently cause joint pain can help relieves pain and swelling.
Exercise when performed at levels that do not cause joint pain usually does not aggravate osteoarthritis. Exercise is helpful for strengthening the muscular support around the joints resulting in relief of symptoms of osteoarthritis. It also helps with weight reduction and prevents the joints from freezing up and improves and maintains joint mobility. Applying local heat before and cold packs after exercise can help relieve pain and inflammation. As swimming is an exercise with minimal impact stress to the joints, it is recommended for patients with osteoarthritis. Walking, stationary cycling, and light weight training are other recommended exercise. Support devices, such as splints, canes, walkers, and braces which can be helpful in reducing stress on the joints can be provided by a physical therapists.
The demands of daily activities can be assessed by a occupational therapist who can suggest additional devices that may help people at work or home. Finger splints can support individual joints of the fingers. Paraffin wax dips, warm water soaks, and nighttime cotton gloves can help ease hand symptoms. A neck collar, lumbar corset, or a firm mattress can improve spine symptoms, depending on what areas are involved.

Medications:

There are a number of different types of OA medications that can help provide relief from pain or swelling. They include:

Oral analgesics:

Tylenol and other pain relievers reduce pain but not swelling. Aspirin and acetaminophen are mild pain relievers which are sufficient treatment in many OA patient. Acetaminophen given in adequate doses can often be equally as effective as prescription anti-inflammatory medications in relieving pain in osteoarthritis of the knees. Since acetaminophen has fewer gastrointestinal side effects than NSAIDS (see below), especially among elderly people, acetaminophen is generally the preferred initial drug given to patients with osteoarthritis.

Topical analgesics:

These OTC products are available as creams, gels, and patches. They help to numb the joint area and can provide pain relief, especially for mild arthritis pain. Capsaicin, salicin, methyl salicylate, and menthol are some of the examples of these OTC product. Diclofenac and diclofenac patch are anti-inflammatory lotion used for the relief of the pain of osteoarthritis

NSAIDs (nonsteroidal anti-inflammatory drugs):

NSAIDs such as Advil (ibuprofen) and Aleve (naproxen) reduce swelling as well as pain. To decrease the risk of side effects of these medications, NSAIDs should be used temporarily and then discontinue them for periods of time without recurrent symptoms.
As in osteoarthritis, the symptoms vary in intensity and can be intermittent, this is more often possible in case of people with osteoarthritis. The most common side effects of NSAIDs involve gastrointestinal problem, such as stomach upset, cramping diarrhea, ulcers, and even bleeding. The risk of these and other side effects increases in the elderly. Cox-2 inhibitors is a new NSAIDs that is found to be less toxicity to the stomach and bowels.

Cymbalta:

Your doctor may prescribe the antidepressant Cymbalta for you to help provide OA pain relief.

Corticosteroids:

Cortisone is used in many forms to treat arthritis. It can be taken orally in the form of prednisone or methylprednisolone, given intravenously, and injected directly into the inflamed joints to rapidly decrease inflammation and pain while restoring function. These can be used only for the patient with severe symptoms, as repetitive cortisone injections can be harmful to the tissue and bones.
If surgery is not being considered as an option for persisting pain of severe osteoarthritis of the knee, a series of injections of hyaluronic acid can be injected into the joint which can be helpful sometimes. This is the option when it that does not respond to weight reduction, exercise, or medications.These injections can temporarily restore the thickness of the joint fluid and allow better joint lubrication.

Surgery:

Surgery can be considered as an option for people with permanent damage that limits daily function, mobility and independence. Surgical procedures can be performed to relieve pain, improve function, and correct deformity. Occasionally, joint tissue is surgically removed for the purpose of biopsy and diagnosis. Orthopedic surgeons are doctors who is specialized in joint surgery.
Arthroscopy is a cutting instrument with viewing tube is generally used for this surgery. A bone-removal procedure called osteotomy can help realign some of the deformity in selected patients, usually those with knee disease. Removal of inflamed joint lining tissue is called synovectomy. Joint replacement surgery can relieve pain and restore function in joints which are badly damaged by OA. Damaged parts of a joint can be replaced with artificial joint (arthroplasty) such as metal and plastic parts in surgery. The small joints of the hand can be replaced with plastic material where as large joints, such as the hips or knees, are replaced with metals. Most common replacement are done for hip and knee. However, ankles, shoulders, wrists, elbows, and other joints may also be considered for replacement.Total hip and total knee replacements are now very common. These can relief pain and improved joint function.