Curative treatment for osteoarthritis

Arthritis refers to biomechanical changes within a joint. Osteoarthritis (OA) is the most common kind of arthritis. There are a number of contributing factors to osteoarthritis, including age.

What is osteoarthritis?

Osteoarthritis, also known as degenerative joint disease (DJD), is the most common type of arthritis. Osteoarthritis is more likely to develop as people age. The changes in osteoarthritis usually occur slowly over many years, though there are occasional exceptions. Inflammation and injury to the joint cause bony changes, deterioration of tendons and ligaments and a breakdown of cartilage, resulting in pain, swelling, and deformity of the joint.

There are two main types of osteoarthritis:

• Primary: Most common, generalized, primarily affects the fingers, thumbs, spine, hips, knees, and the great (big) toes.

• Secondary: Occurs with a pre-existing joint abnormality, including injury or trauma, such as repetitive or sports-related; inflammatory arthritis, such as rheumatoid, psoriatic, or gout; infectious arthritis; genetic joint disorders, such as Ehlers-Danlos (also known as hypermobility or "double-jointed; congenital joint disorders; or metabolic joint disorders.

Symptoms

Common symptoms of arthrosis and other types of arthritis often overlap and include joint pain, stiffness, and difficulty moving around. However, different types of arthritis can present with additional symptoms.

Symptoms of Arthritis

Arthritis causes joint inflammation. Certain types of arthritis can also affect other structures in the body, such as the skin. In addition to pain and stiffness, arthritis symptoms can include:

• Redness and swelling

• Warm skin in the affected area

• Fever

• Weight loss

• Rash

• Itching

• Breathing issues

In addition to arthrosis (osteoarthritis), other types of arthritis include:

• Rheumatoid arthritis is an autoimmune disorder in which the body mistakenly attacks healthy tissues in the joints. This condition can also cause damage to other structures, such as internal organs.

• Juvenile arthritis develops in childhood and causes joint inflammation.

• Gout occurs when crystals form in joints due to too much uric acid in the body. Gout most often affects the big toe.

• Ankylosing spondylitis causes arthritis in the spine.

• Reactive arthritis can occur when certain infections cause inflammation in the joints.

• Psoriatic arthritis causes scaly skin with white and red patches and joint issues.

Symptoms of Arthrosis

Arthrosis (osteoarthritis) is the most common type of arthritis, affecting more than 32.5 million people on one continent. This condition slowly destroys the cartilage that provides padding between bones in joints.

Symptoms include:

• Achy pain in the affected joints

• Swelling

• Decreased range of motion

• Stiffness

• Feeling like the joint will "give out"
  

Joints Affected by Arthrosis

Arthrosis (osteoarthritis) most often affects joints in the fingers, hands, knees, and hips. It also commonly affects the spine.

What is cartilage?

Cartilage is a firm, rubbery, flexible connective tissue covering the ends of bones in normal joints. It is primarily made up of water and proteins whose primary function is to reduce friction in the joints and serve as a "shock absorber." The shock-absorbing quality of normal cartilage comes from its ability to change shape when compressed, because of its high water content. Although cartilage may undergo some repair when damaged, the body does not grow new cartilage after injury. Cartilage is avascular, meaning there are no blood vessels in it. Therefore, healing is a slow process.

Cartilage is made up of two main elements: cells within it known as chondrocytes and a gel-like substance called matrix, composed mostly of water and two types of proteins (collagen and proteoglycans).

• Chondrocytes, and the precursor form chondroblasts, are highly complex multifunctional cartilage cells. Functions include synthesizing and maintaining the extracellular matrix comprised of collagen and proteoglycans that help healthy cartilage grow and heal.

• Collagen is a structural protein found in many tissues such as skin, tendons and bone and is a key structural component of cartilage. Collagen provides cartilage with its strength and creates a framework for the other components.

• Proteoglycans are complex molecules composed of protein and sugar combinations that are interwoven in the matrix of cartilage. Their function is to trap large amounts of water in cartilage, which allows it to change shape when compressed thus acting as a shock absorber. At the same time, proteoglycans repel each other, allowing cartilage the ability to maintain its shape and resilience.

Who is affected by osteoarthritis?

Approximately 80% of older adults, ages 55 years and older, have evidence of osteoarthritis on X-ray. Of these, an estimated 60% experience symptoms. It is estimated that 240 million adults worldwide have symptomatic osteoarthritis, including more than 30 million U.S. adults. Post-menopausal women have an increased incidence of knee osteoarthritis compared to men.

What are the risk factors for osteoarthritis?

In addition to age and secondary causes such as inflammatory arthritis and prior injury/ trauma, several other risk factors increase the chance of developing osteoarthritis including obesity, diabetes, elevated cholesterol, sex, and genetics.

• Obesity is a risk factor for osteoarthritis, particularly of the knee. In addition to overloading the weight-bearing mechanisms of the body, the metabolic and pro-inflammatory effects of obesity have been studied as contributory to osteoarthritis. Maintaining ideal body weight or losing extra weight is important for those at risk.

• Both diabetes and hyperlipidemia (elevated lipids/cholesterol) contribute to the inflammatory response within the body, increasing the risk of osteoarthritis. Oxidation of lipids can also create deposits in cartilage which affects affecting blood flow of subchondral bone in the same way that blood vessels are affected by atherosclerosis. Elevated blood sugars, as well as elevated cholesterol/lipids, increase free radicals within the body, this oxidative stress exceeds the resilience of cartilage on the cellular level. Managing diabetes and hyperlipidemia is important for bone health in addition to general health.

• Decreased estrogen as experienced by post-menopausal women increases the risk of knee osteoarthritis as estrogen is protective of bone health specifically reducing oxidative stress to the cartilage.

• Heredity can play a role in osteoarthritis, as individuals born with other bone diseases or genetic traits may be more likely to develop osteoarthritis. For example, Ehlers-Danlos, which is characterized by joint laxity or hypermobility, can contribute to osteoarthritis.

What causes osteoarthritis?

Primary osteoarthritis is a heterogeneous disease meaning it has many different causes, it is not only “wear and tear” arthritis. Some contributing factors to OA are modifiable (can be changed) and others are non-modifiable (cannot be changed such as born with it or now permanent). Age is a contributing factor, although not all older adults develop osteoarthritis and for those who do, not all develop associated pain. As discussed above, there can also be inflammatory and metabolic risks that can increase the incidence of osteoarthritis, particularly in the setting of diabetes and/or elevated cholesterol.

Osteoarthritis can be genetic both as primary such as nodular OA of the hands as well as secondary related to other genetic disorders, such as hypermobility of joints. Inflammatory and infectious arthritis can contribute to the development of secondary osteoarthritis due to chronic inflammation and joint destruction. Previous injuries or traumas including sports-related and repetitive motions can also contribute to osteoarthritis.

Although the exact mechanisms of cartilage loss and bone changes are unknown, advancements have been made in recent years. It is suspected that complex signaling processes, during joint inflammation and defective repair mechanisms in response to injury, gradually wear down cartilage within the joints. Other changes cause the joint to lose mobility and function, resulting in joint pain with activity.

Causes of Arthritis

Different types of arthritis have varying underlying causes.

Arthrosis

Arthrosis is often called a wear-and-tear condition because it develops from repeated joint stress. Other factors that can contribute to arthrosis include:3

National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteoarthritis basics.

• Older age

• Joint deformities

• Family history of arthrosis

• Previous injury to a joint

• Joint surgery

• Excess body weight

Arthritis

Other types of arthritis can have additional causes and risk factors, such as:4

• Smoking

• Infection in a joint

• Female gender

• Genetic predisposition

• High blood sugar levels

• Jobs that involve repetitive motion

How do I know if I have osteoarthritis?

Unlike other types of arthritis, the pain from osteoarthritis usually develops gradually over many months or years. Often it increases with activities that put stress on the joint, such as running or prolonged walking. Pain and joint swelling tend to increase slowly over time. Sometimes, especially in more advanced disease, a sensation of crunching or grinding may be noticed in affected joints. Prolonged morning stiffness is not a prominent symptom in OA as compared to inflammatory arthritides, such as rheumatoid or psoriatic arthritis. Osteoarthritis does not usually cause fevers, weight loss, or very hot and red joints. These features suggest some other condition or type of arthritis.

Your healthcare provider typically diagnose osteoarthritis by obtaining a complete history of your symptoms and examining your joints. X-rays may be helpful to make sure there is no other reason for the pain. Magnetic resonance imaging (MRI) is generally not needed except in unusual circumstances or in cases when the cartilage or surrounding ligament tear is suspected. There are no blood tests that diagnose osteoarthritis. If a joint is particularly swollen, a doctor may need to drain fluid from that joint. Tests can be performed on the fluid to look for clues for other types of arthritis, such as gout.

How Is Arthritis Diagnosed?

Diagnosing different types of arthritis, including arthrosis, begins with an examination by a healthcare provider. Your provider will ask questions about your symptoms—how long they have been present, what activities make them better or worse—and review your medical history.

Your provider will perform a physical exam to look for joint swelling or redness and evaluate how your joint moves.

Lab Tests

Lab tests often test blood, urine, and the fluid inside your joints to diagnose various types of arthritis. However, there are no specific lab tests for arthrosis (osteoarthritis).

Examples include:

• Complete blood count (CBC): Arthritis can cause lower levels of white blood cells, red blood cells, or platelets in the blood.

• Arthrocentesis: This test involves the insertion of a small needle into the joint to remove a sample of the joint fluid called synovial fluid. The fluid can be tested for blood cell counts, uric acid, bacteria or viruses, and the presence of crystals, which could indicate gout.

• Complement tests: A complement is a group of proteins in the blood. Measuring levels of complement can help diagnose rheumatoid arthritis.

• Rheumatoid factor: This protein is often elevated in people with rheumatoid arthritis.

• Urine tests: These tests can assess for signs of kidney disease, which often occurs with arthritis. Elevated levels of uric acid in urine can help diagnose gout.

• Erythrocyte sedimentation rate (ESR): ESR can be elevated with some types of arthritis that cause inflammation.

• C-reactive protein: Levels of this protein are often elevated with inflammatory types of arthritis.

• Antinuclear antibody: Specific antibodies are present in the blood for certain types of arthritis.

What is the curative treatment for osteoarthritis?

There is no cure for osteoarthritis. Mild to moderate symptoms are usually well managed by a combination of pharmacologic and non-pharmacologic treatments. Curative treatment for osteoarthritis and recommendations include:

• Medications (topical pain medicines and oral analgesics including nonsteroidal anti-inflammatory medications, NSAIDs).

• Exercise (land- and water-based).

• Intermittent hot and cold packs (local modalities).

• Physical, occupational, and exercise therapy.

• Weight loss (if overweight).

• Healthy eating, managing diabetes and cholesterol.

• Supportive devices such as braces, orthotics, shoe inserts, cane, or walker.

• Intra-articular injection therapies (steroid, hyaluronic acid “gel”).

• Complementary and alternative medicine strategies, including vitamins and supplements.

Physical Therapy

Physical therapy can help relieve symptoms of arthritis and improve mobility and overall quality of life.

Physical therapy treatments can include:

• Heat/ice

• Ultrasound

• Electrical stimulation

• Manual therapy

• Stretching

• Massage

• Gait training

• Strengthening exercises

• Use of assistive devices, such as a walker or cane

The type of treatment regimen prescribed depends on many factors, including the patient's age, overall health, activities, occupation, and severity of the condition.