WHAT CAUSES OSTEOARTHRITIS?

Osteoarthritis is the most common type of arthritis, occurring in up to about 10% of adults, with as many as 50% of the elderly suffering from it. It is basically a degenerative form of arthritis, in which the cartilage, whose function is to cushion the joints, gets worn out with age.

This "wear-and-tear" of the cartilage over time, results in the bone surfaces becoming less protected and increases friction between the bones during movement. This friction eventually results in pain, swelling and loss of mobility. In more advance stages, the joint loses it normal shape and bony spurs may grow on the edges of the joint. Bits of bone or cartilage may break off and float inside the joint space, further causing pain and loss of mobility.


The cause is multi-factorial, but the following would increase your risk:


Being overweight
Getting older
Previous injury to the joint
Mechanical stresses on the joint from high impact sports, certain jobs, pathological or congenital mal-alignment of bones

SYMPTOMS

Symptoms in the initial stages may include pain, tenderness, stiffness, creaking and locking of the affected joint. As the arthritis progresses, there may be swelling of the joint due to collection of synovial fluid within the joint. In the more advanced stages, there is bony deformity (caused by bony spurs) and mal-alignment of the limb (eg. "varus" deformity of the knee). Patients experience increasing pain upon weight bearing, thus limiting walking, and ultimately, even standing.

Osteoarthritis commonly affects the hands, feet, spine and weight-bearing joints, such as the hips and knees. In the smaller joints, such as in the fingers, hard bony swellings called Heberden's nodes and Bouchard's nodes may form. These are typically not painful, but they do limit joint movement.

DIAGNOSIS

Diagnosis can often be made by your doctor with reasonable certainty by a thorough physical examination. X-rays are used to confirm the diagnosis as well as to document progressive X-ray changes (thinning of cartilage, bony spurs, loose bodies, mal-alignment of joint etc) as the condition progresses.

TREATMENT

1. Non-Pharmacological:


Weight loss - Excess body weight puts more strain on the knee joints. A typical vicious cycle exists: (1) Overweight person develops knee osteoarthritis (2) painful knees reduce mobility (3) with reduced mobility, more weight is gained (4) more weight worsens the arthritis.
Regular exercise - regular aerobic, strengthening and range of motion exercises help strengthen muscles that stabilize the joints.
Adequate intake of Calcium and Vitamin D for bone strength.
Warm soaks and heat packs to help relief pain.
Avoid excessive walking during periods of acute pain.
Orthoses and walking aids - splints and braces help with joint alignment and weight redistribution. Walking frames and crutches help take load away from the arthritic knee.
Physiotherapy
Acupuncture

2. Pharmacological Measures:


Pain-killers - paracetamol-based medication, Non-steroidal anti-inflammatory drugs (NSAIDS) etc.
Glucosamine and/or chondroitin sulfate.
Topical rubs with NSAIDS or capsaicin.
Intra-articular joint injections

3. Surgical Treatment:


Joint lavage (wash out) and arthroscopic debridement (clearing)
Osteotomy - a wedge of bone located near the damaged joint is removed to realign the knee. This causes a shift of weight from the area of damaged cartilage to the area where there is more healthy cartilage.
Total Joint Replacement - considered to be the last resort option in which the severely arthritic joint, having failed more conservative methods of therapy, is replaced with a prosthetic joint.

The decision to treat as well the type of treatment appropriate must be individualized according to the needs of the patient.

For example, young athlete with arthritis to the knee from a previous injury, will require treatment because his arthritis impacts his activities. For him, conservative treatment with possible arthroscopic lavage and debridement would be more appropriate than total joint replacement, in view of his young age.

In contrast, severe osteoarthritis of the knee in an elderly gentleman, which when examined in isolation, would lead one to consider total knee replacement. However, if this knee belonged to a bed-bound gentleman, then perhaps simple pain-killers would be all that is needed.

Arthritis is a medical term that implies inflammation of joint(s).

Causes of this illness are diverse and involve many pathological mechanisms. The causes of arthritis are either infective or non-infective. However, whatever the cause is, it leads to pain, tenderness and limitation of movements of the affected joint(s) in most cases.

Infective causes of arthritis are numerous and include viral, bacterial, fungal and parasitic causes. Hepatitis A virus, Hepatitis B virus, Hepatitis C, Alphaviruses, Rubella virus, Retroviruses, Epstein-Barr virus, Varicella-zoster virus and Mumps virus are recognizable causes of arthritis. Bacterial arthritis is sometimes termed septic arthritis and is usually caused by Staphylococcus aureus and Streptococci. Septic arthritis is usually caused by spread of infection from nearby bones (osteomyelitis). Bacterial arthritis is rather common in the pediatric age group. Fungal causes of arthritis usually affect immune-compromised individuals like HIV infected patients. Lyme disease is one of the recognizable infective causes of arthritis in America.

Non-infective causes of arthritis are numerous and are related to many pathological mechanisms. Gouty arthritis occurs due to accumulation of uric acid in the body which might be caused by faulty diet habits or congenital metabolic abnormalities. Rheumatologic causes are numerous and lead to inflammation of the joints due to autoimmune related mechanisms. Systemic lupus erythematosus, rheumatoid arthritis, rheumatic fever, ankylosing spondylitis and reactive arthritis are amongst the commonest causes of rheumatologic inflammation of joints. Rheumatologic arthritis is commonly accompanied by other systemic manifestations such as fever, skin rash, eye inflammation, nephritis and inflammation of the blood vessels (vasculitis).

Osteoarthritis is one of the types of arthritis that are related to aging. Osteoarthritis often affects people beyond the age of 50 years and commonly affects the knees. Other rather uncommon causes of arthritis include leukemia, bone tumors and amyloidosis.

Whatever the cause of arthritis is, arthritis should be differentiated from isolated pain of the joints (arthralgia). Arthritis leads to arthralgia, but is also often accompanied by swelling, hotness, tenderness and limitation of movement of the affected joint(s).