Osteoarthritis- Causes, Symptoms, and treatment

Osteoarthritis is also known as osteoarthrosis is falsely called degenerative joint disease, it is the most common form of arthritis. Osteoarthritis has a strong association with an increase in age and is a leading cause of pain and disability in elderly people. Osteoarthritis is a condition of synovial joints that is characterized by loss of the articular hyaline cartilage with the rapid formation of new bone and remodeling of joint contour.

Signs of inflammation are not specifically found in osteoarthritis. Osteoarthritis selectively targets specific small and large joints, osteoarthritis is a dynamic repair process of synovial joints, which is triggered by a variety of noxious factors.

Types of Osteoarthritis:

1. Primary osteoarthritis.
2. Secondary osteoarthritis.

Primary osteoarthritis:

Primary osteoarthritis occurs in old age, it mainly affects joints which have to bear the weight of the body like knee and hip joint, the generalized variety of primary osteoarthritis joints of the thumb and finger joints are affected, this type of osteoarthritis is more common than secondary osteoarthritis.

Secondary osteoarthritis:

This type of osteoarthritis is related to some underlying primary disease of the joints, which in turn leads degeneration of joints, secondary osteoarthritis occurs at any age after adolescence, and affects hip joint commonly. The predisposing factors of secondary osteoarthritis are:

1. Excessive weight and obesity
2. Maldevelopment of a joint that is congenital (present by birth).
3. Irregularities of the surface of the joint which is due to trauma.
4. Damaged articular surface due to any previous disease.
5. Internal derangement of the knee like a loose body.
6. Bowleg etc.

Any major trauma or injury and continuous use of joints are very important risk factors for the development of osteoarthritis. The pattern that how joints are involved is also influenced by types of vocational overload.

Causes of osteoarthritis:

1. There are many causes like metabolic, mechanical, genetics and other factors that may damage a synovial joint.
2. The cause is unclear in primary osteoarthritis, but the trauma is the main cause of secondary osteoarthritis.
3. Loss of articular cartilage, OA is not a disease of only cartilage, rather a disease of synovial joint, in which subchondral bone, synovium, meniscus, ligaments all are affected.

Clinical features of osteoarthritis:

The patient of osteoarthritis is elderly over the age of 45 years often over the age of 60. The hip joint OA is found mostly in western wold and knee OA is mostly found in Asians because they have a habit of squatting and sitting crosslegged.

1. The main symptoms are pain and functional restriction.
2. Pain may be aggravated at night.
3. Mostly major joints of lower limbs are involved, in both limbs.
4. Pain in osteoarthritis may occur intermittently in starting but become constant after some time.
5. Pain at the start of OA is dull and aggravates after starting an activity, but after some time pain becomes worse and occurs after activity.
6. Crepitus is present in some patients.
7. The swelling of joints is a late feature that is caused by the effusion which is caused by inflammation tissues of the synovium.
8. There is a period of good and bad days of pain.
9. Morning stiffness is brief less than 15 minutes.
10. There is no regional pain but only one or a few joints are only painful.

Nodal generalized OA:

1. Mostly in middle-aged women who are between 40-50 years of age group.
2. This is presented by pain, stiffness, and swelling of one or more finger joints.,as time passes more finger joints are involved.
3. There is development of Heberden’s nodes (distal finger joints) and Bouchard’s nodes (proximal finger joints).
4. Each joint go through a phase of episodic symptoms which takes one to five years, and the nodes evolve and OA develops in underlying finger joints. When the disease is fully established, however, the symptoms usually subside and hand function often remains relatively unimpaired.
5. The affected finger joints sometimes show characteristic lateral deviation.
6. First carpometacarpal joints are also involved, there is the presence of marked osteophytes and subluxation which results in thumb base squaring, thumb base OA causes more chronic symptoms and functional impairment than a finger joint OA.

Patients suffering from nodal OA are on more risk to get OA of sites i.e generalized osteoarthritis, specifically the knee joint. Nodal generalized OA has a very strong genetic predisposition among all the major rheumatic problems.

Knee OA:

Calcium pyrophosphate dihydrate crystal deposition in association with OA is most common in the knee. Common difficulties are; unable to prolonged walk, rising from the chair, bending to put on shoes and socks., OA of the knee is localized to both side of the knee joint and upper tibia.

Young-onset OA:

1. The patient is of a young age group before 45 years of age.
2. In most cases, the patients of young-onset OA have OA at a single joint like knee and there is history of trauma.

Causes of Young-onset OA:

1. Previous trauma, and localized instability if it is monoarticular.
2. If it is polyarticular this may be due to some old joint disease like juvenile idiopathic arthritis, or due to metabolic or endocrine diseases like ochronosis, hemochromatosis.

Investigations of osteoarthritis:

A plain radiograph is sufficient.

Management of osteoarthritis:

1. The disease once started, gradually progresses and it cant be stoppable, so steps must be taken to delay the progression of the osteoarthritis and relieve the symptoms, to rehabilitate the patient with or without surgical interventions are the mainstay of treatment.
2. Analgesics to supress the pain.
3. Chondroprotective agents like glucosamine and chondroitin sulfate.
4. Viscosupplementation.
5. Supportive therapy like weight reduction in obese patients, avoidance of stress, and strain like patients of osteoarthritis of the knee must be advised to avoid long-standing, excessive running or walking, squatting and sitting cross-legged must be avoided in patients of OA.
6. Local heat and the use of counter irritants and liniments are used to relieve pain.
7. Exercises that help to build up muscle control over joint stability must be encouraged.

Natural approach to osteoarthritis:

1. Epsom salt bath or local hot fomentation or warm compresses of Epsom salt, help to relieve the pain of osteoarthritis.
2. Anti-inflammatory spices to be used like ginger, turmeric, rosemary.
3. Local heat to a particular joint by heat pad when there is joint stiffness and cold compresses when there is joint pain.
4. Oil of wintergreen, aloe vera, eucalyptus oil, thunder god vine as liniments.
5. Green tea and turmeric are beneficial. Turmeric capsules can be taken 400 to 600 mg three times a day, turmeric helps to reduce pain stiffness and inflammation. Green tea helps in the protection of cartilage.
6. Food to eat in osteoarthritis:
   1. Citrus fruits, tart cherries, avocado, raspberries, grapes, strawberries, watermelon, broccoli.
   2. Dark leaf vegetables, like spinach, kale, collard greens.
   3. Nuts.
   4. Garlic
   5. Fishes that are rich in omega 3 like salmon, tuna mackerel, herring, lake trout, sardines, and albacore tuna.
   6. Dairy products which are in low fat, yogurt, cottage cheese.
   7. Oil made from walnuts, extra virgin olive oil, almond oil, avocado, grape seed oil, peanut oil, rice bran oil, etc. sunflower seed oil, safflower seed oil.
7. To avoid in osteoarthritis:
   1. High refined carbohydrates, white bread, alcohol, fried products, red meat, eggs, omega 6 fatty acid-rich foods, full-fat dairy products, White rice, processed sugar to be avoided it is also found in preserved fruit juice, soft drinks, products with artificial sweetener, and alcohol.