Definition and causes of Osteoarthrisis
Osteoarthritis is the most prevalent joint disease. The disease is defined by changes to and destruction of the joint cartilage and bone around the joint. The function of the smooth cartilage that covers the end of a bone is to transfer pressure to the neighboring bone. When arthrosis develops the surface of the cartilage becomes increasingly rough, creating cracks and fissures in the cartilage, and the thickness decreases. In the initial stage symptoms are limited or absent. With increasing destruction of the cartilage varying degrees of pain and movement of the joint is experienced and changes to the position of the joint may be observed.
Osteoarthritis is a very frequent disease, and at the age of 65 years, almost all people have X-ray changes similar to arthritis in one or more joints (this is not necessarily symptomatic).
The joints that are most frequently affected are the joints in the hands and feet, knees and hips joints as well as the back.
There are several factors that are predisposing to the development of arthrosis:
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Obesity. - The increased weight load will cause additional wear and tear of especially knee and hip joints.
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Increasing age.
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Hereditary factors.
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Previous joint damage, for example meniscus lesions in the knee.
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Chronic heavy and uniform physical work.
Arthrosis can also be seen in association with diabetes or acromegaly. Osteoarthritis should not be mistaken for rheumatoid arthritis, which is an entirely different disease.
Symptoms of osteoarthritis
The symptoms of arthrosis are many. They often develop very slowly and they can come and go. Many have light arthrosis without any symptoms.
The symptoms are:
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Pain.- Frequently the pain starts when movement is initiated e.g. getting out of bed but after a while the pain may decrease. After movement for a longer period of time such asa workday the pain may re-intensify. With more pronounced arthrosis there may be pain even at rest and during the night. Many patients experience that weather changes affect the pain pattern. The pain may be radiating, and sometimes it is perceived as if coming from another joint (arthrosis of the hip often causes pain from the knee).
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Joint rigidity. - After a rest the joint may feel stiff. This is most evident in the morning.
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Decreased movement. - The joint capsule may shrink and newformed bone in the joint may impair movement of the joint which can lead to impaired movement. Initially the pain itself may cause reduced movement.
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Creaking sounds. - The irregular cartilage and possibly newformed bone can cause a squeaking sound when the joint is moved.
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Swelling. - The joint capsule is often irritated causing swelling of the joint. New formed bone can appear as hard nodules around the joint.
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Malposition. - Due to a wrong wear of the cartilage, and possibly coinciding with collapse of the bone may cause the joint to slide and malposition.
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Instability and loss of function. - The above symptoms leads to insecurity and reduced function. This may result in reduced strength of the surrounding muscles, which in turn affects the functioning and stability of the affected joint.
Precautions and diagnosis
The diagnosis is made relatively easily by the physician. The typical symptoms, combined with older age leads to the diagnosis. Cartilage destruction will appear on an X-ray as a narrowing of the space between the bone and the bone socket. Cartilage destruction cannot be seen on X-ray directly. Patients usually only have complaints directly from the affected joint and have normal blood samples.
If overweight it is important to lose weight in order to ease the pain and slow progression of the disease.
Light work out and sports such as cycling and swimming where there is no direct weight bearing on the joint are very important to maintain joint function and muscle strength. Using tools as a stick, ergonomic chairs or specially made cutlery can be a great help and relief for patients with arthrosis.
Treatment of osteoarthritis
Treatment can be divided into 3 groups.
Lifestyle Changes.
- Which include the aforementioned weight reduction and proper muscle- and joint training, often in consultation with a physiotherapist. Training in a warm water basin may have a soothing effect.
Treatment with medication.
- This treatment is designed mainly to reduce the pain and reduce joint inflammation. Weak pain can be treated with so-called NSAIDs e.g. Aspirin or Ibuprofen. It may be necessary to use morphine preparations when the patient is in great pain. In large joints there may be effect of injections of adrenal cortical hormones. However, excessive use of this hormone can lead to further joint destruction. It is important to follow the medical treatment as prescribed as excessive use of arthritic medication is associated with severe side effects.
In recent years it has become increasingly common to try to stop the cartilage destruction by taking glucosamine. This is however in most countries not an officially approved medication as the effect has not been properly documented.
Surgical treatment.
- Can be considered if there is unbearable pain, and or severe joint and function impairment. In large joints such as the knee and hip it is possible to replace the affected joint with an artificial joint, which usually gives very good results. In the hands, feet and back, affected joints are sometimes made stiff by the surgeon in order to relieve the pain.
Prognosis and complications
Osteoarthritis has a natural progression but careful training and prudent use of joints can slow down this development. Many will be able to manage for years without a hip replacement operation, while others will be delighted with a surgical solution.
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