Osteoarthritis

OSTEOARTHRITIS 

Osteoarthritis (OA) is the most common form of arthritis, affecting millions of people around the world. It can be thought of as a degenerative disorder arising from the biochemical breakdown of articular (hyaline) cartilage in the synovial joints. However, the current view holds that osteoarthritis involves not only the articular cartilage but also the entire joint organ, including hands, neck, lower back, knees and hips. 

Primary osteoarthritis: 

It is mostly related to aging. With aging, the water content of the cartilage increases, and the protein makeup of cartilage degenerates.
Secondary osteoarthritis: 

Secondary osteoarthritis is caused by another disease or condition. 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. 

Causes 

Osteoarthritis occurs when the cartilage that cushions the ends of bones in joints deteriorates over time. Cartilage is a firm, slippery tissue that permits nearly frictionless joint motion. In osteoarthritis, the slick surface of the cartilage becomes rough. 

The daily stresses applied to the joints, especially the weight-bearing joints (e.g., ankle, knee and hip), play an important role in the development of osteoarthritis. 

Older age: The risk of osteoarthritis increases with age. 

Sex: Women are more likely to develop osteoarthritis, though the reason is unknown. 

Obesity: Carrying more body weight puts added stress on weight-bearing joints, such as knees. 

Joint injuries: Injuries, such as those that occur when playing sports or from an accident, may increase the risk of osteoarthritis. 

Pathophysiology 

Osteoarthritis is a degenerative joint disease that may cause gross cartilage loss and morphological damage to other joint tissues, more subtle biochemical changes occur in the earliest stages of osteoarthritis progression. The water content of healthy cartilage is finely balanced by compressive force driving water out and swelling pressure drawing water in. Collagen fibres exert the compressive force, whereas the Gibbs–Donnan effect and cartilage proteoglycans create osmotic pressure which tends to draw water in. 

However during onset of osteoarthritis, the collagen matrix becomes more disorganized and there is a decrease in proteoglycan content within cartilage. The breakdown of collagen fibres results in a net increase in water content. This increase occurs because there is an overall loss of proteoglycans (and thus a decreased osmotic pull), it is outweighed by a loss of collagen. Without the protective effects of the proteoglycans, the collagen fibres of the cartilage can become susceptible to degradation and thus exacerbate the degeneration. Inflammation of the surrounding joint capsule can also occur, though often mild (compared to rheumatoid arthritis). 

Symptoms 

Osteoarthritis symptoms often develop slowly and worsen over time. Signs and symptoms of osteoarthritis include: 

Pain: Joint may hurt during or after movement. 

Tenderness: Joint may feel tender, if light pressure is applied on it. 

Stiffness:Joint stiffness may be most noticeable when wake up in the morning or after a period of inactivity. 

Loss of flexibility: The joints are not able to move through its full range of motion. 

Grating sensation: May hear or feel a grating sensation when use the joint. 

Bone spurs: These extra bits of bone, which feel like hard lumps, may form around the affected joint. 

Treatments and Drugs 

There is no known cure for osteoarthritis, but treatments can help to reduce pain and maintain joint movement. 

Medications: Osteoarthritis symptoms can be relieved by a variety of medications, including: 

Acetaminophen: Acetaminophen can relieve pain, but it does not reduce inflammation. 

NSAIDs: NSAIDs may reduce inflammation and relieve pain. NSAIDs include Ibuprofen, Indomethacin, Diclofenac sodium, Aceclofenac and Naproxen. 

Narcotics: Narcotics like codeine and may provide relief from more severe osteoarthritis pain. 

Exercise: Exercise can increase endurance and strengthen the muscles around joint, making joint more stable. 

Lose weight: Being overweight or obese increases the stress on weight-bearing joints, such as knees and hips. Even a small amount of weight loss can relieve some pressure and reduce pain. 

Use heat and cold to manage pain: 

Both heat and cold can relieve pain in joint. Heat also relieves stiffness, and cold can relieve muscle spasms and pain