Symptoms, diagnosis & treatment of Osteoarthritis

Osteoarthritis (OA) is the most common type of arthritis, in which there is a breakdown of cartilage. It is a disease in which all structures of the joint undergoes pathological changes results in joint failure, cartilage loss, it is not a single disease but involves one or more joints. It is also known as degenerative arthritis or degenerative joint disease.

Osteoarthritis is the most common cause of chronic knee pain in persons over age 45 and uncommon in adults under age 40 and highly prevalent in those over age 60. It is very much common in women than in men. Osteoarthritis involves the entire joint including the nearby muscles, underlying bone, ligaments, joint lining called synovium and the joint cover called a capsule. And there are outgrowths of osteophytes and thickness and sclerosis of the bony plate. Pain in knees and hips results in lack of mobility and inactivity which results in increasing the risk of obesity and cardiovascular disease.

Our normal joint protectors are joint capsule and ligaments, muscle, and underlying bone. Joint capsule helps in fixing the range of joint motion. The shock-absorbing function is performed by the bone underneath the cartilage. When you lose cartilage, bones rub together; this rubbing can permanently damage the joint. And the failure of these joint protectors increases the OA and the risk of joint injury. Ultimately resulting in failure of protective mechanisms and disability

Signs and symptoms -
• Symptom varies from patient to patient. Some patients present with very severe symptoms, others may have very few symptoms though degeneration of the joint is seen.

• It commonly affects weight-bearing joints, hip and knee, cervical and lumbosacral spine. In hands, smaller joints responsible for griping, interphalangeal joints and base of the thumb are often affected joints.

• Osteoarthritis involves the entire joint including the nearby muscles, underlying bone, ligaments, joint lining called synovium, and the joint cover (capsule).

• The main symptom is pain, causing stiffness and disability. Pain comes on during or just after joint is used and gradually resolves. Stiffness of the affected joint may be the prominent symptom but morning stiffness usually lasts for about half-hour.

• Early in the disease, pain is episodic, for a day or two after the overuse of a diseased joint while running, climbing stairs or walking. As the disease progresses, then the pain is continuous and becomes severe at night.

• Crackling noise of knees called crepitus is seen when the joint is moved or touched.

• When there is a progression of the disease the affected joints appear larger, painful, swollen, hot to touch and are very stiff. There is the formation of hard bony enlargements, called Heberden's nodes. In smaller joints, such as at the fingers causes limitation of movements, at toes it leads to the formation of bunions, causes redness and swelling.

• There is an effusion of joint, an accumulation of excess fluid in or around the knee joint.

Risk Factors -

• Obesity:- As more bodyweight is exerted in obese people on the knees while standing, so the severity of symptoms increases in obese people.

• Ageing:- As the age advances joint vulnerability increases and failure of major joint protectors. So age is the most important risk factor for OA. In older persons muscle becomes weak and a ligament also stretches easily. Older women are at high risk and also hormone loss during menopause contributes to the risk.

• Hereditary factor:- Disease present in other members of the family called hereditary also one of the factors.

• Injuries:- Major injuries resulting abnormalities of the joints and surrounding structures,tears of ligaments, major fractures of the joints, increases joint susceptibility leading OA.

• Repetitive use of joint:- Occupational use causing increase stress on a particular joint, resulting in exhaustion of our joint protectors.

Diagnosis -
- Based on proper history and clinical examination diagnosis should be done.

- X-rays may confirm the diagnosis and are indicated to evaluate chronic pain which was thought to be due to OA, In case of knee pain, x-rays should be obtained if symptoms or signs are not typical of OA or if knee pain persists after effective treatment.

- The typical changes seen on X-ray are narrowing of joint space, and bony formations, and subchondral cysts.

- Examination of the synovial fluid is very helpful for diagnosis.

Treatment -

- In OA main aim is to reduce pain and minimize loss of physical function.

- Reassurance and nonpharmacological treatments required for mild symptoms.

- Drugs and nonpharmacological treatment are required for patients with disabling pain.

- Many times the most effective treatment for many patients is avoiding the physical activities that are responsible for pain. Limiting motion often minimizes pain. So, activities such as running, up and down climbing stairs which brings on symptoms of knee pain should be avoided.

- Lifestyle modifications in that reducing weight and exercise is helpful. It decreases pain, reduces stiffness and fatigue, and reduces the medicinal need.

- Weight-bearing joints such as knees and hips can be unloaded by using a cane in the hand opposite to the affected joint for partial weight-bearing. It decreases pain, improving function, reducing stiffness and fatigue, and reducing medical usage.

- Some exercises that increase pain should be avoided, the help of a therapist who can guide properly for exercise should be taken.

- Analgesics for mild to moderate symptoms, for more severe symptoms Non-Steroidal Anti-inflammatory Drugs (NSAID) may be more effective.

- Joint replacement surgery may be required in advanced cases.

- Homoeopathic medicines are also very useful and give very good results in decreasing pain, morning stiffness and help in prevention of further destruction of bone.

- Also alternative medicine such as acupuncture can be done to reduce pain.