Osteoarthritis is a chronic progressive disease of the joints, resulting from the deterioration of the cartilage with subsequent change in the underlying (located just under the articular cartilage) bone tissue, development of edge osteophytes, joint deformities, as well as development of moderately expressed synovitis. Osteoarthrosis, osteoarthritis, deforming arthrosis are presented in the 10th International Classification of Diseases as synonyms.
Osteoarthritis is one of the most ancient human and animal conditions. According to the paleontological findings, people suffered from it as far back as in the Stone Age. Arthritis is a most common form of articular pathology, with around 10-12% of the population affected. The disease correlates with the age, it is more likely to develop after 40-45 years of age, and 97% of individuals aged 60 and older are affected by the disease. Osteoarthritis is identified in men and women equally often, except for osteoarthritis of the interphalangeal joints of hands which is 10-fold more frequent in women. According to the data of US and European rheumatologists, this disease accounts for up to 69-70% of rheumatic diseases.
0 (zero phase)-lack of radiological signs;
I – clustery reorganization of bone structure, a linear osteosclerosis in subchondral regions, emergence of small edge osteophytes;
II – symptoms of phase I + more pronounced osteosclerosis – joint space narrowing;
III – pronounced subchondral osteosclerosis, large edge osteophytes, a significant joint space narrowing;
IV – grave massive osteophytes, the joint space is hardly traceable, the epiphyses of bones forming the joint are deformed with a dramatic increase in density.
Osteoarthritis is considered to be a disease with many possible causes. The onset of osteoarthritis, its severity and degree of pathological processes progression are determined by the following factors:
Chronic microtraumas of cartilagilages
The main cause of osteoarthritis can be a mismatch between the mechanical load on the chondral surface and the ability of cartilage tissue to resist this load. Therefore, osteoarthritis tends to develop in individuals engaged in hard physical work involving mechanical overloading on joints due to frequent stereotyped movements and especially in athletes. Adverse effects can also be caused by work in a monotonous posture involving bent knee joints or a sitting position with pressure on the knees. The stress on knee joints increases if combined with obesity.
Congenital malformations of joints
Dysplasias contribute to chronic microinjuries of cartilage and lead to the decrease in the articular surfaces congruence, which results in displacements of load axes in joints. The risk of developing osteoarthritis in individuals with congenital defects of locomotor system is increased by 7.7 times.
The most important risk factor of developing a symptomatic (i.e., clinically detectable) and radiographically proven osteoarthritis. It has been proved that the incidence of osteoarthritis for men and women with body mass index 30-35 is 4 times higher than for people with a normal BMI. It has been established that each 5 kg of excess body weight present a 40% risk of developing diseases of joints and, on the contrary, a 5 kg reduction in body weight leads to a reduction in clinical symptoms.
Development of osteoarthritis of the interphalangeal joints of hands with concomitant erosive changes in articular cartilages is 10 times more common in women, due to the autosomal dominant inheritance of this disorder in females and a recessive transmission of this trait in males. Newly discovered defects in gene responsible for Type 2 collagen production lead to the development of this condition.
Acute or chronic infectious arthritis, including tuberculous arthritis, non-specific inflammation of the joint, rheumatoid arthritis, etc lead to the development of osteoarthritis. Identification of specific immunoglobulins and complement components deposition in the articular surfaces suggests their involvement in the progression of osteoarthritis.
Disorders of proprioceptive impulses lead to decreased tone in the muscle near the hip and, consequently, to increased mechanical stress on the joint. E.g. a normally developed quadriceps can compensate for not less than 30% load on the knee joint; however, in the case of pathologic impulsation the muscle does not receive information from the brain about the strain required to perform its function, and the joint begins experiencing a physical overload.
In particular, so-called "deposition" diseases, such as hemochromatosis, ochronosis, chondrocalcinosis, gout. The deposition of various substances in the cartilage matrix tends to lead to direct damage of chondrocytes and secondary disorders of shock absorbing ability of the cartilage.
The main component of pathogenesis is degradation of cartilage. Osteoarthritis is characterized by disturbed balance between the production of a new building material to restore cartilage and the cartilage destruction.
The influence of pathologies accounts for earlier and more rapid aging of the articular cartilage. Its metabolism is disrupted, above all, the decline in the basic substance and partial loss of chondrocytes occur. In the cases of osteoarthritis the chondrocytes phenotype changes, proteoglycans and collagens which are uncharacteristic of a normal cartilage are synthesized.
In the early stage of osteoarthritis, usually in the areas of maximum load, local zones of cartilage softening emerge, in the later stages fragmentation occurs, vertical cracks are formed in it. The cartilage loses its elasticity initially in the centre, becomes rough, disintegrates into fibrils, there appear cracks, the underlying bone is exposed, eventually the cartilage can fully disappear.
When the cartilage covering is thinned the pressure experienced by articular surfaces is distributed unevenly. The impaired architecture and metabolism of the articular cartilage leads to an emergence of an overload zone. This leads to local overloads, increased friction between the articular surfaces.
In the absence of shock-absorption by the cartilaginous tissue, bone articular surfaces experience a greater and more uneven mechanical loading. Zones of dynamic overload emerge in the subchondral bone causing local microcirculation disorders, which contributes to the emergence of subchondral osteosclerosis, changes in the curvature of articular surfaces and emergence of bone and cartilage growths, osteophytes. While these compensatory changes provide an increased area of contact, reduce the pressure on the articular cartilage, they limit the range of motion in the joint.
In the articular cavity the necrotic (dead) cartilaginous and bony fragments undergo phagocytosis by leukocytes with release of the products of inflammation, which is clinically manifested by cartilage synovitis and development of immune response to degradation products.
Immune pathologic process in the articular cartilage and the synovial sheath is developing in parallel with degenerative and dystrophic processes. Inflammation leads to fibro-sclerotic changes in the cartilage soft tissues. Diffuse growth of fibrous tissue occurs, leading to a considerable thickening of the capsule.
Simultaneously there develops an atrophy of the neighbouring muscles associated with inactivity due to pains in the affected joints during movement.
Attention! The changes due to osteoarthritis are irreversible.
Osteoarthritis prevention is complicated, it has not been entirely developed. Identification and prompt treatment of orthopedic anomalies is vital in this respect, especially the congenital hip dislocation, varus and valgus deformities of the shin.
Adequate orthopedic correction of these pathologies enables to prevent early development of secondary osteoarthritis. Long stereotyped or static mechanical loads on joints should be avoided in job activities.
One of the most effective preventive measures is body weight reduction by means of keeping a proper diet and adequate physical activity. Especially important is a combination of exercises which would include a gradual increase in the length of walking time with strengthening the muscles of the lower limbs which are of great importance in the cases of osteoarthritis.
It is important to be aware that in the cases of osteoarthritis, the limited motor activity leads to at least 60% reduction in the strength of the quadriceps, so strengthening it is essential for the functioning of the knee joint as a whole. To strengthen the muscles, isometric contractions of the quadriceps are indicated, which can be achieved by stressing the knee joint, bending the ankle under stress, as well as through transcutaneous electrical stimulation of nerves. Strengthening the quadriceps over a period of 6 months reduced the pain and improved the function of knee joints.
It must be remembered that a patient with osteoarthritis should avoid overloading the joints, so any physical activity should be alternated with rest.
Similar to other diseases, early diagnosis of osteoarthritis is the key to successful treatment. Any pain in the joints, occurring when the joint is moved and, moreover, at rest signal a need to consult with your physician. Modern diagnostic tools enable early detection of osteoarthritis and increase the chances of successful treatment by an order of value. The nature of pain in the joint can let the physician judge about the extent of the lesion. It is not by accident that pains during physical exertion or at rest, at night, or by palpation are listed as the main symptoms of osteoarthritis. The pain that occurs under physical load and is not experienced at rest is usually an early sign of the manifest osteoarthritis. Later the pain in the affected joint (joints) appears not only at the beginning of the load (starting pain), but also at rest and at night, becoming permanent.
Important symptoms are morning stiffness in the affected joint ("gelling phenomenon") or a pain experienced after any rest, lasting no more than half an hour, as well as restricted mobility of the joint or a sense of instability.
Other signs of the disease progression that usually draw attention include a growing functional restraints reaching a stage when only partial flexion and extension of the affected joint is possible, a sense of insecurity and instability.
Attention! Modern methods of diagnosis (x-ray, magnetic resonance imaging, ultrasound) used to diagnose osteoarthritis, provide the most reliable information on the phase of the disease. Accurate diagnosis without the findings of these studies is unlikely, even for a highly qualified physician. The most common practice is diagnosis based on a combination of two or more studies.
Treatment of osteoarthritis is a lengthy process. It is mainly conducted in the outpatient setting. It includes a number of measures aimed at slowing down the progression of osteoarthritis and improving the joint function.
Maintaining the joint function is based on chondromodulation. Chondroprotective agents administered orally, intramuscularly and intra-articularly are applied as a course therapy. As it is the pain that makes the patient consult the physician, analgesics-antipyretics, or nonsteroidal anti-inflammatory drugs prescribed to relieve pain and inflammation are a priority in the therapy. During the phase of acute pain, when osteoarthritis can be aggravated by synovitis, doctors traditionally use intra-articular administration of hormone injections - corticosteroids.
For intra-articular administration, hyaluronic acid preparations are applied that maintain the medium of the joint and compensate for the lack of natural synovial fluid, or hydrogels-based medications, which have a longer term of effectiveness and a powerful indirect anti-inflammatory effect.
Hydrogels-based drugs super-long term of effectiveness, compared with preparations of hyaluronic acid, as well as the minimum level of complications lie at the core of their efficacy.
Total joint replacement. Knee, hip and other large joints implants have been developed and are currently used successfully. Further conservative treatment helps to reduce the period of recovery in the post-surgery patients and enhance the effectiveness of the treatment.
Attention! Self-medication or ignoring the symptoms can entail irreversible effects! Any treatment of the musculoskeletal system diseases should be carried out by qualified medical personnel on the basis of modern efficient techniques with the use of certified drugs.
An important stage in the treatment of osteoarthritis is sanatorium-and-spa treatment and physical therapy. Their main healing effect consists in the activation of the body’s natural recovery potential by stimulating metabolic processes both in the affected joint, and in the entire organism. The main objectives set for the patients with osteoarthritis are restoring mobility and the required range of motion in joints, increasing muscle strength and endurance.
The opinion that physical activity can lead to early “wear and tear of the joint” is wrong. On the contrary, any motor activity aimed at preserving joint mobility and muscle strengthening enables to maintain good joint function and resist diseases for a long time. However, according to the latest data obtained by the scientists, a connection between jogging and the incidence of osteoarthritis has been established. Therefore, it is walking rather than jogging that is recommended as a method to prevent lower limb osteoarthritis.
Not at all, although you can see on TV particles of "an innovative drug" penetrate through the skin directly into the affected area and healing the damaged tissues. No doubt, a cream or ointment particles can penetrate the skin. However they would never be able to penetrate the joint: the articular bag would not allow such a penetration. It is tight enough to prevent anything from penetrating into it through the skin. A cream, at best, can only provide a local anesthetic effect. The well-known method of applying compresses with Dimexide solutions on the sore joint is also capable to achieve only a temporary symptomatic result.
The effect of such drugs consists in controlling exacerbations, characterized by acute inflammatory processes, however they are not capable of providing a fundamental improvement in the condition of the affected joint. Most often non-steroidal anti-inflammatory drugs are used to relieve exacerbations. The second type of drugs for oral use is chondromodulating agents intended to improve the joint function. The best-known of them are Glucosamine and Chondroitin. Dietary supplements are not worth considering as therapy with at least some effect. In the best case the supplements are absolutely neutral. The effect of their application is rather negative, as while they are being used the opportunity for an early stage disease progression control using the methods that are really effective is missed.
Attention! A certificate of a dietary supplement only guarantees its safety, but not effectiveness.
In this case the key point is the timely correction of the injury consequences. The main task here is to restore the joint stability, which would eliminate an uneven distribution of loads on the articular surface and prevent the destruction of cartilage. For example, in cases of ligamentous disruption arthroscopic restoration of the ligaments apparatus and stabilization of the joint can be achieved, provided there is timely treatment in a medical facility. The length of recovery period will be the shortest possible. Otherwise, surgical intervention may be less successful and require a longer recovery period.
Attention! Neglected injuries will inevitably lead to an onset of clinical osteoarthritis.
It all depends on the nature of the drug itself. Chondroprotective agents can be divided into two main groups: natural or synthetic drugs, based on hyaluronic acid (Fermatron, Sinvisk, Ostenil, etc.), and hydrogel-based materials, such as NOLTREX. All the products based on hyaluronic acid are prone to very rapid resorption from the articular cavity, so the period of effectiveness is relatively short. The drugs of the second type, injectable hydrogels- based materials, are more effective. They are fragmented inside the joint very slowly, their effect can last for more than 12 months after a single course of treatment.
Well, yes and no. Let us make it clear. Any joint, including that affected by arthritis needs physical activity. A lack of movement can lead to deterioration as a result of two factors: reduction in metabolism in the immobile joint and degradation of the muscle relieving the load on the joint. Therefore, the movement is necessary. But the mode and type of loads must be carefully selected. Shock loads on the joint should be absolutely avoided. Mobility periods must alternate with the rest.
In the case of intense workouts pain can actually decrease, but for a short period. This is due to the release of endorphins that accompanies intense motor activity. The danger of this situation consists in the fact that under the guise of endorphins an intensified destruction of articular cartilage and, naturally, the development of osteoarthritis occur.
No formally recognized special diet for osteoarthritis exists. A diet can only be recommended to reduce the excess weight, which is one of the most significant risk factors for the onset and progression of osteoarthritis. The use of foods containing gels (jellied meat, cartilage), traditionally recommended to patients with arthritis has no proved positive effect; neither do dietary supplements.
"At the end of the 20th century, however, the situation changed dramatically. The development of new technologies in the food industry, and in particular injecting meat products with preservatives led to the emergence of a new type of osteoarthritis: a so-called "metabolic arthritis." Or, to use a pseudo-scientific term "osteoarthritis on the background of metabolic syndrome ...” (P.V. Yevdokymenko "Osteoarthritis. Getting rid of joint pains. " ONYX publishing house: 2011.) Quoting the renowned rheumatologist, we wish to emphasize the importance of a healthy, balanced and useful nutrition in the life of any person, and patients with chronic joint disease in particular.
In practice, this situation may occur in case of a bone fracture. To achieve a bone fracture healing, the limb is immobilized, sometimes for a long period of time. Signs of osteoarthritis can be noted in immobilized joint after the treatment.
Osteoarthritis is a multi-factorial disease. It can be triggered and influenced by many factors. The rate of the disease progression is very individual. While in some patients osteoarthritis can progress almost imperceptibly, without complications and even without pains, it takes others just a few years to progress from the emergence of the first symptom to the prosthetics surgery.
The overarching goal of orthopedics is, no doubt, the development of non-surgical treatment techniques; however, despite certain achievements in this area, widespread implementation of new methods in the near future is unlikely. Joint replacement remains the main method of treatment in the late stages, but modern medicine is capable of maximum slowing down the pathology progression. For example, it is possible thanks to the application of modern synovial fluid implants, which are capable to provide effective protection of the joint.
As numerous studies show, favorable prognosis in treating the joints depends on the patient's knowledgeability: a large number of foreign scientific sources highlight the importance the patients’ awareness of the disease, lifestyle, and treatment methods available. The knowledge of the fact that with an affected joint you have to live and work, be aware of the disease, should lead to a change in the patient's vital activity, where high motor activity should be combined with a strict regime to relieve the joint.
A major task in the treatment of arthritis includes motivating patients to motor activity, healthy lifestyle, forming required motive qualities, training the patient in physiotherapy techniques for self-application.