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Osteoarthritis

Osteoarthritis, or also called “Degenerative Joint”, is the most common joint disease in general populations caused by the breakdown of cartilage located at the ends of the bones in a joint, resulting in an erosion of cartilage which leads to joint stiffness and pain. Several conditions contribute to the deterioration of cartilage including obesity, joint trauma, weakness of muscles surrounding the joint, sensory loss of nerves around the joint (neuropathic joint), inflammation of the joint’s surrounding tissues, and rare heredity.

Osteoarthritis can involve a number of joints with the majority in the weight-bearing joints or joints subjected to strenuous use such as knees, hips, spines at the back and neck, small joints of fingers, and big toe joints. It is rare in wrists, elbows or ankles except secondary to trauma, infection or excess use of such joints.

Osteoarthritis is more common at older ages and occurs in either men or women. Before age 45, men are more likely to have osteoarthritis than women, but it is more common in women after age 50. Although there are millions of people with osteoarthritis, but only a few of those will have symptoms.

Osteoarthritis is a treatable disease. Even though there is no complete cure, but the symptoms can be eased by the treatments. Correct diagnosis and consultation with a physician are essential for the successful treatment.

What Happens in Osteoarthritis?
Usually the ends of the bones, which are the components of a joint, will be covered with cartilage which acts as a sponge or cushion to help reduce rubbing between bones during joint movement. Patients with osteoarthritis will find the affected cartilage with reduced water content, deterioration and erosion, resulting in a pain and swelling of the affected joint. The erosion of cartilage will progress as follows:
  1. The cartilage structure will change with age and starts to lose its elasticity when getting older, causing a decreased function of joint friction reduction which leads to further erosion and damage when moving. When to develop the cartilage degeneration will be based on several factors such as heredity, use of joint, joint trauma, obesity, etc.
  2. As a result of cartilage degeneration, the surrounding tissues of the affected joint will be inflamed, causing a production of secretion by white blood cells that stimulates further inflammation and erosion of cartilage.
  3. Further erosion of cartilage will cause additional rubbing and weight bearing of the bone ends at the affected joint during joint movement, resulting in a structural change of the bones. The ends of the bones begin to thicken, grow out from the joint margin and the build-up of marginal bone nodules called osteophytes or spurs or bony growth.
  4. The more the progress is, the more the joint inflammation will be. This will result in an excess accumulation of fluid in the inflamed joint which then extrudes into the bones causing cyst or fluid-filled sac in the bone. Fragments of degenerative cartilage or/and bone may break off and float around freely in the joint as “loose body”, which will provoke further inflammation or interrupt the joint function.
In addition to the degeneration of cartilage, the nourishing fluid or synovial fluid may also affect the pathology of the disease. This joint nourishing fluid acts as a lubricating fluid of the joint that enables a smooth joint movement. The major component of this joint nourishing fluid is hyaluronan substance which is found in higher content but with a diluted concentration in the lubricating fluid of the joint with degenerative cartilage. This variation of hyaluronan properties will cause a reduction of lubricating efficiency during joint movement.
Symptoms of osteoarthritis usually occur after the excess use of the joint or after the inactivity of joint for a long time. The movement of the joint will be more difficult due to stiffness or pain. When worsened, the joint with long inactivity will cause weakness of its surrounding muscles and will not be able to bear the weight well enough during joint movement which can lead to further joint pain.
 
Osteoarthritis of the Hips
Patients may experience pain in the groin or inner thigh, or buttocks while standing or walking. Some patients may feel the pain spreading down to the knees which can cause a limp.
 
Osteoarthritis of the Knees
Patients may experience pain in the knees or kneecaps while standing, walking or going up-down stairs. Patients may hear or feel a sound while walking or moving the knees. If the pain leads to less movement, it can cause the muscles surrounding the joint, particularly the quadriceps muscles at the front of the thighs, to shrink.
Osteoarthritis of the Fingers
The cartilage degeneration of the fingers will lead to an ache, swelling, osteophyte or spur at the fingers, which can cause bony lumps on the joints closest to the fingertips called Heberden’s nodes, or on the middle joints of the fingers called Bouchard’s nodes. Heberden’s nodes are common in women from the age of 40. In some cases, Heberden’s nodes or Bouchard’s nodes may become swollen, red and inflamed. Although Heberden’s nodes and Bouchard’s nodes usually cause an unpretty look of the fingers, but the finger-joint function will generally remain normal.
 
Osteoarthritis of the Toes
It is common in the big toes, causing pain and ache. Symptoms can be worse if wearing tight or high-heeled shoes.
 
Osteoarthritis of the Spine
Osteoarthritis of the spine causes joint stiffness and pain in the neck which may extend into the shoulder or down the arms. If occurring in the back, it will cause stiffness or pain in the back which may extend down the hips and legs. If under more progressive condition, osteophytes or cartilage tissues may cause pressure on the nerves resulting in numbness or weakness of the fingers, arms or legs.
Many patients get confused between osteoarthritis and rheumatoid arthritis. These two diseases are not the same and the differences are shown in the table below. A person may also suffer from both diseases. Another disease which may cause confusion is osteoporosis, which is the porous bones resulting from decreased bone mass which may lead to fragile bones that fracture easily. In the case of spinal fractures, hunched back or shorter height will be a result.
 
Osteoarthritis Rheumatoid arthritis
  • Usually begins at about the age of 40.
  • Usually begins during the age of 20-50.
  • Occurs in 2/3 of people more than 65 years of age, and 10% of those with advanced symptoms.
  • Occurs in about 1% of the population in the United States of America.
  • Usually has a slow onset over the years.
  • May have an acute onset, rapid progression over weeks or months.
  • Usually affects only a few joints, most likely the weight-bearing joints or joints subjected to strenuous use and may occur on both sides of the body.
  • Usually affects the small joints of the fingers (except the joints nearest to fingertips) or toes, and must occur on both sides of the body.
  • Not much pain, swelling, redness and warmth with possible morning stiffness of joint lasting less than 20 minutes.
  • Highly possible pain, swelling, redness and warmth of joint with morning stiffness usually lasting longer than 20 minutes, probably hours.
  • Affects the weight-bearing joints or joints subjected to strenuous use such as knees, hips, spine, and fingers, with very rare wrists, ankles or elbows.
  • Affects the small joints of fingers, toes, on both sides of the body, and may also affect wrists, ankles and elbows.
  • Without fatigue, weight loss.
  • Can cause fatigue and weight loss.
Heredity
Certain patients and families develop osteoarthritis due to the genetic defect of collagen protein which is a component of cartilage. These families will have osteoarthritis at an early age but can also have it when getting older. These patients, particularly women, usually develop Heberden’s nodes and Bouchard’s nodes on the fingers. Some patients with genetic defect that causes abnormal shape of the joint such as abnormal bending of hip joints or knee joints, or with excess joint movement, may have a greater chance of developing osteoarthritis than normal people.
Obesity
Studies show that obesity is a risk factor for Osteoarthritis of the knees and also a factor that causes Osteoarthritis to get worse. Therefore, weight-gain prevention and weight reduction will help prevent the development of Osteoarthritis and improve disease condition.
Muscle weakness
Studies have shown that people with weak quadriceps muscles at the thighs may have a greater chance of developing osteoarthritis of the knees than normal people. In addition, the weak quadriceps muscles may also cause faster degeneration of the osteoarthritis-affected knees.
Trauma or overuse
Joint trauma increases the chance of osteoarthritis development. For example, football players with knee trauma will be at increased risk for osteoarthritis of the knees. Excess use of joints, such as frequent knee bending or frequent squats, will increase the risk of osteoarthritis of the knees more than in normal people. Therefore decrease of trauma or frequent knee bending will help reduce the chance for the development of osteoarthritis of the knees.
 
Osteoarthritis Prevention
As mentioned above, weight control and joint trauma prevention will help prevent the development of osteoarthritis.
 
The physician will make a diagnosis of osteoarthritis by asking about the patient’s medical history and conducting a physical examination. X-ray or magnetic resonance imaging (MRI) of the joint may be required to diagnose the stage of the disease and to confirm the ruling out of other causes. In some cases the physician may perform joint fluid aspiration to diagnose other diseases or to rule out other causes such as gout, pseudogout, or joint infection, etc.
 
Treatment of osteoarthritis can help a patient to alleviate the pain, increase the ability of movement, and perform daily activities. The treatment plan may include medication, weight control, physical therapy, and especially the patient education about the disease. If failed, joint replacement surgery will help patient to relieve the symptoms and gain better movement. Treatment of osteoarthritis also depends on which joint(s) affected, severity of the disease and especially the patient’s chronic disease (s) which contributes to the selection of the type of medications and physical therapy. The changes of personality and everyday movement which may associate with the patient’s occupation are also important in the planning of treatment for the patient.
 

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