Other Names: Degenerative Joint Disease; Degenerative Arthritis.
Osteoarthritis is a disease characterised by degeneration of the articular cartilage and the formation of bony outgrowths at the edges of the affected joints with joint, tenderness, stiffness, locking and some times an effusion. Mostly one or two of the longer joints are involved. Osteoarthritis occurs in elderly people in both sex but it may appear at any age in a joint which has been damaged by disease or injury.
Aetiology of Osteoarthritis :
• Osteoarthritis tends to run in families
• Often the cause of osteoarthritis is not known. It mainly related to aging. The symptoms of disease usually appear in middle age. Almost everyone has some symptoms by the age of 70.
• Osteoarthritis occurs as a result of an exaggeration of the normal ageing process in the joints.
• There may be a history of joint injury few years before, when one joint is affected.
• Mal alignment, following fractures of the long bones, often give rise to osteoarthritis in adjacent joints.
• Symptoms of the disease are prone to develop in weight bearing joints and in those joints exposed to excessive strain.
• Osteoarthritis of hips, spine or knees is common in those persons engaged in heavy labour, and in obese.
• It is a disease associated with advancing years, and the most patients symptoms do not appear before the age of 50.
• Medical conditions that can lead to osteoarthritis are(i)Bleeding disorders that cause bleeding in the joint, such as Haemophilia,(ii)Disorders that block the blood supply near a joint causing a-vascular-necrosis and(iii) Other type of arthritis like chronic gout, pseudo-gout or rheumatoid arthritis.
Pathology of Osteoarthritis :
There is patchy degeneration and splitting of the articular cartilage at the points of maximum weight bearing, with exposure of the underlying bone, which tends to become denser and harder. New bone is laid down at the edges of the joints, resulting in the formation of osteophytes. Bony ankylosis never occurs, although limitation of movement may be very marked.
Clinical features of Osteoarthritis :
• The onset of disease is gradual.
• The joints most commonly involved are those of the spine and the hips, knees and elbows.
• Pain is at first intermittent and of an aching character, appearing especially after the joint has been used, and relieved by rest.
• As the disease progresses, movement in the affected joints becomes increasingly limited, at first by muscular spasm and later by the loss of joint cartilage and the formation of osteophytes.
• There may be repeated effusion into the joints, especially after minor twist or injuries.
• Crepitus may be felt or even heard.
• Muscular wasting is always present to a greater or lesser extent. This is an important factor in conditioning the disease, as in the absence of normal muscular control the joint becomes more prone to injury.
• In majority of cases the disease is limited to one or two joints, especially the hips or the knees.
• A clinically distinct form of osteoarthritis occurs mainly in middle aged females as a familial trait and has been termed primary generalised osteoarthritis.
• The terminal interphalangeal joints of the fingers are commonly affected.
• Cartilaginous or bony outgrowths appear on the dorsal aspect of the joints (Heber den's nodes) and may give rise to considerable deformity and at times pain, but little disability.
• The first carpo-metacarpal joints, the hips, ankles and knees may also be involved.
• General health is usually excellent; the ESR is moderately raised in about one third of cases.
Diagnosis of Osteoarthritis :
The diagnosis of osteoarthritis is usually a bit difficult in distinguishing the condition from rheumatoid arthritis, in which there is evidence of a general systemic disturban-ce and characteristically the proximal interphalangeal and metacarpophalengeal joints are involved. It is important to remember, that in long-standing cases of rheumatoid arthritis osteoarthritic changes may appear in the affected joints. Degenerative chan-ges commonly appear in the joints in gout.
Radiological Examination : In osteoarthritis there is characteristically a loss of joint space, and some sclerosis of the articular margins. In more advanced cases osteoph-tes appear at the bone edges. Radiographic diagnosis results in diagnosis of a fracture within a joint and is not to be confused with osteoarthritis which is a degenerative change affecting a high incidence of distal phalangeal joints of female patients.
Prognosis of Osteoarthritis :
The prognosis of osteoarthritis will depend on the amount of use of the affected joints. It is always borne in mind that degenerative changes are present in the joints of most of the people over the age of 50 years, but only a few of them complain of any symptoms. The pain in osteoarthritis is most probably due to changes in the joint capsule and peri-articular tissues.
Treatment of Osteoarthritis :
• The pathological changes in osteoarthritis are irreversible, but much may still be done to alleviate symptoms, particularly in the early stages of the disease.
• It cannot be cured. It will most likely become worse over time.
• Much will depend on the social status the patient and whether undue stresses and strains can be removed from the affected joints by a change of occupation or switch over to lighter work.
• It has been observed that rest periods during the day may greatly alleviate pain and stiffness.
• The patient may follow to give up unduly strenuous hobbies.
• The fitting of rubber heels to the footwear may help by reducing jerking and minimising the risk of slipping.
• In obese patients the most important single form of treatment is to obtain a substantial reduction in weight, especially in cases where the hips or knees are affected.
• When pain is a prominent symptom rest in bed is required, combined with local heat and gentle active exercises.
• In medications of osteoarthritis full dose of the analgesics should be given which are:
• Acetaminophen first prescribed by health provider, because it has very few side effects than other drugs.
• Non steroidal anti inflammatory drugs (NSAID) are helpful in relieving pain and swelling which are Aspirin, Ibuprofen, and Naproxen.
• Taking analgesics or non steroidal anti inflammatory drugs before exercising is not harmful but do not overdo the exercise because it may cause harm to affected joint.
• There may be risk of ulcers and bleeding when too much pain killers are used.
• Corticosteroids is given orally or injected right into the joint can reduce the pain and swelling.
• Phenylbutazone may be effective in relieving pain where other measures have failed.
• Hydrotherapy is beneficial in cases of osteoarthritis. Gentle movement of joint under water relaxes spasm of muscles, minimises the pain and increases the range of movement.
• In cases where one hip and one knee is mainly affected, arthrodesis of the joint will provide a stable pain-free joint.
• Arthroplasty is used with success in osteoarthritis of the hip.
• The intra-articular injection of corticosteroids shows improvement in proportion of cases. Results are quit effective in the knee, but less in the hip. Improvement may be observed by injections given at interval of one to three months. Avoid excessive use of weight-bearing joints during period following injection.
Lifestyle Changes in Osteoarthritis :
• Regular exercise may help in maintaining joint and its overall movement. Ask your health provider to advise an appropriate home routine exercise. Water exercises like swimming are beneficial in osteoarthritis.
• In case of over weight lose your weight.
• Eat a balanced and healthy diet.
• Proper rest and joint protection in necessary.
Physio-therapy in Osteoarthritis :
• Physiotherapy in case of osteoarthritis can improve the muscle strength and the movement of stiff joints. When physiotherapy is not effective after 6-8 months, then it will not work at all.
• Massage therapy may provide short term relief in pain. It should be done skilled massage therapist.