Definition of Osteoarthritis
It can present as localized, generalized or as erosive osteoarthritis. Osteoarthritis most often occurs at the knees, hips, neck, lower back, small joints of hands and feet.Osteoarthritis (OA) is the second most common rheumatological problem and is the most frequent joint disease with prevalence of 22% to 39% in India.
Classification of Osteoarthritis
Etiology or Risk factors of Osteoarthritis
Bone density : Negative association has been reported between osteoporosis and osteoarthritis at certain sites particularly the hip.
Joint location : People with joints that move or fit together incorrectly, such as bow legs, a dislocated hip, or double jointedness, are more likely to develop Osteoarthritis in those joints.
joint injury or overuse caused by physical labor or sports : OA is more common in hip and knee joint but occur rarely in ankle. Traumatic injury (e.g. Ligament or meniscal tears) to the knee or hip increases the risk for developing Osteoarthritis in these joints.
Etiology or Risk factors of Osteoarthritis Contd.
Sex or Gender : Females are found to have more severe OA, more number of joints are involved, and have more symptoms and increased hand and knee OA. These observations and others reporting a painful form of hand osteoarthritis after the menopause suggest that loss of estrogen at the time of menopause increases a woman’s risk of getting osteoarthritis.
Obesity : Being overweight during midlife or the later years is among the strongest risk factors for Osteoarthritis in Knee.
Clinical Features of Osteoarthritis
Morning stiffness lasting less than 30 minutes
Joint instability or buckling
Loss of function
Bony enlargement at affected joints
Limitation of range of motion
Crepitus on motion
Pain with motion
Malalignment and/or joint deformity
Pattern of joint involvement
Axial: cervical and lumbar spine
Peripheral: distal interphalangeal joint, proximal interphalangeal joint, first carpometacarpal joints, knees, hips
Diagnosis of Osteoarthritis
X-rays – X-rays are the most useful test to confirm osteoarthritis, although you probably won’t need one. They may show changes such as bony spurs or narrowing of the space between your bones. They’ll also show whether there are any calcium has settled in your joint. X-rays can’t really show how much pain or disability osteoarthritis is likely to cause. Some people have a lot of pain from fairly minor joint damage, while others have little pain from more severe damage.
Magnetic resonance imaging (MRI) scans – Rarely, an MRI scan of your knee can be helpful. This will show the soft tissues (cartilage, tendons, muscles) and changes in your bone that can’t be seen on a standard x-ray. Its main use is to look for another joint or bone problem in someone who doesn’t have the normal symptoms of osteoarthritis, for example, if you have a torn meniscus that causes your knee to ‘lock’ sometimes.
Non – Pharmacological Treatment & Management of Osteoarthritis :
Well-cushioned shoes and orthotic shoe inserts may reduce stress on the joints of the spine and leg.
Splints that immobilize the joints can reduce pain and inflammation, and many splints can be worn throughout the day and night. Braces can help stabilize unstable joints.
Transcutaneous electrical nerve stimulation (TENS) : A TENS unit delivers a mild electrical current to the skin, stimulating nerve fibers in the skin that may interfere with the transmission of pain signals from the arthritic joint.The use of TENS as an arthritis treatment is controversial. Some studies have found that those who use TENS for arthritis of the knee have reduced knee pain, a greater ability to bend the knee, and a reduced duration of morning stiffness.
Exercise & Physical Therapy : Physical Rehabilitation Therapy improves flexibility and strengthens muscles surrounding the joints. Arthritics who regularly do supervised exercise despite their pain will typically have less pain and better function than those who are inactive.
Weight Loss : A vicious cycle exists between obesity causing OA which enhances immobility to aggravate obesity. Even modest weight loss appears to lower this risk, as weight reduction reduces pain and immobility that reduces obesity . Joints such as the hips and knees benefit most.
Rest : Arthritis symptoms are typically worsened by activity and are improved with rest. However, a complete lack of activity can lead to a loss of muscle strength and increase joint stiffness. During acute flares, rest for a day or two in beneficial.
Pharmacological Treatment & Management of Osteoarthritis :
Glucocorticosteroids injections : Corticosteroids or cortisone are natural substances known as hormones. They are produced by the adrenal glands in the human body. They can provide pain relief and reduce inflammation with a subsequent increase in quadriceps (thigh muscle) strength. However, excessive use of steroids may cause weakened bone, reduced immunity, salt and water retention along with a voracious appetite causing abnormal weight gain.
Viscosupplimentation with Hyaluronic Acid : There are several versions of hyaluronan injections, also called viscosupplementation, that are used to treat osteoarthritis of the knee. They are injected directly into the joint. Some studies have shown some benefit for reducing pain for periods of up to 6 months.
Surgical intervention in Osteoarthritis
Hip resurfacing surgery : This is most often done in younger, more active people who have pain and disability caused by a badly damaged hip.
Joint replacement. This is done when other treatments haven’t worked and damage to the joint can be seen on X-rays. It involves surgery to replace the ends of bones in a damaged joint.
Arthrodesis : Arthrodesis is a type of surgery that joins (fuses) 2 bones in a diseased joint so that the joint can no longer move. It may be done when pain and disability or instability from a diseased joint can no longer be managed with medications, splints, and other methods.
Osteotomy : This is done to correct certain defects in the hip and knee. In most cases, it’s done in active people younger than 60 who have mild arthritis and want to delay surgery to replace their hip or knee.
Role of SCT in OA
It comprises use of site and pathology specific primitive, tissue marker-less potent cells called Stem Cells that engraft in the injected tissue, assumes character of the local tissue, and helps resident damaged stem cells to revive and regenerate the damaged tissue. They also secrete specific cell stimulants that may decrease inflammatory reaction, enhance new blood vessel and nerve fiber growth and repair. Animal studies have shown that they may even grow new correct cells in the damaged tissue.
Diagnosis and Assessment
SCT Regenerative Medical Intervention (Experimental) & Clinical case studies