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Definition of Osteoarthritis

Osteoarthritis is degeneration of joint cartilage and the underlying bone (weight bearing components) by varying degrees of functional limitation and reduced quality of life. It comprises an element of degeneration aggravated by inflammatory lesion.
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

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Etiology or Risk factors of Osteoarthritis

Genetic or Hereditary Gene defects : A defect in one of the gene for the cartilage component collagen can be cause deterioration of cartilage. Hip osteoarthritis has a significant genetic component.

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.

Age : Age is the strongest factors for Osteoarthritis. It may occur in many young people in early 20’s, the frequency of condition escalates markedly in advancing years. Over 45 years old are at high risk category.

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

Symptoms

Joint pain

Morning stiffness lasting less than 30 minutes

Joint instability or buckling

Loss of function

Signs

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

Blood tests – There’s no blood test for osteoarthritis, although your doctor may suggest you have them to help rule out other types of arthritis.

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 :

Orthoses : Orthoses are devices that help to keep the joints aligned and functioning correctly. There are many different types of orthoses that can reduce symptoms and that can help maintain function in people with 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 :

Anti-inflammatory Painkillers (NSAIDs) : Some are available over the counter. Just provide temporary relief as pain killer. Side effects range from acid peptic disorders to blood production problems, interference with heart, diabetes and epilepsy controlling drugs, drowsiness, dry mouth and blurred vision. Rarely, these drugs can lead to mood changes or suicidal thoughts.

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

Arthroscopy : Could help relieve pain for half to two years to allow the joints to move better. In some cases, the relief lasts a long time. Arthroscopy may help delay surgery to replace the joint that hurts. But it doesn’t seem to help the arthritis itself. It may work best for people who have pain or a hard time moving when their joints become “locked” or stuck because of loose cartilage or bone fragments.

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

Stem Cell is an experimental Therapy, done only when standard approved and available therapies have failed to provide cure or even significant relief.

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.

Osteoarthritis Treatment

Counseling
Diagnosis and Assessment
Pharmacologic Intervention
Assistive Devices
SCT Regenerative Medical Intervention (Experimental) & Clinical case studies