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Osteoarthritis is the commonest chronic disorder involving the joints. It is also called degenerative arthritis as it is related to the ageing process. In normal life, joint surface is covered with soft and very smooth bone that is called cartilage. In normal health it provides elastic tissue or padding in joints that act as a smooth cushioning material inside joints, and prevents bones from rubbing together with friction-free movement of the joints



What is Osteoarthritis?
Which joints are most likely to be affected?
What are the causes?
What are the symptoms?
How is osteoarthritis diagnosed?
What is the treatment?
What care can be taken at home?


What is Osteoarthritis?

Osteoarthritis is the commonest chronic disorder involving the joints. It is also called degenerative arthritis as it is related to the ageing process. In normal life, joint surface is covered with soft and very smooth bone that is called cartilage. In normal health it provides elastic tissue or padding in joints that act as a smooth cushioning material inside joints, and prevents bones from rubbing together with friction-free movement of the joints.

However, with decades of use of joints, often with their misuse (wrong postures, burdening them with excess weight etc.) joint cartilage gets damaged, develops cracks, and becomes rough and flaky so that small pieces of damaged cartilage start to break off. With time, large sections of cartilage may get worn out completely, leaving the bone ends unprotected so that the rough surfaces rub against each other and cause painful joints.

There are several factors, which contribute to the painful movements. One of these factors is thickening of the bone ends. The capsule surrounding the joint may also thicken. In addition, bony growths called “spurs”, or osteophytes form at various places in the joint. Finally, bits of bone and cartilage may break off and float in the joint space, resulting in painful movement of the joint and may even cause ‘locking’ of the joint.

Which joints are most likely to be affected?

The joints that carry the body’s weight are most likely to develop osteoarthritis. The joints most commonly affected are knees and vertebral spine joints mainly in the neck and lower back. However, finger joints near the nails and a joint called ‘1st carpo-metacarpal joint’ in the hands are also common sites of osteoarthritis. Hip joints may also be involved with osteoarthritis but, for reasons not clear, this is much less common among Indians.

What are the causes?

Although osteoarthritis occurs generally as a natural process of ageing, there are several well-defined causes of the disease. These include being overweight and obese, having a prior joint injury, and lack of exercise. Bad posture and overuse can also cause extra strain on joints. Any underlying primary joint disease (e.g. past joint injury, rheumatoid arthritis, gouty arthritis or of septic arthritis) predispose to osteoarthritis.

Heredity also plays an important role, and families with a history of osteoarthritis seem to have a genetic defect of the cartilage gene. Extensive new research has shown that certain common habits of daily-living among Indians (and other populations in Asian countries) are detrimental for the knee cartilage and cause severe and early-age osteoarthritis of the knees.

These include sitting cross-legged, squatting (e.g. using Indian-style toilets), kneeling (as for cleaning the floor), repeatedly sitting down on low levels or floor and then repeatedly getting up (as in push-ups), over-use of stairs, standing still for prolonged periods (as cooking on cooking counters). However, being overweight is one of the main causes of osteoarthritis of the knees.

What are the symptoms?

The most common symptom of osteoarthritis is mild to severe pain in the joint. Initially the pain usually occurs following activity, and rest provides relief. In the later stages, pain occurs with minimum movement and even at or after rest. There may also be swelling and stiffness of the joints, which occurs especially in the morning or after a period of inactivity. Other symptoms include weakness in the muscles around the affected joints due to lack of use, deformity of the joint and a creaking or grating sound in the joint.

How is osteoarthritis diagnosed?

The doctor will make the diagnosis after taking the patient’s medical history and performing a physical examination. He may also suggest some blood tests if the symptoms suggest of some other type of arthritis such as rheumatoid arthritis. An X-ray may confirm the diagnosis and indicate the severity of involvement of the joint.

What is the treatment?

The treatment is directed towards reducing pain, keeping the joint moving and preventing further damage. Medicines like ibuprofen, diclofenac and other newer non-steroidal anti-inflammatory drugs (NSAIDS) called coxibs, are used primarily to relieve pain and reduce stiffness. Certain ointments and oils are also beneficial if applied regularly.

Physiotherapy including exercise, heat or cold compresses, and soaking in warm water are also beneficial. Exercise is an important complement of treatment. In the beginning, the patient should do light exercise and gradually increase the intensity and the duration of the exercise. In the beginning it is advisable to carry out physiotherapy under guidance of an expert.

The patient may need to modify the diet if obesity or overweight is one of the causes of the disease.

Surgery can be helpful when other treatments fail to help the patient. But one should consider surgery only when pain and disability seriously interfere with daily living. Surgery can also be helpful in end stage osteoarthritis of the hip or knee. Surgery for osteoarthritis involves joint replacement, following which the patient requires to stay in the hospital for a few days.

What care can be taken at home?

Although there is no cure for osteoarthritis, the patient can try to prevent symptoms from getting worse by the following:

  •  The joints should be kept active by doing muscle-building exercises.
  •  Healthy diet is necessary not only to shed extra weight but also to remain fit.
  •  The patient should follow the doctor’s prescription seriously.
  •  Kneepads can be used.
 

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