Osteoarthritis

What is Osteoarthritis?

Osteoarthritis (OA) is commonly known as degenerative joint disease. It is a Greek term where ‘Osteo’ is bone, ‘Arth’ is joints and ‘itis’ is inflammation. It is the most common type of Arthritis that can happen to almost any joint in the body. The degeneration in osteoarthritis happens due to inflammation, breakdown and eventually theloss of cartilage tissue which serves as cushion between the joints such as knees, hands, feet, shoulders, hips, cervical and spine. Knees osteoarthritis is the most common type of osteoarthritis.

What is cartilage and what happens to it in Osteoarthritis?

Cartilage is a firm but flexible tissue at the end of bones. It is like a rubber or a cushion which acts as shock absorber by changing shape when pressure is exerted. Cartilage is made of 65-80% water, proteins, sugars and chondrocytes.

In osteoarthritis cartilage loses its elasticity and over time, it starts wearing off. When it starts breaking down, then there is no cushion left between the bones and soon friction between the bones starts. The ligaments and tendons stretch that causes inflammation and pain.

Generally weight bearing or overused joints are severely affected. In Spinal arthritis, the discs start getting thinner and stiff causing loss of motion. In some cases bone spurs or outgrowths also called as osteophytes start building up e.g. bunions in the toes.

Symptoms of Osteoarthritis

Muscle tenderness and acute pain, inflammation, stiffness leading to loss of mobility. Overusing the affected area hurts more. There may be bone enlargement or fluid deposition also.

Prevalence of Osteoarthritis

Worldwide osteoarthritis used to be considered a disease of elderly people (85% people being affected in 65 and above age group) which was later known more in 50+ age group and post menopausal women being more prone to it. As per recent reports in India (TNS Arogya 2006-07 The Health Monitor,’ conducted by an ISO-accredited market research agency), osteoarthritis is second most prevalent disease in the 25-35 years age group, with key reasons being obesity and sedentary lifestyle. About 46 million Americans have osteoarthritis. By 2030, the figure is estimated to grow upto 67 million.

Diagnosis of Osteoarthritis

X-rays are used to diagnose OA. Typically narrowing of joint spaces, osteophytes formation or bone loss indicates osteoarthritis.

What causes Osteoarthritis?

• Physical or Mechanical Stress: Experts believe that any kind mechanical stress could be the underlying cause of degeneration of cartilage. There may be some injury or repetitive stress. Athletes commonly have knees or spine injuries and may be predisposed to osteoarthritis. Occupational hazards (eg. At construction sites, assembly lines workers etc.) could make cartilages wear off.
• Heredity: Genes play an important role in making defective cartilage or the one that is more prone to degeneration. Indians have a predisposition to osteoarthritis.
• Obesity or being overweight: Obesity can make joints bearing weight such as knees or hips degenerate faster
• Lack of muscular exercises: Sedentary lifestyles and poor muscle mass increases proneness to osteoarthritis.
• Aging:  above 50 years men and above 45 years old women (post-menopausal) are prone to osteoarthritis. With aging, the water content in cartilage tends to decrease making it less resilient.

How Osteoarthritis is different from Rheumatoid Arthritis? What are the other common types of arthritis?

In Osteoarthritis the affected area hurts and gets worse with over usage, while in Rheumatoid Arthritis overusing does not affect. Rheumatoid arthritis is an autoimmune disorder which is diagnosed through a blood test and not X-rays. Other common types of arthritis are spondyloarthritis, gout (where uric acid builds up in the body).

Treatments

• Lifestyle modification including weight loss comes as a key advice. Diet modification and light exercises are required which must be done on consulting an expert.
• Using mechanical support devices such as canes etc. are advised as a preventive measure to stop worsening the condition.
• Drugs/Injections:
  • Glucosamine Sulphate and Chondroitin Sulphate are advised for 12 weeks to 6 months especially in Knee osteoarthritis.  These are said to strengthen or re-build cartilage and reduce pain. Their effectiveness is though debatable
  • Analgesics or Pain killers such as acetaminophen are prescribed for pain relieving.
  • Non steroidal anti-inflammatory drugs such as ibuprofen are used to reduce inflammation and pain. However, regular use can lead to severe side effects such as gastrointestinal bleeding.
  • Steroid injection in joints helps in pain for weeks or months, hyaluronic injections are also known to help
• Surgery:
  • Arthroscopy is a non-invasive procedure which is done under local anesthesia. Microscopic lens are used and surgery is performed. In this the meniscal tears can be stitched and pain-causing broken cartilage pieces are removed.
  • Joint replacement is performed when the joints function becomes very poor or painful. Mostly people opt it is as a last resort. Though mostly joint replacement surgeries are successful and enhance mobility, yet complete mobility may take longer.
  • Stem Cell treatment– Recent developments in medical science is heralding lot of possibilities through stem cells. Cartilage repair and regrowth is one of those.
• Rotational field quantum magnetic resonance (RFQMR) delivers complex high quantum electromagnetic beams through cytotron.  This stimulates chondrocytes (cartilage producing cells).
• Alternative Medicine for osteoarthritis
  • Reconstructive Therapy/Prolotherapy-In prolotherapy injections of natural substances such as dextrose, glycerin, and phenol are administered in order to stimulate the growth of connective tissue. This strengthens weak or damaged joints, cartilage, ligaments, and tendons. Degenerative arthritis, lower back pain, torn ligaments, carpal tunnel syndrome, and other conditions are treated through this.
  • Ayurveda-According to Ayurveda Osteoarthritis is a vata dosha. Basti or Vasti is done for the areas that need treatment. Example for knees Janu Basti is done where medicated oils are held over the knees. In Kati basti medicated oils are held on the back.Guggul (Commiphora mukul) and Shallaki (Boswellia serrata) are anti-inflammatory herbs that are also known to reduce pain and stiffness.
  • Acupressure & Acupuncture: According to Chinese alternative medicine any kind of pain or disease occurs when vital energy pathways are blocked. Treatment is done to remove these blocks and improve energy flow. According to experts, insertion of needles may trigger natural painkiller in body. Acupressure is safer than acupuncture, with no insertion of needles.
  • Meditation -Mediation helps reduce suffering. A sitting pose is not required to meditate.
• Diet for osteoarthritis-Foods like soybeans and avocados are recommended. Ginger, Turmeric, Omega-3 fatty acids are known to reduce inflammation and pain.
• Physical exercises [Yoga, Tai Chi, Physiotherapy in osteoarthritis]-Walking on flat surface is good. Jogging or Aerobics or intense exercises that may further damage the tissues should be strictly avoided.
  • Yoga for osteoarthritis– One can do asanas sitting on chair. Turn around while seating on chair, Rest one leg on the other (placed on thigh). Forward bending, and other exercises while standing can also be done with the support of chair. Trikonasan Triangle pose and Bhujangasan Cobra pose are good poses for spine flexibility
• Hot showers help in osteoarthritis-15 minutes hot shower is advisable before any physical exercise. In cold muscles contract which may lead to more of stiffness.
• Hot and cold packs in osteoarthritis: In stress situations also muscles tighten up causing pain. While anxiety adds to it. This causes inflammation. Cold packs help at this time. Coldness decreases inflammation and muscle spasm. One is advised not to use it if there is poor circulation Hot packs can be used in winters or when muscles are stiff.
• Herbal packs or pillows are also advised for pain relieving
• Walking improves posture and maintains weight.
• Rest breaks are extremely important to avoid continued stress

Preventive Measures

• Avoid repetitive stress and give attention to your posture
• Avoid strain that could be physically damaging. Know your physical limitations.
• Maintain healthy weight with a balanced lifestyle- proper diet, exercise, sleep and rest
• Work out the muscles that support joints
• Vitamin D is important for bones health. Sunlight is a natural source of vitamin D.
• Avoid squatting or other postures that is going beyond your limits
• Use mechanical devices/ aids such as cane sticks to walk, back cushions for seats or ergonomically designed seats or support devices for proper postures.