“Winter is coming
(for Pinoys ‘Ber months)”
– your aching joints
Yes, as soon as August ended we started hearing
Christmas songs played on the radio. We
Pinoys have the radio to remind us of the upcoming Christmas holidays which for
us means family gathering, gifts, parties and yes colder weather.
But for a lot of people, they feel something
else. Yup for people born in Carole
King’s generation (hi Mom!) they feel the earth move under their feet – and
their joints starts to aching.
For some odd reason a lot of people with
arthritis feel the rain and the cold coming through their joints.
So for this season, let’s dive a little deeper
on osteoarthritis.
Osteoarthritis
Osteoarthritis (OA), also known as
"wear and tear" arthritis, is the most common form of arthritis
affecting millions of people worldwide.
It affects both weight bearing and non-weight bearing joints, but has a
predilection towards the medial aspect of the knee.1
It is a complex progressive process of
joint degeneration brought about by ageing. What happens in the joint is that the
articular cartilage breaks down, resulting in the eventual loss of the
full-thickness joint surface, which alters gait. Altered biomechanics produces
instability; since our body has an inherent instinct to fix what’s wrong with
it, it would adapt to stabilize the aberrant joint—this is in the form of
inflammation (synovitis), hypertrophic bone formation (osteophytes), and
subchondral bone remodeling (seen in X-rays as lytic lesions with sclerotic
edges.2
Don’t confuse OA with Rheumatoid arthritis,
which is an autoimmune disease. The
University of Michigan, describes it as the immune system malfunctions and attacks the body instead of
intruders. In this case, it attacks the synovial membrane that encases and
protects the joints. Rheumatoid arthritis often targets several joints at one
time.
Who’s affected?
Osteoarthritis occurs in people of all ages,
with the risk of developing OA substantially increases with each
decade after the age of 45 years3. Common risk factors
include modifiable (articular trauma, occupation, repetitive knee bending,
muscle weakness, obesity) and non-modifiable (gender: females >males,
increased age, genetics)
What causes osteoarthritis?
https://www.orthobullets.com/recon/12287/knee-osteoarthritis
Osteoarthritis
can be classified as primary or secondary.
Primary
osteoarthritis has no known cause. Secondary osteoarthritis is caused by
another disease, infection, injury, or deformity.
Primary osteoarthritis
Considered “wear and tear” osteoarthritis, this type of osteoarthritis
is more commonly diagnosed:
· People tend to develop
this type of osteoarthritis around age 55 or 60.
· The longer you use the
joints, the more likely you are to have this form of osteoarthritis.
· Chances are if we live
long enough, we’ll all get this type of osteoarthritis, the difference is with
the intensity - very mild or more severe.
Secondary osteoarthritis
This type of osteoarthritis is affected by a specific cause, i.e.
an injury, an effect of obesity, genetics, inactivity, or other diseases. It tends to strike at
an earlier age, around 45 or 50:
· Injury: you’re more likely to later develop osteoarthritis in the joint
that was injured before, and more likely to experience osteoarthritis at a
younger age than those who have primary osteoarthritis.
· Obesity: the extra weight that bears down on the joints can cause the
joint to wear away faster. According to the Arthritis Foundation, every extra
pound you gain adds three pounds of pressure to your knees and six pounds of
pressure to your hips.
· Inactivity. Donna Mills was once quoted to keep arthritis away you have to
keep moving. It is also common sense
that you will gain weight if you are not physically active and to lose weight
you need to exercise.
· Genetics. Sadly, if either your mother-side or father-side has it, chances
are you might have it also.
· Inflammation from
other diseases. Diseases that cause
inflammation, such as rheumatoid arthritis, can increase your risk of getting osteoarthritis later in
life.
· Infection from septic
arthritis. Pus formation within the joint contributes in
the erosion of the articular cartilage
(source:
https://www.everydayhealth.com/arthritis/osteoarthritis/index.aspx)
Symptoms and Diagnosis
Before I go even further, time for the disclaimer. Do not self-diagnose. And I strongly suggest that you go to your
doctor for a more accurate diagnosis. I
recommend that you see your friendly neighborhood Orthopedic Doctor or better
yet an Orthopedic Surgeon.
Symptoms
The
cardinal symptoms that suggest a diagnosis of OA include:
· pain (typically described as activity related
or mechanical, may occur with rest in advanced disease; often deep, aching and
not well localized; usually of insidious onset;),
· reduced function
· stiffness (of short duration, also termed
“gelling” i.e. short-lived stiffness after inactivity),
· joint instability, buckling or giving way
· patients may also complain of reduced movement,
deformity, swelling, crepitus, and increased age (OA is unusual before age 40)
in the absence of systemic features (such as fever)4
Diagnosis
Ye good
ole’ physical examination. Your doctor
will look for creaking or grinding noises (crepitus) which indicates bone
friction, muscle loss (atrophy), signs of injury/injuries, etc.
Medical
history – your doctor will want to know if this is common with your immediate
family (genetics), when the pain began, the nature of the pain, does it come
and go? Is it worse after a long time of not moving (like sleeping). Injuries you had before, etc.
And the
orthopaedic surgeon’s best friend the x-ray.
X-ray can show joint deterioration, bone erosion, bone spurs, excess
fluid in the joint, and other abnormalities.
Laboratory
tests – particularly blood tests, to rule out infection or rheumatoid arthritis
Treatment
I cannot emphasize this enough. DO NOT SELF-MEDICATE! I strongly suggest you see an orthopaedic
surgeon or doctor to find out what really is the best treatment for you.
Remember you may be doing yourself more harm than good.
And hell no! Google
is not a doctor.
Nonsurgical Treatment
Early detection increases the chance for nonsurgical
treatment. This form of treatment can
help maintain joint mobility, improve strength, and relieve pain. Most programs
combine lifestyle modifications, medication, and physical therapy.
Lifestyle
Changes Your friendly neighborhood doctor may recommend rest or a change in
activities to avoid provoking osteoarthritis pain. This may include making
changes with work or sports activities. Such as switching from high-impact
activities (dancing, running, jumping, or competitive sports) to low-impact
exercises (such as stretching, walking, swimming, or cycling). If needed a weight
loss program may be recommended, if osteoarthritis affects weight-bearing
joints (such as the knee, hip, spine, or ankle).
Medications
Non-steroidal anti-inflammatory drugs or NSAIDs can help reduce inflammation. Your
doctor may recommend corticosteroids which are strong anti-inflammatory agents,
which are injected directly into the joint. Corticosteroids provide short term
relief of pain and swelling. Dietary
supplements like glucosamine and chondroitin sulfate MAY help relieve pain from
osteoarthritis.
Hyaluronic injections - joints are like gears – they work best if they’re well
lubricated. In a healthy joint, a thick substance called synovial fluid
provides lubrication, allowing bones to glide against one another. Synovial
fluid acts as a shock absorber, too. In people with osteoarthritis, a critical
substance in synovial fluid known as hyaluronic acid breaks down. Loss of
hyaluronic acid appears to contribute to joint pain and stiffness. Replacing
hyaluronic acid through injections provide a lot of people relief for 3 to 9
months. This is commonly used especially
for knee arthritis.
Physical Therapy
A balanced fitness, physical, and/or occupational therapy may improve
flexibility, increase range of motion, reduce pain, and strengthen the joint/s.
Supportive or assistive devices (such as a brace, splint, elastic bandage,
cane, crutches, or walker) may be needed. Ice or heat may need to be applied to
the affected joint for short periods, several times a day. (do you know a rehab
dr in the area? Which I can talk to so I can pitch including them)?
Surgical Treatment
If non-surgical treatments do not stop the
pain or if they lose their effectiveness, surgery may be considered. Again, it depends
on the age and activity level of the patient, the condition of the affected
joint, and the extent to which osteoarthritis has progressed.
Surgical
options for osteoarthritis include arthroscopy, osteotomy, joint fusion, and
joint replacement.
Arthroscopy
this is rarely done, especially for advanced aged patients and patients whose
x-ray shows minimal or obliterated joint space. A surgeon uses a pencil-sized,
flexible, fiberoptic instrument (arthroscope) to make two small incisions to
remove torn meniscus, loose fragments in the joint or loosen tight ligaments
anchoring the patella.
Osteotomy
done if the joint are in severely wrong angulation. The long bones of the arm
or leg are surgically cut to realign and take pressure off of the joint.
Joint fusion
A surgeon eliminates the joint by fastening together the ends of bone (fusion).
This procedure eliminates the joint's motion.
Joint replacement
A surgeon removes ends of the bones and replaces it with an artificial joint that
has metal or plastic components (total joint replacement or arthroplasty). Common joints that are replaced are the knee
and hip.
Sources
1. Vincent K,
Conrad B, Fregly B, Vincent H. The Pathophysiology of Osteoarthritis: A
Mechanical Perspective on the Knee Joint. PM R. 2012 May; 4(5 0): S3–S9.
2. Martel-Pelletier
J, Pathophysiology of osteoarthritis. Osteoarthritis Cartilage. 2004;12 Suppl
A:S31-3.
3. Andriacchi
TP, Koo S, Scanlan SF. Gait mechanics influence healthy cartilage morphology
and osteoarthritis of the knee. J Bone Joint Surg
Am. 2009 Feb;91( Suppl 1):95–101.
4. Hunter D,
The symptoms of OA and the genesis of pain. Rheum Dis Clin North Am. 2008 Aug;
34(3): 623–643.
