Osteoarthritis (what you should know)

October 02, 2011


Osteoarthritis is the most common type of arthritis and is usually seen especially among older people. Sometimes it is seen in younger people who had previous joint injuries eg accidents or sports injuries. Osteoarthritis mostly affects cartilage which is the hard but slippery tissue that covers the ends of bones. Healthy cartilage allows bones to glide over one another. This enables movements in a smooth, quiet and painless manner. In osteoarthritis, the surface layer of cartilage breaks / crumbles and wears away. This allows bones under the cartilage to rub together, causing pain, swelling, and loss of motion of the joint. Many patients also notice that their joints creak (noisy) on movement.

Over time, the joint may lose its normal shape. Sometimes, bone spurs may grow on the edges of the joint. Bits of bone or cartilage can break off and float inside the joint space. This causes more pain and damage. Occasionally, the joint becomes jammed (locked) because of this.

Both men and women have the disease. Before age 45, more men than women have osteoarthritis; after age 45, it is more common in women. It is also more likely to occur in people who are overweight and in those with jobs that stress particular joints.

Osteoarthritis most often occurs in the hands, spine, knees, and hips. People with osteoarthritis usually experience joint pain and stiffness. Osteoarthritis affects different people differently. It may progress quickly, but for most people, joint damage develops gradually over a period of years. In some people, osteoarthritis is relatively mild and interferes little with daily life. In others, it causes significant pain and disability. Some people may note deformity (bowing) especially at the knee joints.

Usually, osteoarthritis comes on slowly. Early in the disease, your joints may ache after physical work or exercise. Later on, joint pain may become more persistent. You may also experience joint stiffness, particularly when you first wake up in the morning or have been in one position for a long time. Commonly, patients may experience pain after standing up after dinner or after watching a long TV program.

Common areas affected by osteoarthritis are the hands, back, hips and knees. There is no ‘best’ of treatment of osteoarthritis, neither is there a cure for this disease.

Commonly methods of treatment are:

Exercise: Exercise can improve mood and outlook, decrease pain, increase flexibility, strengthen the heart and improve blood flow, maintain weight, and promote general physical fitness. Walking, swimming, and water aerobics are a few popular types of exercise for people with osteoarthritis. The common saying, if it hurts, something is wrong.

Weight control: Osteoarthritis patients who are overweight or obese should try to lose weight. Weight loss can reduce stress on weight-bearing joints, limit further injury, and increase mobility.

Heat and cold: Heat or cold (or a combination of the two) can be useful for joint pain.

Massage: In this pain-relief approach, a massage therapist will lightly stroke and/or knead the painful muscles. This may increase blood flow and bring warmth to a stressed area. However, arthritis-stressed joints are sensitive, so the therapist must be familiar with the problems of the disease.

Complementary and alternative therapies: Some people have found pain relief using acupuncture, a practice in which fine needles are inserted by a licensed acupuncture therapist at specific points on the skin.

Nutritional supplements: such as glucosamine and chondroitin sulfate have been reported to improve the symptoms of people with osteoarthritis, as have certain vitamins. There are several brands in the market. At best, these supplements help maintain the joint health.

Traditional Medications: Traditional medications have varying effects on osteoarthritis. Sometimes, steroids are added in traditional medications. While these medications are extremely effective in pain relief, they carry significant complications including weight gain and bone damage and this should be avoided at all cost.

Medications to control pain

Paracetamol: A medication commonly used to relieve pain, acetaminophen, is available without a prescription. It is often the first medication doctors recommend for osteoarthritis patients because of its safety relative to some other drugs and its effectiveness against pain.

NSAIDs (non-steroidal anti-inflammatory drugs): Aspirin, ibuprofen, naproxen are examples of NSAIDs. They are often the first type of medication used. Some NSAIDs are available over the counter, while more than a dozen others, including a subclass called COX-2 inhibitors, are available only with a prescription.

Narcotic or central acting agents: Tramadol is a prescription pain reliever and synthetic opioid that is sometimes prescribed when over-the-counter medications don’t provide sufficient relief. It works through the central nervous system to achieve its effects.

Injections: Corticosteroids are powerful anti-inflammatory hormones made naturally in the body or man made for use as medicine. They may be injected into the affected joints to temporarily relieve pain.

Viscosupplements: hyaluronic acid substitutes are designed to replace a normal component of the joint involved in joint lubrication and nutrition. Depending on the particular product your doctor prescribes, it will be given in a series of three to five injections.

Surgery

For many people, surgery helps relieve the pain and disability of osteoarthritis. Surgery may be performed either to remove of loose pieces of bone and cartilage from the joint if they are causing symptoms of buckling or locking (arthroscopy), repositioning of bones (osteotomy) or resurfacing (smoothing out) bones (knee replacement).

Surgeons may replace affected joints with artificial joints called prostheses. These joints can be made from metal alloys, high-density plastic, and ceramic material. The decision to use surgery depends on several factors, including the patient's age, occupation, level of disability, pain intensity, and the degree to which arthritis interferes with his or her lifestyle. After surgery and rehabilitation, the patient usually feels less pain and swelling and can move more easily.

Newer methods to perform knee replacement may use the aid of computers to further enhance the accuracy of fixing the implants to the affected joint.



On the left side, there is loss of the cartilage which is present on the right side (pearly white in colour). The pink tissue seen on the left side is bone. Rubbing bones cause pain.


Extra pieces of bone growing on the right side of the knee joint.



(borrowed image): of the fingers.



A tray containing the templates used in a knee replacement, being laid out for a knee replacement procedure.



Implants being laid out just before being cemented into the knee joint.



Knee implants securely in place at the end of the knee replacement just before closing the skin.



One of the knee replacement surgery in Columbia Asia Hospital using a computerized knee replacement.


Screen shot showing the amount of bone being cut (mm) and the accuracy of the cut (degrees).


Dr. Yoga Raj
Consultant Orthopedic Surgeon
Columbia Asia Hospitals- Nusajaya