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Osteoarthritis Causes, Classification and Treatment

Osteoarthritis Causes
Contents

OVERVIEW:

Osteoarthritis is the most common joint disease in humans. It mainly affects the articular cartilage, the smooth tissue that covers the ends of bones where they meet in a joint and lets them glide without rubbing.

In osteoarthritis, this cartilage breaks down over time and the bone underneath changes too. Unlike rheumatoid arthritis, osteoarthritis is not an autoimmune disease, although low-grade inflammation can be part of it.

The knee is one of the most commonly affected joints, and knee osteoarthritis is a major cause of disability in older adults. Hips, hands, the neck and the lower back are also often involved, according to the NIAMS osteoarthritis overview.

There is no single cause. Risk rises with age, but experts no longer see it as simple wear and tear.

Osteoarthritis****Causes:

  • Age: osteoarthritis becomes more common as people get older and is a leading cause of disability in older adults. Younger people can get it too, usually after a joint injury.
  • Gender: both men and women can develop osteoarthritis, but women are more likely to have it, especially after age 50.
  • Trauma: major joint trauma including accident, fall from height or any other joint injury may cause osteoarthritis
  • Stress on joints: repeated stress or overuse of a joint, for example from certain jobs or sports, raises the risk over time.
  • Obesity: extra weight increases the load on weight-bearing joints such as the knees and hips. Weight is a risk factor you can change, and losing weight can lower the risk and ease symptoms.
  • Family history and joint shape: osteoarthritis can run in families, and joints that did not form correctly are more likely to wear down early.

Classification of Osteoarthritis:

1-Primary osteoarthritis:

The most common form of osteoarthritis is primary osteoarthritis in which there is no predisposing factor. It has no proper evidence of the causative factor and is idiopathic in nature.

2-Secondary osteoarthritis:

Secondary osteoarthritis is attributable to an underlying cause for example

  • Other arthropathies: other joint diseases like gout may cause secondary osteoarthritis
  • Endocrinal causes: endocrinal diseases for example acromegaly and diabetes mellitus have been linked with secondary osteoarthritis
  • Deposition diseases: the deposition diseases like hemochromatosis is included in the list of osteoarthritis causes
  • Mechanical factors: mechanical stress like unequal leg length, or knock-knee (valgus) or bow-leg (varus) alignment, can overload the joint and eventually lead to osteoarthritis

How does Osteoarthritis present?

Osteoarthritis is a long-term chronic disease affecting joints. The major joints involved are weight-bearing joints such as the knees and hips, plus the small joints of the fingers (the middle and end finger joints) and the base of the thumb.

  • Pain: pain usually starts slowly, over months or years. It typically gets worse with use and eases with rest. In advanced disease, pain can also occur at rest or at night.
  • Tenderness: joint surfaces are tender to touch. By tenderness we mean the patient feels pain on putting pressure over the joint surfaces
  • Crackling sounds: cracking sounds or crepitations may be heard with the movement of joints
  • Morning stiffness: stiffness after waking or after rest usually lasts less than 30 minutes. Morning stiffness that lasts much longer points toward an inflammatory arthritis, such as rheumatoid arthritis, and should be checked.
  • Effect of activity: pain tends to increase with heavy use of the joint. Even so, regular, well-chosen exercise is one of the most effective treatments for osteoarthritis.
  • No whole-body illness: osteoarthritis does not cause fever, swollen lymph nodes or organ problems such as kidney or heart disease. These features suggest a different condition.

How to Diagnose Osteoarthritis?

Osteoarthritis is usually diagnosed clinically. However various laboratory tests are available which may help diagnose osteoarthritis when there is Diagnostic uncertainty.

  • Erythrocyte Sedimentation rate: erythrocyte sedimentation rate is normal. If ESR is elevated some other process is complicating osteoarthritis, for example, septic joint disease or it is not osteoarthritis we must think of something else.
  • C reactive protein: the level of C reactive protein is in the normal range
  • Complete blood count: complete blood examination is normal and there is no anemia or thrombocytopenia
  • Antinuclear antibody: ANA is absent
  • Rheumatoid factor: rheumatoid factor is absent
  • X-ray of joints: x-rays can show joint space narrowing and bone spurs, also called osteophytes. Bony lumps on the middle finger joints are called Bouchard's nodes, and those on the end finger joints are called Heberden's nodes.

How to Treat Osteoarthritis?

There is no cure for osteoarthritis, so treatment aims to reduce pain and keep you moving. Exercise, weight loss for people who are overweight, and self-management programs are strongly recommended in the 2019 ACR/Arthritis Foundation guideline.

Pharmacological Treatment:

1- NSAIDS:

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen can be taken by mouth or applied to the skin as a gel. Oral NSAIDs and topical NSAIDs for knee osteoarthritis are strongly recommended for pain relief, but they do not slow the disease. Oral NSAIDs can cause stomach, kidney and heart side effects, so ask your doctor before long-term use.

Osteoarthritis Treatment and it’s Prevention’s

2- Acetaminophen:

Acetaminophen was once the standard first drug for osteoarthritis. Current guidelines only conditionally recommend it because its benefit is small, and regular users may need liver monitoring.

3- Steroids:

Steroid (glucocorticoid) injections into the joint are strongly recommended for knee and hip osteoarthritis flares. Their relief is temporary, and they are used when other treatments do not control pain.

4- Pain Receptor blockers:

Capsaicin cream: capsaicin cream depletes sensory nerve endings of substance P, which can reduce pain signals from the joint. Guidelines conditionally recommend it for knee osteoarthritis but not for hand osteoarthritis, partly because of the risk of getting it in the eyes.

5- Surgery:

Joint replacement is reserved for severe cases in which other treatments have not given enough relief.

WHEN TO SEEK MEDICAL HELP?

See a doctor if joint pain is severe, limits your daily activities or keeps getting worse. Also get checked if morning stiffness lasts more than 30 minutes, or if a joint is hot, red or very swollen. Only a clinician can confirm the diagnosis and choose the right treatment for you.

Sources

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