December 26, 2017

Osteoarthritis

Osteoarthritis

Osteoarthritis is one type of arthritis in which articular cartilage of one or more joint is destroyed. It usually occurs after mid-life, and various factors can affect the condition of the disease. According to the scientific issues, osteoarthritis results from aging, weight, or excessive use of joints. The most common involved joints are pelvis and knees undergoing the weight. If osteoarthritis is not caused by physical damages or diseases, it is called primary osteoarthritis. Osteoarthritis is often caused by erosion of joints followed by increasing age. Repeated use of the cartilage results in abrasion of articular cartilage that is followed gradually with cartilaginous inflammation, articular joint pain and swelling. If the cushion-like performance of cartilage is removed, due to friction between bones, pain and limitation of motion can occur that eventually leads to ossification. The result of this process is the bony outgrowth or osteophytes.

The secondary osteoarthritis is caused by several agents including obesity, frequent traumas, articular surgery, congenital abnormalities, gout, diabetes, and other hormonal disorders.

The early development of osteoarthritis takes place among weightlifters due to their heavy weight. Similarly, the frequent traumas or blows to articular tissue (ligaments, bones, and articular cartilages) may create premature osteoarthritis among footballers and army personnel.

Unlike lupus or rheumatoid arthritis, osteoarthritis (OA) is not a systemic disease and only involvement of multiple joints exists in this disease.

 

Signs and symptoms

  • The most common symptoms of osteoarthritis is the pain that is caused by repeated use of the involved joint. Climate change, especially cold and humidity may increase pain.
  • Limitation of movement, dryness and flexibility of joints at the beginning of the day and gradually decrease during the day. But this dryness is repaired quicker than dryness of rheumatoid arthritis, and usually this improvement takes nearly 30 minutes.
  • Swelling and inflammation are sometimes occurred in affected joints.
  • Deformation in the joints is uncommon due to osteoarthritis, but it is sometimes happened.
  • Cracking and wringing joints during activity.
  • A number of patients may have no clinical symptoms and in the simple image, joints will change in osteoarthritis.

In most occasions, knee osteoarthritis is associated with the weight in upper extremity, obesity, frequent damages and joint surgery. The progressive destruction in knee joint results in an outward curvature of knee or an inward curvature of knee. The conservative drug therapies may not be often responsive to pain, lameness and restricted motion in patients. Other treatments in case of progression of the disease include joint replacement.  In the lack of disease control, osteophytes in the spinal column affects the spinal nerves and cause severe pain with numbness.

 

Diagnosis

There is no diagnostic blood test for osteoarthritis, but is used to rule out other causes. A simple radiography can be helpful to confirm the diagnosis and rejecting other scenarios. Advanced methods such as CT or MRI are rarely required unless the diagnosis is suspected or other diagnosis were proponed such as damage to the meniscus.

Simple joint radiography can be used to diagnose a joint with arthrosis, in which the following symptoms are seen.

  • Lowering the joint space, in other words, reducing the gap between the two bones that make the joint
  • Bone formation along the joint surface of the bones called osteophytes
  • Increase bone density below the joint surface
  • Create bone cysts below the joint surface
  • The deformation of the joint surface and the torsion of bone formation

 

Treatments

Weight loss and avoidance of activities damaging joint are assumed as only definite solutions to stop destruction of articular cartilage and to repair them. The main goal of treatment is to reduce pain and inflammation and to improve performance of joint. In some patients, the conservative treatment including relaxation, exercise, diet control, weight loss, physical therapy, improvement of occupation factors, and use of the supportive tools such as braces and crutches are effective.

Furthermore, the drug therapies are emerged to complete the treatment. Drugs are administered topically, orally, and direct injection of joints. The surgery is required if the above-mentioned therapies are failed.

Relaxation of joint and avoidance of activities, which may exacerbate the pain, may relieve the pressure on the joint, pain and swelling. As long as sport activities cause no pain, it may stop the progress of osteoarthritis which comes with the following mechanisms:

  • Increasing muscle strength around the joint that enhances the protective role of muscles
  • Preventing stiffness and improving stimulation
  • Weight loss and increasing physical endurance

 

Drug therapy

Taking mild-painkillers such aspirin and acetaminophen may relieve the pain in many patients. According to some studies, the effects of adequate dosage of acetaminophen in reducing pain caused by knee osteoarthritis are equal with those of other anti-inflammatory drugs. Other treatments which can named is including anti-inflammatory lotions as diclofenac. If the pain does not diminish, other medications which can be used such as ibuprofen, naproxen and celecoxib as an inhibitor.

In addition to oral drug therapies, other treatments that help the patient are including:

  • Injection of steroids (corticosteroids) into the joint to reduce pain and inflammation that was carried out over the years and this was is rarely use with advent of new method of treatments.
  • An artificial articular fluid (hyaluronic acid) injected into the joint that reduces the patient’s pain for 3 to 6 months.
  • Pepper ointment to relieve pain
  • Physiotherapy: If the pain does not improve after 6 to 8 weeks, it will probably not continue to be effective.

Hyaluronic acid injection into the joint is helpful in the event of severe and refractory pain and inability to treat. Hyaluronic acid maintains temporary joint fluid and increased joint potential and it is likely to have direct effects on the recipients of the pain.

Surgical Treatment

Surgery in extreme cases is an option that arthroscopy allows restoration of cartilage rupture without open surgery. Arthroscopy surgery allows better recovery in cases with cartilage teas as compared to open surgery. Osteotomy is employed for the patients whose joints are deformed, particularly some deformation in knee. Osteotomy includes removal of some part of bone to create the balance again that was lost in the joint. Arthrodesis (welding bones and fixing of joints) and articular replacement are those techniques, which are employed in serious cases of articular decay.

 

Stem cell treatment

In this manner, the mesenchymal stem cells (named MesestroCell) are isolated from the bone marrow and injected into the arterial occlusion. The mesenchymal stem cells have the abilities of proliferation and differentiates into mesoderm categories, including bone, cartilage and fat. These cells migrate to the region by mediating chemical signals from the damaged tissue. As a result, it is an appropriate option for the treatment of arthritis.