Osteoarthritis (OA)

Definition and Causes:

DEFINITION:

Is a chronic inflammatory joint disease involving progressive loss of joint cartilage. There are over 100 different types of arthritis; most common among these are osteoarthritis and rheumatoid arthritis.

CAUSES:

Osteoarthritis can be divided into:

  • Primary Osteoarthritis: Results due to regular wear and tear of the joint cartilage. As we age, the water content of the cartilage increases; while the protein content degenerates, resulting in weak and flaky cartilage
  • Over time, this gradual degeneration of the cartilage, continuous use of affected joint, causes further degeneration and inflammation with pain. Eventually, leads to bone/joint deformity (overgrowth) and decreased mobility
  • Secondary Osteoarthritis: Caused by some other disease or condition e.g. obesity, repeated trauma or surgery of the joints, congenital joint abnormalities, gout, and hormonal disturbances like diabetes or growth hormone disorders
Symptoms:

Pain is the main symptom associated with OA, which is typically exacerbated by repetitive use of the affected joints, and relieved by rest.

Symptoms are variable from patient to patient but often include:

  • Morning stiffness always <20-30 minutes
  • Crepitations may be noted with movement of joint.
  • Joint involvement progresses slowly and irreversibly
  • Some patients with osteoarthritis of the finger and knee may have years of pain-free interval between symptoms
  • Arthritis of the knees is often associated with excess upper body weight
  • Can affect the spine and cause neck (cervical) or low back (lumbar) pain
  • Bone spurs, called osteophytes that form along the bones of the spine can irritate spinal nerves, causing severe pain that can radiate from the spine as well as numbness and tingling of the affected parts of the body, e.g. sciatica (pain radiating from low back through buttock into leg)
  • Osteoarthritis causes the formation of hard, bony enlargements of the small joints of the fingers. The swollen enlarged joints at the ends of the fingers are sometimes called a Herberden’s node. The presence of these nodes can be helpful in diagnosing osteoarthritis

 

Investigations and Treatment:

INVESTIGATION:

Laboratory:

There is no blood test for the diagnosis of osteoarthritis.

However, blood test may be obtained to:

  • Exclude other arthritic conditions (e.g. rheumatoid arthritis) or other conditions that might cause joint inflammation (e.g. gout or infections)
  • Monitor disease status and response to treatment
  • Monitor medication effects

X-rays:

Common findings related to the affected joints may include:

  • Loss of joint cartilage
  • Narrowing of the joint space between adjacent bones
  • Bone spurs formation
  • Helpful to exclude other causes of pain in a particular joint and assists in making decision, as to when surgical intervention might be considered

Arthroscopy:

  • A procedure which involves insertion of a viewing tube into the joint space. Abnormalities/damage to the cartilage and ligaments can be seen and repaired sometimes through the arthroscope. It is very helpful in making the definitive diagnosis of osteoarthritis

Arthrocentesis:

A minor procedure to remove fluid from the joint through a sterile needle.

This procedure can be used to:

  • Analyze for gout, infection, and other causes of arthritis
  • Instill corticosteroids into the joints to help relieve pain, swelling, and inflammation
Risk Factors and Prevention:

Risk Factor Management

  • Obesity
  • Inactive lifestyle
  • Family history of disease
  • Age – more common in individuals over 65
  • Joint trauma
  • Diet
  • Certain types of infection

To reduce the risk of arthritis patients should:

  • Maintain a healthy weight
  • Exercise regularly
  • Wear appropriate equipment to minimize injury during sport
  • Adopt appropriate measures, to minimize sport injury
  • Ensure diet contains necessary vitamins and minerals
Risk Factors and Prevention:

Risk Factor Management

  • Obesity
  • Inactive lifestyle
  • Family history of disease
  • Age – more common in individuals over 65
  • Joint trauma
  • Diet
  • Certain types of infection

To reduce the risk of arthritis patients should:

  • Maintain a healthy weight
  • Exercise regularly
  • Wear appropriate equipment to minimize injury during sport
  • Adopt appropriate measures, to minimize sport injury
  • Ensure diet contains necessary vitamins and minerals
Outcome:
  • OA is incurable. Early diagnosis and treatment may help to reduce or delay joint injury
  • Chronic cases will require lifelong treatment
  • Early recognition and lifestyle modification may help improve quality of life