Osteoarthritis, the most common form of arthritis,
is the condition characterized by painful swelling of the joints, caused
by breakdown of the cartilage, or by wear and tear of the joints. Cartilage
is the tough elastic material that covers and protects the ends of bones.
Over time, the cartilage may wear off completely, causing the bones to rub
against each other. While osteoarthritis is most common in people over 45,
it can occur in any age group.
What are the joints most affected by Osteoarthritis?
Osteoarthritis can affect any joint but usually
affects the weight-bearing joints such as the hips, knees, hands and spine.
Non-weight bearing joints such as finger joints and the joint at the base
of the thumb could also be affected. Other joints are not affected unless
they have been injured or put under unusual stress.
What happens within the joints when they are affected by
Osteoarthritis?
Osteoarthritis causes certain parts of the joint
to weaken and break down. Bits of cartilage can break off into the joint
space and irritate soft tissues, such as muscles, causing problems with
movement.
As a result of damage to the cartilage, the muscles, tendons and ligaments
that help joint movements are forced to work in ways, for which they were
not designed. This is the main cause of pain in osteoarthritis. The cartilage
itself does not have nerve cells and cannot sense pain, but the muscles,
tendons, ligaments and bones do. After many years of cartilage erosion,
bones may actually rub against each other. This grinding of bone against
bone adds to the pain. Bones can also thicken and form growths, called spurs
or osteophytes, which rub against each other. When cartilage is weak or
damaged the surrounding bones exert pressure on it, causing excessive blood
flow that could cause pain, especially at night.
What are the symptoms of osteoarthritis?
The following symptoms should alert a person
to seek the advice of a doctor or a rheumatologist.
· Pain, stiffness, or swelling in the joints lasting for more than 2 weeks
· Visible swelling of joints especially the joints of the fingers or feet
· Difficulty in doing everyday tasks
A grating sound due to the rubbing of cartilage on the surface of the bone.
What are the causes of osteoarthritis?
The exact cause of osteoarthritis is not known. But there are several
factors that increase the risk of being affected by this problem.
Heredity
A tendency for defective cartilage may be passed on in families. Slight
defects in the way joints fit together could also be inherited. Such defects
may not show up until a person is over 40.
Excess Weight
Excess body weight increases the stress on the weight-bearing joints,
especially the knees and hips. In women who are slightly over-weight,
reduction of even 5 kg in their body weight, has shown to help prevent
osteoarthritis.
Injury
Injuries to the joints from accidents or from repeated use through activities
like sports or work can increase the chance of being affected by osteoarthritis.
Complications of other types of arthritis
Other types of arthritis such as rheumatoid arthritis could lead to osteoarthritis.
What is the treatment for Osteoarthritis?
Though there is no permanent cure for osteoarthritis,
there are many steps a person can take to manage the condition and lead
an active life. Treatment is aimed at reducing the pain and swelling and
making movements easier.
Oral Medication
Mild
forms of osteoarthritis may be treated with acetaminophen (paracetamol).
This may relieve the pain but not the inflammation. This drug may be found
in many cold medications and hence care should be taken to prevent an overdose
of the drug.
The most common type of medicine used to treat osteoarthitis is
nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs help reduce the pain and
swelling of the joints and decrease stiffness. However, they do not prevent
further joint damage. The common examples of NSAIDS are Nimesulide, Aspirin
etc.
NSAIDs reduce pain when taken at a low dose, and relieve inflammation when
taken at a higher dose. Though the various NSAIDs, taken in full doses,
usually have the same levels of anti-inflammatory effect, different individuals
may experience different levels of relief from one medicine or other. It
is important to take the right dosages to avoid stomach irritation, heartburn
and ulcers. It may be advisable to take antacids or other drugs with the
advice of the doctor, to avoid such problems.
Injections
Cortisone is a steroid that reduces inflammation and swelling. It is a hormone
naturally produced by the body. Corticosteroids are man-made drugs that
closely resemble cortisone. Sometimes, a doctor may choose to inject a corticosteroid
into an affected joint or ligament to bring short-term relief in the case
of severe pain and inflammation This can provide immediate relief for a
tender, swollen and inflamed joint. However, corticosteroids can weaken
the cartilage and remove the minerals from the bone, thereby weakening the
joint further. So, the doctor may use them only when they are most needed.
In most cases, the medication does not result in total relief of pain. The
doctor and the person affected will have to work out as to which drug brings
about the best relief from pain and inflammation.
Viscosupplementation is a treatment, in which a clear gel-like substance
is injected into the knee. This substance lubricates the cartilage, thus
reducing pain and allowing greater movement of the knee.
Exercise
Exercise helps a person to maintain an ideal weight. This can help relieve
the stress on the joints. Not using a sore joint could cause the muscles
around it to become weak, resulting in pain. Exercise can reduce pain and
prevent further joint damage. It can make a person feel better overall.
Three types of exercises may be done:
· Exercises to increase the range of motion, reduce stiffness and help keep
the joints moving. For example, a range of motion exercise for the shoulder
would be to move the arm in a large circle.
· Strengthening exercises to maintain or increase muscle strength
· Walking or endurance exercises like swimming and cycling can strengthen
the heart, increase stamina, improve flexibility and control a person's
weight. A person should always consult a doctor before beginning an exercise
program.
Hot or Cold Fomentation
Heat helps to reduce pain and stiffness by relaxing aching muscles and increasing
circulation to the area. Fomentation or even a hot shower can give good
relief from pain. There is some concern that heat may worsen the symptoms
in an already inflamed joint. Cold compresses help to lessen the pain and
swelling in a joint.
Protect Your Joints
Joints should be protected from excess mechanical stress resulting from
daily tasks. The following techniques should be kept in mind.
Alternating heavy or repeated tasks with easier tasks or breaks (pacing),
reduces the stress on painful joints and allows weakened muscles to rest.
Pacing and planning also provide you with ways to deal with fatigue.
Positioning joints wisely helps a person to use them in ways that avoid
extra stress. Larger, stronger joints should be used to carry loads. For
example, one can use a shoulder bag instead of a hand-held one. The back,
arms and legs should also be used safely, to avoid stress on joints. One
should avoid being in the same position for a long period of time.
Using devices, such as canes, raised chairs, grips and reaching aids, can
help make daily tasks easier and avoid falls.
Maintaining an ideal weight is very important, as it helps reduce the risk
of osteoarthritis of the knees. It also lessens pain by reducing stress
on the joints. Before starting any major weight-reducing program, it is advisable to
consult a doctor and a dietician.
Relaxation
Relaxing the muscles around an inflamed joint reduces pain. |
Deep breathing exercises, music, meditation, etc. can all help a person
relax and achieve a positive outlook, thereby giving a feeling of greater
control over the arthritic condition.
Surgery
A doctor may advise surgery if one of the joints becomes badly damaged,
or if the pain is too intense.
There are different types of surgery to treat osteoarthritis. Some are less
invasive than others.
Arthroscopic surgery, for example, involves making small incisions through
which surgeons can clean cartilage debris from the joint.
Some kinds of surgery repair bone deformity, fuse joints, or rebuild part
of a joint.
A joint could also be replaced with an artificial or a man-made joint. The
benefits of surgery may include decrease in pain, better movement and function,
and in some cases, better physical appearance, such as in the hands.
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