Arthrosis, another name for osteoarthritis (OA) is a disease that progressively destroys the cartilages that are part of the joints. Thus, the bones in this region begin to rub against each other during the realization of any movement. It appears with high frequency, making it one of the most common rheumatic pathologies.
“Osteoarthritis is the most common chronic joint disease in the world. It is a degenerative disease that affects joint cartilage leading to joint pain, stiffness, swelling and dysfunction. It has a multifactorial etiology (age, obesity, trauma, poor alignment and genetics). The joint most commonly affected by osteoarthritis is the knee, and the literature shows that more than 10% of men and more than 13% of women suffer from this degenerative disease. Intra-articular steroids are a good alternative for patients with osteoarthritis.
Rheumatoid arthritis (RA) is a chronic inflammatory disease that mainly involves diarthrodial joints. Intraarticular injections of glucocorticoid (GC) have been used for more than half a century in the treatment of refractory synovitis in RA patients. There are limited data on the effectiveness of intra-articular injection of various preparations of GCs in inflamed joints.”1
“Osteoarthritis (OA) is a classic age-related disorder. It is often described as a chronic degenerative disease and thought by many to be an inevitable consequence of growing old. In OA, degradation and loss of the articular cartilage is a central feature that is sometimes attributed to ‘wear and tear’. However, unlike an automobile tire that wears thin over time, the tissues affected by OA contain living cells that respond to mechanical stimulation and function to maintain joint homeostasis. Rather than OA being a simple consequence of joint aging and repeated ‘wear and tear’, the current conceptual framework for the relationship between aging and OA is that aging of the musculoskeletal system increases the susceptibility to OA but alone does not cause it. Changes outside the joint (including sarcopenia and reduced proprioception) and within the joint (including cell and matrix changes in joint tissues) contribute to the development of OA, when other OA risk factors are also present. The concept that aging contributes to, but does not directly cause OA, is consistent with the multifactorial nature of OA and the knowledge that not all older adults develop OA and not all joints in the body are affected to the same degree. In this review, we will discuss the relationship between aging and the development of OA from both an epidemiological perspective and from a biological perspective with the goal of answering the question of why OA is an age-related disease.”2
The individual suffers localized pain, inflammation and deformation of the parts affected by osteoarthritis. The parts that are affected the most are the hands, knees, hip and spine.
“Patients with knee OA exhibiting significant muscle weakness is one of the most frequent and earliest reported symptoms of OA. Furthermore, muscle weakness is reported in patients with either painful or non-painful OA, suggesting that muscle weakness may precede the onset of disease and be directly involved in its pathogenesis. Histochemical studies have shown specific atrophy of type II muscle fibers in the quadriceps muscles of patients with knee OA and in the hip muscles of patients with hip OA. Although it is unclear whether a strong quadriceps muscle can be a protective factor in the initiation of knee OA, there is extensive clinical evidence to suggest that strengthening lower limbs through exercise may improve OA symptoms in patients with established OA. Furthermore, the benefits of exercise and dietinduced weight loss have been investigated in overweight and obese OA patients with beneficial effects on various disease parameters. However, improving skeletal muscle strength and functional performance through intensive exercise regimes is often inappropriate for the many OA patients who are elderly, overweight, co-morbid and may be frail. Therefore, the development of pharmacological agents, that, either alone or in combination with adjuvant exercise programs, are capable of mimicking intensive exercise regimes by improving muscle function in knee OA patients could provide a plausible route through which to modify the disease course of OA during both initiation and late-stage progression. Several pharmacologic agents have been shown to increase skeletal muscle mass, including androgens such as Testosterone. Therefore, selective androgen receptor modulators (SARMs) that are selectively anabolic hold promise as anabolic therapeutics.”3
Treatments include the use of drugs, a series of preventive guidelines and surgical intervention in the most serious of cases.
We can differentiate between two types of osteoarthritis: primary (without a known or specific cause) and secondary (related to some pathologies or medical conditions).
“Primary osteoarthritis is a chronic degenerative disease that is related to, but not caused by, aging. As a person ages, the water content of their cartilage decreases, thus weakening it and making it less resilient and more susceptible to degradation. There are strong indications that genetic inheritance is a factor, as up to 60% of all OA cases are thought to result from genetic factors.
Secondary arthritis tends to show up earlier in life, often due to a specific cause such as an injury, a job that requires kneeling or squatting for extended amounts of time, diabetes, or obesity. But though the etiology is different than that of primary OA, the resulting symptoms and pathology are the same. The main symptoms are pain, loss of ability, and “joint stiffness after exercise or use.” These symptoms are often aggravated by activity or rigorous exercise and relieved during rest, though the disease may eventually progress to the point where the patient even feels pain when resting, and some people report pain so intense that it wakes them up when they are sleeping.
Osteoarthritis, at present, cannot be cured, and will likely get worse over time, but the symptoms can be controlled. Treatments vary widely, from alternative medicine, to lifestyle changes such as exercise and diet, to physical aids such as canes or braces, to medications such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDS), corticosteroids, and more.”4
The following measures serve to alleviate the symptoms if the patient has already developed osteoarthritis. The most common risk factors are:
Overweight or Obesity
The increase of body mass that befalls the joints slowly wears away cartilages. Therefore, a guideline to follow would be to maintain a healthy weight through a balanced diet and the performance of physical exercise. These recommendations prevent a large number of diseases and improve our quality of life.
Maintain a Proper Postural Hygiene
Poor posture when sitting or walking is not recommended. Forcing our back to repeat certain movements can alter the functioning of the joints involved. For example, when practicing sports or during work. Also, it’s important to avoid or reduce postures that include a backward tilt of the spine.
Injuries or Traumatisms
They can occur due to a variety of causes and can be produced after a surgical intervention. It can also be caused by excessive repetition of certain postures or movements. Good advice to follow would be the use of protection during risky sports.
“The incidence and prevalence of severe knee injuries requiring medical attention are not well documented. The differential diagnosis of knee injuries includes contusion, subchondral or chondral injury with and without meniscal tear and with and without ligamentous injury or complete tear. In the best studied sports injuries, even injury not precipitating a medical visit appears to be a risk factor for knee OA; the rate is high and increasing worldwide. Meniscus injuries are common in athletes and the general population.”5
It is a disease in which the pancreas does not function properly. This organ secretes insulin to the blood, which helps in the metabolism of glucose. However, if the patient is overweight or obese, he or she has a higher probability to develop OA.
Sedentarism or Reduced Physical Activity
With physical exercises, we strengthen the different structures of our body, improving our physical condition.
“When considering the type of aerobic exercise, walking has been the most widely used modality in this population. Yet, it is likely that walking is not as effective in obese patients with weight-bearing joint OA. In a recent literature review, we observed limited evidence for the effectiveness of walking programs on pain and physical function in patients with both obesity and OA, whereas prior studies on leaner individuals have reported beneficial effects. The increased joint load combined with the increased inflammation characteristic of obesity may preclude the effectiveness of walking programs. Therefore, alternative modes such as cycling, arm ergometers, underwater walking or water aerobics may be better choices.
Special considerations ought to be given for resistive exercises in individuals with joint pain. Resistive exercise should be performed at pain-free ranges and maximum resistance should be avoided.”6
The hereditary component is very important in OA. For this reason, it is imperative order a complete medical history (making sure it includes rheumatic diseases, especially cases of osteoarthritis) and personal history of injuries, such as fractures, joint pain, etc. The objective is to establish an early diagnosis to treat the pathology as soon as possible. This can offset the evolution of the disease and minimize the deterioration of the cartilage.
Commencing treatment to battle the symptoms is extremely crucial to improve the quality of life of the patient. Therefore, in the presence of the first symptoms, it is recommended to go to the doctor and avoid self-medication with anti-inflammatory ointments or oral corticosteroids.
(1) Silvinato, A., & Bernardo, W. M. (2017). Inflammatory arthritis or osteoarthritis of the knee-Efficacy of intra-joint infiltration of methylprednisolone acetate versus triamcinolone acetonide or triamcinolone hexacetonide. Revista da Associação Médica Brasileira, 63(10), 827-836. Available online at http://www.scielo.br/pdf/ramb/v63n10/0104-4230-ramb-63-10-0827.pdf
(2) Anderson, A. S., & Loeser, R. F. (2010). Why is osteoarthritis an age-related disease?. Best practice & research Clinical rheumatology, 24(1), 15-26. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2818253/
(3) Tonge, D. P., Pearson, M. J., & Jones, S. W. (2014). The hallmarks of osteoarthritis and the potential to develop personalised disease-modifying pharmacological therapeutics. Osteoarthritis and cartilage, 22(5), 609-621. Available online at https://www.oarsijournal.com/article/S1063-4584(14)00996-0/pdf
(4) Wittenauer, R., Smith, L., & Aden, K. (2013). Background paper 6.12 osteoarthritis. World Health Organization. Available online at https://www.who.int/medicines/areas/priority_medicines/BP6_12Osteo.pdf
(5) Ratzlaff, C. R., & Liang, M. H. (2010). Prevention of injury-related knee osteoarthritis: opportunities for the primary and secondary prevention of knee osteoarthritis. Arthritis Research & Therapy, 12(4), 215. Available online at https://arthritis-research.biomedcentral.com/articles/10.1186/ar3113
(6) Piva, S. R., Susko, A. M., Khoja, S. S., Josbeno, D. A., Fitzgerald, G. K., & Toledo, F. G. (2015). Links between osteoarthritis and diabetes: implications for management from a physical activity perspective. Clinics in geriatric medicine, 31(1), 67-87. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4254543/