Arthrosis is a disease that affects the cartilages of a joint by slowly destroying them. It’s a chronic pathology that mostly affects the hands, spine, knees, and hip.
“Osteoarthritis refers to a clinical syndrome of joint pain accompanied by varying degrees of functional limitation and reduced quality of life. It is the most common form of arthritis, and one of the leading causes of pain and disability worldwide.
Although pain, reduced function, and effects on a person’s ability to carry out their day-to-day activities can be important consequences of osteoarthritis, pain in itself is, of course, a complex biopsychosocial issue, related in part to personal expectations and self-efficacy, and associated with changes in mood, sleep, and coping abilities.
Symptoms: minimal changes can be associated with a lot of pain and modest structural changes to joints often can occur without with minimal accompanying symptoms. Contrary to popular belief, osteoarthritis is not caused by aging and does not necessarily deteriorate. There are a number of management and treatment options (both pharmacological and non-pharmacological).”1
“Osteoarthritis (OA) is among the most prevalent chronic diseases affecting adults in the United States and is a major cause of functional impairment, morbidity, and utilization of health care resources. Osteoarthritis was second only to ischemic heart disease as the primary diagnosis leading to the awarding of Social Security Disability Insurance benefits (21, and patients with OA reported 6.7 days of restricted activity per month.”2
Currently, there is no drug that completely cures osteoarthritis. However, certain medications will delay the progression of this disease.
“In osteoarthritis, the knee is the joint that is most commonly associated with clinical symptoms and disability. Yet, we know little of the prevalence of this common and important disease in the age group most often affected, the elderly. Several studies, including population-based surveys, have shown that the prevalence of OA of the knee, like OA of other joints, increases with increasing age. Unfortunately, most studies, including large population-based surveys in which radiography was performed, have focused on young and middle-aged adults and, occasionally, have extended the study group to include subjects as old as 74. The study has also shown that women are more likely than men to have symptomatic OA of the knee.”3
Knee OA is related to aging, articular cartilage obesity, fatigue, trauma, joint congenital abnormalities and joint deformities caused by many factors such as degradation of injury, under joint margins and subchondral bone reactive hyperplasia. Clinical manifestations of knee OA are slow development of joint pain, tenderness, stiffness, joint swelling, limited mobility, and joint deformities. There were 20 million individuals suffering from knee OA in the USA, and this figure is expected to double over the next two decades. Knee pain was reported by up to half of the individuals aged over 50, among which severe and disabling knee pain accounted for approximately 50%. The high prevalence and substantial impact on the quality of life of knee OA calls for more high-quality research in this area.
The prevalence of obesity has been growing alarmingly in the world, concurrently with an increased predisposition to multiple comorbidities. Being overweight is a key factor for knee OA, and provides substantial grounds for concern of disease severity and medical costs from treatment and productivity losses.”4
Types of Osteoarthritis
We can differentiate two types of osteoarthritis:
“Primary. In primary OA the cause is unknown (idiopathic/ without a specific cause).
Secondary. There is a link to a specific cause (as a consequence of an underlying disease, a ‘trigger’), such as the previous injury to a joint, pre-existing congenital abnormality (congenital hip dysplasia) or inflammatory arthritis such as gout or rheumatoid arthritis (RA).”5
Among the most common triggers, we can mention are congenital diseases, injuries, traumas, or rheumatoid arthritis. Repetitive movements during work or practicing sports can wear out the cartilages that are involved in that particular action.
There are no medical treatments proven to prevent or delay the onset of OA. However, non-pharmacological measures, such as weight loss, structured exercise programmes, and various aids, can help to improve symptoms in OA. Osteoarthritis appears more frequently in women and in people over 65 years old. Other risk factors or conditions that increase the chances of presenting the disorder are being overweight, menopause, and family history.
“Symptomatic knee osteoarthritis is a common complaint of many elderly patients in primary care offices. For those unable or unwilling to undergo knee replacement, the primary practitioners’ understanding of the strengths and weaknesses of the available treatment modalities for pain relief is critical to successful in-office counseling and expectation management. Treatment requires a multimodal approach of nonpharmacological and pharmacologic therapies to achieve a maximal clinical benefit.”6
In the early stages of osteoarthritis, the patient usually presents certain common signs or symptoms:
“These four aspects can all be considered as targets of a treatment evaluation
- Specific, OA-related, signs/symptoms (described by the WOMAC score);
- Inflammation causing a progression in the disease;
- Alteration (and improvement by treatment) of fatigue resistance and muscular performance;
- Reversing and blocking the vascular problems associated with altered mobility (i.e. often leading to edema and sometimes even to venous and stasis ulcerations).”7
- Inflammation of the affected joint.
- Presence of edema (an accumulation of fluid) in nearby regions.
- Cracks or noises when making hand movements.
- Rigidity or numbness of the altered extremities after a period of inactivity. It is also common to feel a tingling sensation at different times of the day.
- Difficulty to carry out any movement that calls that articulation to action, especially after a few moments of rest.
- Formation of lumps or prominences on the skin of the hands (also called subcutaneous nodules). Therefore, these nodules can cause deformation or an unsightly appearance.
- Pain or discomfort that can vary in intensity, although there are certain cases in which the patient doesn’t present this discomfort, which is caused by the friction between the bones that make up the joint.
“Osteoarthritis can cause morning stiffness, but it usually lasts for less than 30 minutes, unlike rheumatoid arthritis, which causes stiffness for 45 minutes or more.3 Patients may report joint locking or joint instability. These symptoms result in loss of function, with patients limiting their activities of daily living because of pain and stiffness. The joints most commonly affected are the hands, knees, hips, and spine, but almost any joint can be involved. Osteoarthritis is often asymmetric. A patient may have severe, debilitating osteoarthritis of one knee with the almost normal function of the opposite leg.”8
Diagnosis can be made through a physical examination along with other medical procedures. They may include the analysis of substances such as blood, urine, and synovial fluid, along with obtaining images, such as x-rays, ultrasound, magnetic resonance, etc.
“Osteoarthritis (OA) is highly prevalent in the US and around the globe. It is a leading cause of disability and can negatively impact people’s physical and mental well-being. Healthcare resources and costs associated with managing the disease can be substantial. There is increasing evidence that there are different OA phenotypes that reflect different mechanisms of the disease. Various person-level risk factors are recognized, including sociodemographic characteristics (e.g., female gender, African-American race), genetic predispositions, obesity, diet-related factors, and high bone density/mass. Joint-level risk factors include specific bone/joint shapes, thigh flexor muscle weakness, joint malalignment, participation in certain occupational/sports activities, and joint injury. Recent studies have enhanced our understanding of pre-radiographic lesions associated with OA
Application of these new findings may allow us to develop innovative strategies and novel therapies with the purpose of preventing new disease onset and minimizing disease progression.”9
The treatment of osteoarthritis is personalized and depends on the degree of the evolution of the disease. Some general measures include medications that relieve pain and inflammation of the affected joints, namely, analgesics and anti-inflammatories. But, that is not all. In recent years, doctors and specialists have progressively been introducing other drugs that modify the course of the disease, although they do not cure osteoarthritis, they may slow its progress. They also help the patient retain mobility and self-sufficiency for a longer period of time. For example, chondroprotection, such as chondroitin sulfate, can be commercially produced and is found naturally in cells that surround the extracellular matrix in our body.
“Treatment choices fall into four main categories: nonpharmacologic, pharmacologic, complementary and alternative, and surgical. In general, treatment should begin with the safest and least invasive therapies before proceeding to more invasive, expensive therapies. All patients with osteoarthritis should receive at least some treatment from the first two categories. Surgical management should be reserved for those who do not improve with behavioral and pharmacologic therapy, and who have intractable pain and loss of function
Nonpharmacological therapy often starts with exercise. A randomized clinical trial compared supervised home-based exercise with no exercise in 786 patients with osteoarthritis of the knee. The exercise program consisted of muscle strengthening and range-of-motion exercises. The researchers found statistically significant improvements in a validated arthritis symptom score at six, 12, 18, and 24 months.
The mainstay of treatment for mild osteoarthritis is acetaminophen. It is inexpensive, safe, and effective. A 2006 Cochrane review concluded that acetaminophen is better than placebo for treating mild osteoarthritis and equal to nonsteroidal anti-inflammatory drugs (NSAIDs), but with fewer gastrointestinal adverse effects. Patients should be instructed to take 650 to 1,000 mg of acetaminophen up to four times per day to relieve osteoarthritis symptoms. The U.S. Food and Drug Administration recommends no more than 4,000 mg of acetaminophen per day to avoid liver toxicity. It further cautions patients to be aware of coincident use of other over-the-counter or prescription medications that may contain acetaminophen. When acetaminophen fails to control symptoms, or if symptoms are moderate to severe, NSAID therapy is recommended. NSAIDs as a class are superior to acetaminophen for treating osteoarthritis.”8
“The goals of the treatment of osteoarthritis (OA) are to alleviate pain and minimize loss of physical function. To the extent that pain and loss of function are consequences of inflammation, of weakness across the joint, and of laxity and instability, the treatment of OA involves addressing each of these impairments. Comprehensive therapy consists of a multimodality approach including non-pharmacologic and pharmacologic elements. Patients with mild and intermittent symptoms may need only reassurance or non-pharmacologic treatments. Patients with ongoing, disabling pain are likely to need both non-pharmaco-and pharmacotherapies. Treatments for knee OA have been more completely evaluated than those for hip and hand OA or for disease in other joints. Thus, while the principles of treatment are identical for OA in all joints, we shall focus below on the treatment of knee OA, noting specific recommendations for disease in other joints, especially when they differ from those for disease in the knee.”10
“The basic pathophysiological characteristic of OA is a loss of articular cartilage, although the synovial membrane, bone or other components of the joint may also be affected. Chondrocytes are the main component of the cartilage. These cells are relatively inert and rarely regenerate. The outer third of the meniscus (also known as the red-red zone) has better self-healing capabilities compared with other regions due to a good blood supply. Conventional therapies for OA include physiotherapy, anti-inflammatory drugs, pain-relieving drugs, hyaluronic acid, platelet-rich plasma or corticosteroid-based intra-articular injections, and knee arthroscopic surgery. Unfortunately, these treatments have demonstrated modest clinical benefits compared with controls, and articular replacement by prosthesis is recommended as a last therapeutic option
Knee OA is a progressive and degenerative condition, which will remain a serious clinical problem in orthopedics unless significant advancements are made in regeneration technologies. In fact, all of the currently accepted treatments are aimed at symptom control, rather than disease prevention.”11
In the most advanced cases, surgical intervention may be necessary in order to calm the pain. There are also numerous recommendations that do not involve medical treatment. These include carrying out exercises to maintain a healthy quality of life and to avoid becoming overweight, which can only exacerbate symptoms. When thinking about using easy home remedies, patients can apply heat to loosen up the affected area, and cold to reduce swelling or inflammation.
“There is no single cause of OA, and the exact etiology of OA is unknown. A combination of factors increases the risk of developing OA. These include:
- Aged over 50 years
- Female sex
- Increased body mass index (BMI>25)
- Previous injury to the affected joint
- Laxity of joint ligaments
- Occupational or recreational use of the affected joint
- Family history.
OA can affect weight-bearing and non-weight-bearing joints and may involve single or multiple joints. Each of these types of OA has its own risk factors and there is currently no validated risk tool for the quantitative prediction of developing OA.”5
“Risk factors include genetics, female sex, past trauma, advancing age, and obesity. The diagnosis is based on a history of joint pain worsened by movement, which can lead to disability in activities of daily living. Plain radiography may help in the diagnosis, but laboratory testing usually does not. Pharmacologic treatment should begin with acetaminophen and step up to nonsteroidal anti-inflammatory drugs. Exercise is a useful adjunct to treatment and has been shown to reduce pain and disability. The supplements glucosamine and chondroitin can be used for moderate to severe knee osteoarthritis when taken in combination. Corticosteroid injections provide inexpensive, short-term (four to eight weeks) relief of osteoarthritic flare-ups of the knee, whereas hyaluronic acid injections are more expensive but can maintain symptom improvement for longer periods. Total joint replacement of the hip, knee, or shoulder is recommended for patients with chronic pain and disability despite maximal medical therapy.
Swimming, elliptical training, and cycling are exercise options for patients with osteoarthritis in weight-bearing joints.”8
(1) National Clinical Guideline Centre. (2014). Osteoarthritis: care and management in adults. Available online at https://www.ncbi.nlm.nih.gov/books/NBK248069/
(2) Weinberger, M., Tierney, W. M., & Booher, P. (1989). Common problems experienced by adults with osteoarthritis. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 2(3), 94-100. https://onlinelibrary.wiley.com/doi/epdf/10.1002/anr.1790020304
(3) Felson, D. T., Naimark, A., Anderson, J., Kazis, L., Castelli, W., & Meenan, R. F. (1987). The prevalence of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 30(8), 914-918. Available online at: https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.1780300811
(4) Zheng, H., & Chen, C. (2015). Body mass index and risk of knee osteoarthritis: systematic review and meta-analysis of prospective studies. BMJ open, 5(12), e007568. Available online at https://bmjopen.bmj.com/content/5/12/e007568?int_source=trendmd&int_medium=trendmd&int_campaign=trendmd
(5) Barr, A., Hawkins, T. (2015). Osteoarthritis: pathophysiology and diagnosis. Available online at https://www.pharmaceutical-journal.com/learning/cpd-article/osteoarthritis-pathophysiology-and-diagnosis/20068288.cpdarticle?firstPass=false
(6) Taylor, N. (2018). Nonsurgical management of osteoarthritis knee pain in the older adult: an update. Rheumatic Disease Clinics, 44(3), 513-524. Available online at https://www.rheumatic.theclinics.com/article/S0889-857X(18)30034-6/fulltext
(7) Belcaro, G., Cesarone, M. R., Errichi, S., Zulli, C., Errichi, B. M., Vinciguerra, G., … & Pellegrini, L. (2008). Treatment of osteoarthritis with Pycnogenol®. The SVOS (San Valentino osteo‐arthrosis study). evaluation of signs, symptoms, physical performance and vascular aspects. Phytotherapy Research: An International Journal Devoted to Pharmacological and Toxicological Evaluation of Natural Product Derivatives, 22(4), 518-523. Available online at https://www.researchgate.net/profile/Stefano_Stuard/publication/5466796_Treatment_of_osteoarthritis_with_PycnogenolR_The_SVOS_San_Valentino_Osteoarthrosis_Study_Evaluation_of_signs_symptoms_physical_performance_and_vascular_aspects/links/59e86648458515c3631000c0/Treatment-of-osteoarthritis-with-PycnogenolR-The-SVOS-San-Valentino-Osteo-arthrosis-Study-Evaluation-of-signs-symptoms-physical-performance-and-vascular-aspects.pdf
(8) Sinusas, K. (2012). Osteoarthritis: diagnosis and treatment. American family physician, 85(1). Available online at https://www.aafp.org/afp/2012/0101/p49.pdf
(9) PMC. Vina, E. R., & Kwoh, C. K. (2018). Epidemiology of osteoarthritis: literature update. Current opinion in rheumatology, 30(2), 160-167. Available online at https://europepmc.org/articles/pmc5832048
(10) Islam, M. J., Yusuf, M. A., Hossain, M. S., & Ahmed, M. (2013). Updated Management of Osteoarthritis: A Review. Journal of Science Foundation, 11(2), 49-55. Available online at https://www.researchgate.net/publication/282547739_Updated_Management_of_Osteoarthritis_A_Review
(11) Clinical efficacy and safety of mesenchymal stem cell transplantation for osteoarthritis treatment: A meta-analysis. Available online at https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0175449