Osteoarthritis (OA) is one of the oldest and most common diseases among humans. When a person has osteoarthritis, the cartilage of the joints wears, which can cause pain and stiffness in the joints. OA is also known by many other names, such as degenerative joint disease, osteoarthritis, osteoarthrosis or hypertrophic arthritis. (Attention: Osteoarthritis is not the same disease as osteoporosis , which weakens the bones due to a loss of bone mass, which can result in rounded shoulders, loss of height and even painful fractures). There are many conditions and ailments that can cause OA: excess weight, injury to a joint; muscular weakness; damage to the nerves that supply the area of the joints; synovial disease and even hereditary factors.
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Osteoarthritis can affect any joint, but it occurs more often in the small joints of the hands and in the joint at the base of the big toe (the "bunion joint"). It also usually affects the hips, knees and spine. Rarely affects the wrists, elbows or ankles, except as a result of injury or excessive exertion.
Researchers have shown that there are several factors that increase the risk of developing OA. These factors include heredity, obesity, joint injuries, repeated excessive use of certain joints, muscle weakness and nerve damage. These factors are analyzed below.
Heritage
In some families, osteoarthritis can result from a hereditary defect in one of the genes responsible for collagen, one of the main protein components of cartilage. This results in defective cartilage that deteriorates faster. It is possible that during the youth such problems do not pose any difficulty, but with the passage of time the joints may wear away. Women who are predisposed to this condition due to hereditary factors, could develop bony nodules in the joints of the fingers.
People born with minor defects that prevent the joints from fitting and moving properly, such as bowed legs or a hip with congenital abnormalities, may be more likely to develop OA. Being born with too flexible joints also increases the tendency to develop osteoarthritis.
Obesity
Studies indicate that obesity increases the risk of OA in the knee. The researchers found that body weight during the middle and late years seems to be the most important factor in the risk of a person developing osteoarthritis of the knee, especially during the period of eight to 12 years before the symptoms appear. . Therefore, avoiding excessive weight gain as the years go by or losing weight may help prevent osteoarthritis of the knee.
Muscular weakness
Studies have shown that individuals with weak quadriceps (upper thigh muscles) may be more likely to develop OA of the knee than those who do not suffer from muscle weakness. Also, OA of the knee is more likely to progress if the quadriceps are weak.
Injury or excessive use (occupational)
Some people develop osteoarthritis in certain joints due to injuries or excessive uses of specific type. A history of significant knee or hip injuries increases the risk of developing OA in those joints. For example, football or football players who injure their knee may have higher risks. Avoiding trauma or joint injuries can help prevent osteoarthritis.
Joints that are used repeatedly in certain tasks may develop osteoarthritis. The tasks that require bending the knees multiple times seem to increase the risk of OA of the knees. There are studies that indicate, for example, that miners or shipyard or port workers have higher OA rates of the knees. Fortunately, there are methods to modify these tasks in order to prevent damage to the joints due to excessive use.
Aging
The frequency of OA increases with age, and is more common in people over 65. OA affects men and women. Up to 50 years old, OA is more common in men. After this age, it is more common in women.
CAN OSTEOARTHRITIS BE PREVENTED?
Doctors believe that some people can reduce their risk of developing OA or delay its onset. Some of the same techniques that are used to treat OA can also be used in their prevention. Controlling weight is very important in helping to prevent OA of the knee, staying physically active, taking care and avoiding certain occupational injuries and adapting the jobs that require loading and flexing the knees also helps prevent OA.
Although the incidence of OA reaches its peak around 45 years, more and more young people are developing the disease. In certain cases, OA results from childhood sports injuries that manifest approximately a decade later. Children with congenital disorders may also present OA prematurely. Research shows that young people who work in the military may also be more prone to the disease.
In general, the affected joint or joints hurt more after using them in excess or after periods of inactivity. You may find it difficult to move the affected joint easily, but it should not become completely stiff.
If you do not move and exercise the affected joint, the muscles around it will weaken and sometimes even shrink. In turn, weak muscles may not be able to fully support the joint. This could cause more pain in the joint. You may also notice negative changes in both coordination and posture.
What happens when you have osteoarthritis?
In normal joints, a firm, elastic substance called cartilage covers the end of each bone. The cartilage provides a smooth and slippery surface that facilitates the movement of the joints and acts as a cushion between the bones. In osteoarthritis, the cartilage between the joints wears out and causes symptoms such as pain and swelling, as well as problems using the joint.
Cartilage wear in osteoarthritis occurs in several stages:
1. The structure of the cartilage begins to change over the years. When this happens, the cartilage loses its elasticity and is more prone to damage due to injury or excessive use. The timing of these changes, as well as the extent of these changes, depends on factors such as inheritance, traumas suffered by the articulation and others.
2. Over time, the synovium (the lining of the joints) becomes inflamed as a result of cartilage wear. The inflammation produces cytosine (inflammatory proteins) and enzymes that could cause greater damage to the cartilage.
3. As the cartilage wears, the underlying bone is exposed and the joint can lose its natural shape. The ends of the bones become denser, forming bony shoots, or spurs.
4. Cysts full of fluid may form in the bone next to the joint. Pieces of bone or cartilage may float loose in the space of the joint, causing further inflammation of the synovium.
In addition to cartilage wear, the fluid found in the joint may play a role in the disease process. Synovial fluid lubricates the joint and is necessary for it to function properly. Joint fluid is mainly made up of a substance called a hyaluronic acid substitute. In osteoarthritis, there may be more hyaluronan than normal, but it may be diluted. It is also possible that there is a change in the quality of the hyaluronan found in the joint fluid, which could diminish its protective function.
Affected joints
OA joints usually hurt more after using them in excess or after periods of inactivity. It is likely that it will be difficult for you to move the affected joint after getting up in the morning, or after using the joint more than usual.
If you do not move and exercise, the muscles around the affected joint will weaken and sometimes even shrink in size. Weak muscles may not be able to fully support the joint. This could cause more pain in the joint . It is also possible to observe negative changes, both in coordination, posture and walking.
Trochanteric bursitis is often confused with arthritis of the hip. Bursitis is inflammation or irritation of the bursa, a small pocket full of fluid that is located between the bone and the muscle. The trochanteric bursa is on the promising bone on the side of the hip. Although you may have hip arthritis and trochanteric bursitis, bursitis is more common.
OA OF THE HIPS
If OA affects your hip, you may feel pain in your groin, inside your thigh, or on the outside of your hip. Some people feel pain reflected in the knee or on the sides of the thigh (that is, they feel pain in an area that has not really been affected). Pain may cause him to limp when walking.
OA OF THE KNEES
You may feel pain moving your knee. You may also feel a "rough" or "grab" feeling in the knee when you move it. Climbing or descending stairs or getting up from a chair can be painful. If pain prevents you from moving or exercising your leg, the large muscles that surround the area will weaken.
OA DE LOS FINGOS DE LA HAND
OA in the joints of the fingers can cause pain, swelling and, over time, the formation of bony shoots (spurs) in these joints. If the spurs are formed in the joints of the end of the fingers, they are called Heberden nodules. If they appear in the joints of the center of the fingers, they are called Bouchard's nodules. You may notice redness, swelling, tenderness, and pain in the affected joint, especially during the initial stage of OA when these nodules are forming. These nodules can cause pain in the joints of the fingers and make them look thicker. Activities that require fine movements of your fingers, such as pinching, can be difficult.
OA OF THE FEET
If OA affects your feet, you may feel pain and tenderness in the large joint at the base of the big toe. Wearing tight shoes or high heels can make the pain worse.
OA OF THE SPINAL COLUMN
Chronic disc dislocation of the spine and the bony outbreak that this entails can cause stiffness and pain in the neck and lower back. In addition, it could exert additional pressure on the nerves of the spine. This is commonly known as contracture. You may feel pain in your neck, shoulder, arm, lower back, or even your legs . When OA affects the nerves of the spine, it may manifest as weakness or numbness in the arms or legs.
Differences between osteoarthritis and rheumatoid arthritis
Some confuse osteoarthritis with rheumatoid arthritis . As you will see below, these are very different diseases. Some people may have osteoarthritis and rheumatoid arthritis at the same time.
It is also possible that some confuse osteoarthritis with osteoporosis. Both diseases focus on problems with the bones (literally, osteo means bone), but they are not the same. Osteoporosis causes bones to lose mass and become brittle, which can lead to painful fractures.
Osteoarthritis
• Usually begins after 40 years.
• It affects approximately 27 million adults in this country.
• It usually develops slowly over many years.
• It affects some joints and can occur on both sides of the body.
• Redness, warmth and swelling are usually minimal. Morning stiffness is frequent and may be severe, but brief (less than 30 minutes).
• Normally affects only certain joints, such as those of the hands, hips, knees and spine. Rarely affects the wrists, elbows or ankles, except as a result of an injury.
• Does not cause a generalized feeling of illness.
Rheumatoid arthritis
• Usually begins between 30 and 60 years.
• It affects approximately 1.5 million adults in this country.
• It can develop suddenly, in weeks or months.
• It usually affects many joints, but it often starts in the small joints on both sides of the body.
• Causes redness, heat, swelling and morning stiffness in the joints (which often lasts for hours).
• Affects many joints, such as wrists, elbows, shoulders, hips, knees and ankles.
• It usually causes a general feeling of illness and fatigue, as well as weight loss.
Your doctor usually diagnoses osteoarthritis based on your medical history and a physical examination. However, your doctor may also recommend additional procedures, such as x-rays , that will help confirm the diagnosis, eliminate other causes of pain, and determine the extent of damage to the joints. Joint aspiration, a procedure through which the fluid is removed from the affected joints for examination, could also be used to rule out other diseases.
A good treatment program can help reduce joint pain and stiffness, improve joint movement, and increase your ability to carry out daily activities. A plan will be designed exclusively for you, which should include a combination of physical and / or occupational therapy , gentle aerobic exercise , weight management , patient education and medication. If these measures do not produce results, consideration could be given to the surgical intervention .
Your treatment program will depend on the severity of your illness, the affected joints, the type of symptoms and other medical problems. Your age, occupation and daily activities will also be taken into account. You will work in collaboration with your doctor and other health professionals, such as physical and occupational therapists, in order to ensure that the program meets your needs.
The role of physical activity
One of the best things you can do for your OA is to simply move. It may seem contradictory, especially when your body hurts, but moving is truly the best medicine for pain. Unlike other diseases, exercise is considered part of the treatment for OA, perhaps the most effective part of the treatment, and not just a way to deal with the disease. The American College of Rheumatology recommends exercise, particularly aquatic exercise , in its guidelines for treating OA of the knee and hip.
In fact, research shows that exercise can really affect the course of OA. After reviewing several studies of knee OA was found associated with a greater amount of cartilage in the knee and fewer cartilage defects. Another study found an increase in anti-inflammatory activity in the knee joint in women with knee OA immediately after performing intense strengthening exercises of the thighs.
Of course, you should talk to your doctor before starting an exercise program. This will give you recommendations on what is best for you and design an easy-to-follow plan for you. You should try to do three types of physical activity regularly:
Stretching
Slow, gentle stretching can help prevent joint stiffness and make it easier to start moving in the morning. Yoga and tai chi may be helpful for individuals with arthritis. These types of exercises can improve flexibility, increase muscle strength and help you relax. Talk to your doctor before beginning an exercise program.
If you do not think you are ready for a stretching class, such as yoga or tai chi, your doctor or physiotherapist can teach you some gentle stretches to do at home.
Aerobic activity
Performing physical activities on a regular basis is extremely important if you want to be successful in controlling OA. Doing exercises provides many benefits, such as decreasing pain. Aquatic aerobic exercises, walking and stationary bicycle exercises cause less stress on the joints and are good for your general physical condition.
Exercises that strengthen the muscles surrounding the affected joints are also important. Ask the members of your medical team to help you design a program that suits your specific needs.
Strengthening exercises
Also important are exercises that strengthen and / or increase the resistance of the muscles that surround the affected joints. When the muscles surrounding an articulation weaken, the joint loses its ability to function properly. Ask the members of your medical team to help you design a personalized program.
Flexibility and balance exercises
To help prevent falls, try to do soft elasticity or flexibility exercises daily. When you perform muscle strengthening exercises, you must add some stretches; Always stretch the muscles when they are hot to minimize injuries. Finally, add exercises to improve balance, thus reducing your risk of falls. Tai chi or yoga are good options, walking back or standing on one foot serve to practice balance.
NUTRITION AND WEIGHT CONTROL
Staying at your recommended weight or losing weight if it is excessive brings many benefits, such as living a longer life and helping to prevent OA of the knees. This will reduce pain by reducing stress on the joints that carry the weight (hips, knees, back and feet). It will also help you look and feel better.
The rule for weight loss is to eat fewer calories and increase physical activity. Research has shown that for every extra pound, an additional 4 pounds of pressure is exerted on your knee. Losing just a few pounds, if you are overweight, can have a positive impact.
There is also no diet for OA, but in general you must follow a balanced diet, based on foods of plant origin, as indicated by the FDA (Food and Drug Administration). About two-thirds of your diet should consist of fruits and vegetables, in addition to whole grains and the rest include lean protein.
Assistive devices
Assistive devices often help those who have pain or whose instability limits their physical activity and are not eligible to undergo an operation, or wish to postpone it. These assistive devices can help reduce pain and improve your ability to move.
Assistive devices often help those who have pain or whose instability limits their physical activity and are not eligible to undergo an operation, or wish to postpone it. These assistive devices can help reduce pain and improve your ability to move.
Supports, splints, splints and braces are examples of artifacts that provide external support to help stabilize the joints, give them better support, correct their alignment or prevent the joint from deforming further. Some, such as elastic or neoprene kneepads, can be purchased without prescription from pharmacies and medical supply stores. Your doctor can recommend other assistive devices, such as knee braces, splints, and orthopedic shoes that are made to order by a physical, occupational, or orthopedic therapist. They can be made of many types of plastic, metal, leather or moldable foam.
Canes and walkers are assistive devices designed to help you support your joints and / or allow the joint to rest while performing your daily tasks. They work by allowing you to eliminate some of the weight of the affected joint, or unload the joint, while walking, stopping or completing functional activities that require you to stand or walk. Check with your medical team before using them to ensure their proper use and that they fit properly.
The patellar tape, applied correctly by the physiotherapist, has been shown to decrease pain and stabilize the knee in those with patellofemoral OA.
Remember to avoid using assistive devices for extended periods, unless instructed by your doctor or therapist. This can weaken the joints that are inactive. Stop using them for some time and always use them according to the indications.
Physical and occupational therapy
You may find that OA limits certain activities , such as walking, bathing, dressing, climbing stairs, and doing housework. Physical and occupational therapists can help you improve your ability to perform such daily activities by:
• improve the range of motion of the joints, their strength and muscle strength;
• provide assistive devices such as canes, crutches, walkers, orthotics or insoles for shoes;
• teach you how to use heat and cold therapy correctly; Y
• teach the principles of proper use of joints and energy conservation.
The benefits of physical and occupational therapy include: less pain, easier to perform daily activities and less stress on the joints.
Medicines
Controlling pain is the most complex part of managing OA. Pain creates a vicious cycle of inactivity, which leads to more pain, and therefore to greater inactivity. The unpredictable nature of the pain and fatigue that accompanies it, along with the impact on your ability to perform daily tasks, can lead to depression. However, studies show that most people control their OA symptoms through physical activity, physical or occupational therapy or any of the aforementioned techniques.
However, your doctor may recommend medications that help relieve pain. These can decrease the pain enough to start an exercise program. Some medications are taken daily, others are not. Your doctor will decide what is the best medication and dosage for you.
Here we talk about the most common OA medications. There is a range of other medications that are being researched for possible future use.
ANALGESICOS NARCOTICS AND NARCOTICS
Analgesics are medicines that relieve pain. Acetaminophen ( Tylenol ) is a non-narcotic analgesic that is often used to relieve pain. It does not reduce the inflammation or swelling that sometimes accompany OA, but it is useful when the main problem is pain and is less harmful than NSAIDs (non-steroidal anti-inflammatory drugs) for most people (see the next section). Although the number of potential side effects due to acetaminophen is small, there is a risk of damage or liver failure when high doses are taken. Do not take more than 4,000 milligrams in total per day. Carefully read the labels of all the medicines you consume, since acetaminophen is an ingredient that is added to many over-the-counter or prescription medications. This causes some people to take daily doses greater than necessary. Do not drink alcohol when you are under the medication.
Tramadol (Ultram ) is a narcotic- type drug that is prescribed by prescription that can provide greater pain relief than acetaminophen. Narcotic analgesics are occasionally used for moderate or severe pain. They can result in drug dependence and tolerance if they are used for a long time, which means that each time the dose must be increased to obtain relief. Narcotic analgesics include codeine and oxicodein. The adverse effects of narcotic analgesics are dizziness, nausea and constipation. Individuals with problems of addiction to certain drugs or alcohol should not consume them.
Always inform your doctor about the possible side effects of any medication, whether over-the-counter or by prescription you are taking.
NSAIDs
Nonsteroidal anti-inflammatory drugs (NSAIDs) help reduce pain, stiffness and swelling of the joints. In addition to aspirin, ibuprofen ( Advil ), naproxen ( Aleve ) and ketoprofen, whose sale is not restricted, there are many types of NSAIDs available with a prescription to treat OA.
The ingestion of NSAIDs could also lead to more serious problems, such as ulcers or gastrointestinal bleeding. If you experience any of these side effects, your doctor may prescribe another type of medication that does not cause these effects. Your doctor may recommend taking medications with food to avoid symptoms related to stomach problems.
Almost all NSAIDs generally have similar anti-inflammatory and analgesic effects. You should not take aspirin (except the baby dose) while you are under NSAIDs or mix different NSAIDs, unless advised by your doctor.
The COX-2 inhibitor celecoxib ( Celebrex ), is a subcategory of NSAIDs, which has been shown to be less harmful to the stomach. However, it carries a risk of heart attack and stroke in doses higher than 200 mg per day. All NSAIDs, including COX-2 inhibitors, have the risk of causing a fall in kidney function.
It is essential to talk with your doctor about the potential benefits and risks of the medication, and work with your doctor while you are taking it to monitor how it works. Notify your doctor of any negative interaction you have while under this drug regimen.
INJECTABLE STEROIDS
The steroids most commonly used in the treatment of OA are corticosteroids . They are related to cortisone, a natural hormone of the body. They can be injected into the joint after joint aspiration in order to relieve the pain and swelling that are associated with OA. Corticosteroid injections in the same joints are generally limited to three or less per year, because repeated injections in weight bearing joints, such as the hips or knees, can result in cartilage damage.
TOPICAL ANALGESICS
Topical pain relievers come in the form of creams, gels, patches, ointments or sprays that are applied to the skin covering a painful joint. They contain combinations of salicylates, skin irritants and local anesthetics to relieve pain. Salicylates, such as methylsalicylate, work by stimulating blood flow. Irritants stimulate the nerve endings of the skin to produce a sensation of cold or heat, which distract attention from the pain itself.
Topical pain relievers containing capsaicin work by reducing the amount of substance P, which sends pain signals to the brain. You should not use topical analgesics with heat therapies. Using them at the same time can cause burns and serious damage.
Nutritional supplements
Some nutritional supplements , such as glucosamine and chondroitin sulfate , are used in the treatment of osteoarthritis. Both are natural substances found in cartilage. Some researchers believe that these substances could help repair and maintain cartilage. Some studies have shown that these supplements provide the same pain relief as NSAIDs in certain cases of OA pain; others have mixed results. Although in the country supplements are not recognized as treatment, British doctors use them as a second option in the treatment of knee OA. Tell your doctor if you are taking any supplements.
Therapy with hyaluronic acid
Hyaluronic acid therapy involves injecting the knee joint with hyaluronate, a substance found naturally in the joint fluid that helps lubricate and cushion it. In people suffering from OA of the knee, inflammation causes the hyaluronan to wear out.
Sodium hyaluronan ( Hyalgan, Supartz ) and hlan GF 20 ( Synvisc ) are two types of therapy with hyaluronic acid approved by the FDA for the treatment of OA of the knee. Hyaluronan injections are applied directly to the knee joint once a week for a period of three to five weeks, depending on the product used. Side effects may include pain at the injection site. Tell your doctor if you have any allergies to food, dyes, preservatives or animals before you get the injection. There is no convincing evidence yet of whether this therapy changes the natural course of OA or represents a benefit in terms of pain.
Surgery
The majority of those who have OA will never need to undergo an operation. However, surgery could be useful if there are large joint damage, persistent pain in the joints and disability due to limited joint movement.
Arthroscopy allows direct examination of the interior of the joint to determine the extent to which the cartilage is damaged. In addition, arthroscopy can also be used to remove pieces of damaged cartilage in the early stages of arthritis or to smooth the surface of the cartilage. These procedures can help decrease pain and improve the functions of those with OA of the knee.
Cartilage transplants have been performed in people with localized defects in the cartilage, usually caused by an injury. These have not been approved for use in OA, where wear and loss of cartilage is much more extensive.
The osteotomy corrects the deformity of the bones when cutting and replacing the bone in a better position. The osteotomy of the tibia (shin) is done in order to change the position of the leg that carries more weight so that the weight falls on the healthy cartilage and knee pain is reduced. This intervention has become much less common since the emergence of joint replacement surgery.
Total joint arthroplasty involves resurfacing the surface of the joint that has been destroyed by arthritis. Surgeons can replace or repair damaged joints with artificial joints of metal, plastic or ceramic.
Total joint replacement has been done extensively for many years, and the results are excellent, especially on the hips and knees. Other joints, such as shoulders, elbows and knuckles can also be replaced. With new materials, better surgical methods and a broader understanding of the replacement joint , this type of operation has caused many people who were seriously disabled to become active again. However, implants do not last forever. Talk with your doctor about the best time to consider this option.
Non-pharmacological treatments
In addition to staying active and losing weight , you can fight the pain of arthritis with some proven remedies, such as the following:
Treatments of heat and cold . In general they are applied directly on the painful part, heat can be more useful for chronic pain and cold for acute pain. You can use bags of frozen chopped vegetables, which mold very well to the body or fomentations of hot water.
Relaxation techniques. Train the muscles to relax and decelerate the thoughts with deep breathing techniques, guided images and visualization , among others.
Massages Research shows that massage can help relieve arthritis pain, improve joint function and reduce stress and anxiety.
Acupuncture. Acupuncture is the practice of inserting fine needles into the body on special points called "meridians" to relieve pain.
Positive attitude. Several studies have shown that a positive disposition can strengthen the immune system and increase the ability to manage pain.
Some 27 million people in the United States have osteoarthritis. The tendency to develop osteoarthritis increases with age and affects both men and women. Up to 45 years old, OA is more common among men; after that age, it becomes more common among women.
Although OA affects millions of people, only a small percentage of them have obvious symptoms because of it. Osteoarthritis is a serious condition but it can be controlled; Most people improve thanks to the treatment. It is important to get the correct diagnosis and work with your doctor in order to design an appropriate treatment plan.
INCIDENCE
One in four adults will develop symptoms of hip OA upon reaching age 85.
One in two adults will present manifestations of knee OA during their life.
One in every 12 adults aged 60 or older has OA by the hand.
More than 80% of people over 55 will show signs of OA on x-rays.
