Osteoarthritis Symptoms, Risk Factors, Specific Joint Involvment And Treatment
Osteoarthritis is a disease that affects articular cartilages of synovial joints (mobile), accompanied by increased bone activity under the cartilage, having as consequence the formation of new bone and cartilage with joint deformity and functional limitation.
- Older age
- Female sex
- Genetic factors (heredity)
- Major joint trauma (fractures, dislocations)
- Repetitive stress (occupational)
- Overweight and obesity (especially for hip arthritis and osteoarthritis)
- Congenital anomalies (congenital dislocation of the hip)
- Previous inflammatory arthropathy
- Metabolic or endocrine disorders
Initial stages of the arthrosic process are clinically asymptomatic, in contrast to many physical and radiological changes. Pain is a symptom that suggests the diagnosis of osteoarthritis, affecting one joint initially then several joints. Pain is described as deep, accompanied by stiffness, and follows periods of inactivity (wake up in the morning, raising from a chair). Pain may radiate to the surrounding areas, intensify during use of these joints. In early stages of the disease, pain is relieved by rest. Once the disease progresses, pain becomes persistent, affecting normal activity and preventing sleep, sometimes even during treatment.
The most common joints affected by osteoarthritis are the big toe joint, wrist joints, hips, knees, cervical and lumbar spine.
On physical examination the patient presents deformed joints that are usually sensitive to palpation, crepitus, and mobility limitation. Joint instability occurs only in severe forms. Increased joint volume is caused by increases in bone surfaces, and sometimes the accumulation of fluid in the joint space. Patients with advanced disease often experience large deformations, sometimes accompanied by subluxation.
Specific joint involvement
Hand. Heberden nodules are present as bony growths that develop slowly in the distal interphalangeal joints. Sometimes the onset is acute with pain and redness of the affected joint. Heberden nodules can cause deformities of the joint with lateral deviation or in flexion. Another form, erosive osteoarthritis manifests with similar painful episodes but differs radiologically highlighting local erosive changes, and a tendency to bone ankylosis. Another joint affected by the hand osteoarthritis is the thumb joint, with pain at movement. A square shape of the thumb base can be present also.
Knee. Idiopathic gonarthrosis is one of the most common causes of joint pain and is directly related to the individual weight. It is more common in women than men. The most commonly affected compartment is the femurotibial with varus deformation.
In idiopathic gonarthrosis, physical examination reveals pain on pressure, crepitus, and reduced joint mobility. Accumulation of fluid is common, but in low quantity. The radiological exam highlights osteophytes.
Hip. Most cases of primitive coxarthrosis are caused by mild dysplasia of the femoral head and / or of the acetabulum, wtih incongruity of the articular surface . With time, by using the joint, progressive degeneration of cartilage occurs. Pain is localized in the inguinal arch, very rare in the anterior thigh area and knee (irradiated pain). The early sign of hip arthritis is reduced internal rotation. Once the disease progresses, mobility is reduced, with significant functional limitation.
Leg. The big toe joint is often affected, associated swelling and deformity. Much more common in women, was attributed to mechanical stress due to high heeled shoes. In extreme cases the joint space may be canceled, a process known as "hallux rigidus" which requires surgical correction.
Spine (spondylosis). Spine osteoarthritis refers to synovial joints that can determine localized pain and irritation of adjacent nerves. Nerve root compression, due to joint subluxation or a herniated inter-vertebral disc can cause muscle asthenia, reduced reflexes, paresthesia. Spondilosis can be located at any level of the spine.
The objectives of treatment in osteoarthritis are pain and inflammation reduction, mobility increase in affected joints, physical disability prevention
Removal of favoring factors: weight loss, changing jobs, if the patient has a job that affects certain joints, joint measures to protect the injury (same side cane, special shoes).
Adequate physical activity: good for improving joint mobility and prevent muscle atrophy and osteoporosis.
Acetaminophen (paracetamol). Reduces arthritic pain in patients. Acetaminophen – (3g/ day), first intention medication. Recent studies have shown that efficiency of Acetominophen is equal to that of NSAIDs but with fewer severe side effects .
NSAIDs. When inflammation is present or when symptoms are not sufficiently controlled with simple analgesic medication, small doses of NSAIDs are effective, especially COX2 inhibitors (colecoxib 200 mg / day, etoricoxib 120 mg / day).
Intra-articular administration of cortisone preparations keeps under control joint symptoms, especially when inflammatory reactions are present. It must not be repeated more than three times per year due to the potential of chemical erosion of the cartilage by of the steroids.
Chondroprotective agents are theoretically and experimentally, the ideal medication for arthritis, able to prevent joint damage and restore cartilage structure . The most used chondroprotective agents: Atroflex, Dona, Flexodon A, ArthroStop, polysulphate glycosaminoglycans, Piscledine 300.
Balneophysiotherapy: warm baths, hydrotherapy, paraffin packing, diathermy, ultrasound with significant palliative effects.
Surgery. The ideal time for the surgical procedure must be chosen carefully because it can compromise the outcome if delayed (the appearance of irreversible changes like muscle atrophy, paralysis, osteoporosis).
- Debridement, tissue replacement with autologous cartilage grafts
- Resection of large bone spurs
- Prosthetic joints