Six months earlier, my dad started complaining of knee pain every night when he went to bed. He would wake up alright every morning with no signs of any disability or pain, go to office, do a little bit of exercise and perform his real life role of a great father to perfection. But, it’s the bed time he feared the most. Every night he would ask me or my mom to give him a little massage so that he can go to sleep easily. He also ignored to give the doctor a visit. But, I realized that something was wrong and took him to an orthopedic surgeon. He asked us to go for an X-ray imaging of the knees and it was diagnosed as Osteoarthritis.
Incidence of osteoarthritis has been on the rise. The disease primarily affects persons over the age of 60 years but it can also occur a decade early as in the case of my dad. It mainly affects the joints of knees, hips, hand and the cervical and lumbar spine. The main problem with this condition is the high rate of disability associated with it.
Osteoarthritis (OA) is a degenerative process affects the different joints of our body and the primary pathology associated with it is the loss of articular cartilages. A joint has many components- joint capsule, ligaments, muscles, tendons, synovium, synovial fluid, sensory nerves carrying impulses from the joints, articular hyaline cartilage and underlying bone. These components of the joint act as a unit to maintain the integrity of the joint and function as protectors of the joint from damage. For example, cartilages at the ends of bones forming the joint act as cushion during movement at the joint and the synovial fluid secreted from the synovium acts as a lubricant allowing frictionless movement. Any malfunction in the protective mechanisms sets in a complex interplay of molecular action at the joint leading to inflammation and damage to the joint resulting in OA.
Associated risk factors-
- Age- With increasing age the capacity of the joint to repair any damage sustained is reduced and the joint is at increased risk of developing OA.
- Women are at higher risk.
- Genetic influence- If any of the parent is having the disease then the children are at increased risk of developing the disease in future.
- Previous history of ligament tear, major injury to the joint or fractures involving the joint.
- Any deformities of hands or legs.
- Weakness of muscles around the joint due to any muscular or nervous disease.
- Obesity is a major risk for the disease to develop.
- Continuous use of the joint in occupation like women who do sewing for long hours develop OA of hand joints.
Many people with OA on X-ray studies do not have symptoms of the disease.
Joint pain is the chief complaint of almost all patients of OA. The joint pain in OA is related to the amount of activity and occurs when the joint is in use or shortly after it. As the disease progresses the pain becomes continuous and becomes more severe at night time after going to bed. In the knee, buckling, catching or locking can occur and it signifies meniscal tears might have occurred. Also some may complain of long-term knee pain before being diagnosed as OA.
Avoidance of activities that precipitate or increase pain is most important. Weight loss is very helpful as it reduces load on the knee and hip joint. Reducing movements in the affected joints by splinting or bracing is another method.
People living with OA are very reluctant to exercise as they fear putting their joints to use for the fear of precipitating pain. But, exercises that strengthen the muscles around the joint are necessary as it will limit disability. The principal obstacle in this mode of treatment is the compliance or adherence of the patient. The person needs great motivation to continue exercising on the long term. One should consult a physiotherapist for the purpose of individualization of the exercise regimen.
Any deformities or misalignment in bones and joints should be corrected for equal distribution of load on the joint by use of braces.
- Non Steroidal Anti-inflammatory Drugs (NSAIDs) are choice of drugs for relief of pain. Drugs like acetaminophen and ibuprofen can be used as and when required and should always be taken after food. Major side effects of these drugs are gastrointestinal symptoms and these should always be borne in mind when taken on a regular basis.
- Selective COX-2 inhibitors like celecoxib and rofecoxib can also be used in place of NSAIDs.
- In severe cases, intra-articular injections of glucocorticoids are helpful.
- Diacerein has been a new breakthrough and has been found to be much effective in the treatment of OA. It reduces the levels of Interleukin-1, a mediator in the inflammation and damage. Side effects like diarrhea are common.
It is an option for those who fail to improve with medical therapy and in those living with disability.
1. Most commonly performed surgery in these patients is arthroscopic debridement and lavage, but this surgery has got no benefit in long term. But, it is helpful in those having symptoms of buckling, catching or locking.
2. Those having misalignment can be helped with realignment surgery.
3. In advanced disease with disability, the last but the most effective option is total knee or hip arthroplasty.
4. Cartilage replacement surgery has not shown much promise and is not effective too.
If you have ever noticed any elderly member of your family complaining of pain in the knees, hips, spine or joints of hand, please don’t ignore it and make sure they visit the doctor the very next moment so they can get the problem diagnosed early before significant disability occurs and receive proper treatment.
Also published by me at Helium and Associated Content by me under pen name of Dev Senapati.