Osteoarthritis

Osteoarthritis, also known as osteoarthritis, is a chronic disorder of the joints, especially those in constant movement, and is characterized by wear and tear and destruction of the articular cartilage, which triggers pain in the affected joint.

Osteoarthritis affects men and women equally, is the most frequent disorder in primary care and represents the main cause of morbidity and disability. It commonly occurs in people over 65 years of age and is very rare to appear before the age of 40 years, unlike rheumatic diseases that can manifest themselves at any time of life.

Causes

Osteoarthritis damages joint components such as cartilage, subchondral bone, synovial membrane, ligaments, capsule and periarticular muscles. Thus, there is gradual loss of cartilage together with thickening of the subchondral bone and production of new bone at the joint margin(osteophytes or spurs).

Risk Factors

Risk factors include:
-Familial inheritance.
-Overweight and obesity.
-Previous joint injury.
-Intense physical exercise that increases stress on the joints such as: kneeling, heavy lifting, climbing stairs, walking or running for prolonged periods of time.

Symptoms

The discomforts of osteoarthritis include pain, stiffness, increased joint volume, deformity, crunching and varying degrees of functional disability.

Pain. This is the primary symptom, appearing insidiously and progressively over months or years, with mild to moderate intensity, occurring when the joint involved is used and decreasing or subsiding with rest. Over time, the pain may become constant, even at rest and at night, indicating the progression of the disease or the aggregation of acute inflammatory process.

Joint stiffness. Joint stiffness is very common in osteoarthritis and is linked to synovial inflammation, usually appears in the morning and always lasts a short time (15-30 minutes).

Increased joint volume. It is usually more evident in the distal interphalangeal joints of the hands, it is produced by the thickening of the joint capsule and other periarticular structures.

Deformities. The joint deformities that are most frequent in osteoarthritis are genu varum (bowlegged), genu valgus (knees together and ankles apart or X-legs), hallux valgus (bunions), hyperlordosis, kyphosis, kyphoscoliosis, as well as bony nodules in the interphalangeal joints.

Crepitus or crackling. It is the noise that originates when performing a passive movement of the articular structure; it is caused by irregularities of the cartilage surface and is most frequently observed in osteoarthritis of the knees (gonarthrosis).

The knee is the most affected joint structure, followed by the interphalangeal joints, the hips and the spine. In the female sex, this disorder predominates in the knee and in the interphalangeal joints of the hands. In men, it is more frequent in the hip.

Osteoarthritis can appear in one, two or several joints at the same time, although the severity is not the same in all of them. Some 70-90% of people over 75 years of age have osteoarthritis in at least one joint; however, more than 50% of those affected have no discomfort.

Diagnosis

The diagnosis of osteoarthritis is mainly clinical, determined by questioning and physical examination by the physician. On examination, the patient is found to be in good general condition and has no symptoms of systemic involvement. The most frequent findings are local pain, increased joint volume, crunching and limitation of mobility due to the presence of pain.

Radiographs can serve as a guide, but as indicated above, clinical examination is the definitive parameter for making the diagnosis. The most useful radiographic findings are represented by the asymmetric decrease of the articular space, sclerosis of the subchondral bone, presence of osteophytes and in more advanced cases articular collapse. There are no laboratory studies that help in the diagnosis of this condition.

Treatment

It is mainly symptomatic; the most important goal of treatment is to relieve pain and prevent the evolution of functional disability of the affected joints. Osteoarthritis therapeutics include general measures, drugs and surgical procedures.

Prevention Measures

In this joint disorder, prevention is feasible through lifestyle changes, including body weight control, non-weight-bearing exercise such as swimming, running or jogging on smooth surfaces.

Medications

Nonsteroidal anti-inflammatory drugs (NSAID) are the first-line drugs; among the most commonly used are: meloxicam, ibuprofen and diclofenac. It is advisable to associate NSAID with a stomach mucosal protector, for example, omeprazole.

In patients who cannot ingest NSAID for any reason, weak opioids such as tramadol can be used alone or associated with paracetamol. In cases of knee steoarthritis with increased pain, glucocorticoid infiltration can be performed every three months; it is recommended that this procedure be performed by the specialist (traumatologist).

Surgery

Surgical treatment should be implemented when osteoarthritis has severely compromised the joints. The most commonly used surgical techniques are arthroplasty and arthroscopy.

William Bonifaz, M.D.

References

 

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