What is Osteoarthritis?
This occurs in all joints to a greater or lesser extent, and is part of the general degeneration of the body that occurs with advancing years. It commences commonly in the third decade, and is be expected. However, it is when the condition is in excess of the degree of degeneration that would normally expected that it comes into clinical prominence. It is wrapped up with the intrinsic strength of the cartilage of the joint itself, and the way in which it withstands the various biochemical attacks wear and tear, that are made on it.
Some people have an inherited predisposition to the complaint and this is termed “primary ostcoarthrosis.” usually affects many joints, typically the small joints of the fingers. Much more common is “secondary osteoarthrosis,” which follows on from some former injury in life. An accident or injury is a common cause; particularly the fracture has involved the joint. Obesity, through constant excessive trauma to the joints (such as the knees) from excessive weight, can predispose persons to it. Certain congenital disorders can later usher the complaint, as well as endocrine disorders. Or, as one authority succinctly summarises it, “Any factor that cause excessive joint trauma [damage] may lead to secondary osteoarthrosis.” The cartilage lining of the joint tends to soften, fragment and ulcerate as the damage progresses. In an effort to overcome this, nature manufactures new bone around the joint margins. This may have the effect of weakening the mechanics of the joint, increasing the rate of damage and produce greater inefficiency. This may take in any of the affected joints, whether they be in the vertebral column, hands or feet.
This inherited familial disorder that occurs more frequently in women. The ends of the fingers are usually affected and more bony swelling is observed s new bone formation takes place. Cysts filled with thick jellylike may develop. Acute pain may occur when this is taking place, but eventually ceases, and apart from some thickening of the bones of the fingers, there may not be a great deal of discomfort. In some cases there is often considerable deformity, but motion is often not greatly affected.
This may produce local stiffness and discomfort, but if nerve roots are pressed on, neurological symptoms may also be produced. Pain, and altered sensation (tingling, numbness, burning etc) may occur in the areas supplied by the involved nerves.
In the neck (cervical) region, the shoulders and upper limbs may be affected with these altered sensations. In the lower part (lumbar), the roots of the sciatic nerve may be involved and produce sciatic symptoms. Backache is common. If there is a disorder or collapse of the disc located between the vertebrae, then this may aggravate the situation, and accentuate the nerve root pressures.
This is the most common form, and is secondary to some form of joint injury. It may involve one or more joints, and this will be dependent on the basic cause. If joints have been injured through fractures, accidents, or past attacks of rheumatoid arthritis (which may have settled down), then these joints will be susceptible to osteoarthrosis and symptoms of the disease.
Weight-bearing tends to produce pain in affected joints, and this may limit walking, disturb sleep and cause irritation during the day. There may be a reduced range of movement of the affected joints, and this may be very important with large joints such as the hip. Morning stiffness, so typical of rheumatoid arthritis, is usually absent, and blood changes are minimum. X-rays show a loss of the normal cartilage and new bone growth. The rheumatoid factor is absent. All these checks help the doctor in arriving at a diagnosis.
In the overall pattern, treatment is symptomatic. It is essential that the patient understand the basic nature of the disorder, its relation to past incidents and also its relation to age and occupation, past and present. This will help in a sensible attitude, which is essential. The usual types of drugs in the analgesia-anti-inflammatory range as are given for rheumatoid arthritis are frequently tried, and can often reduce pain arid improve the lot of the patient.
In severe cases, particularly if there is considerable pain present, resting the joint in splints may assist. Lumbar corsets that give support are often used. Reduction of weight in the obese helps, although not as much as one would like to think.
Using a walking-stick on the opposite side can bring excellent relief to a hip, and is claimed by some to be the greatest single factor in alleviating discomfort. Surgery has its place, and indeed, a considerable number of very worthwhile operations are now available that can entirely change the picture for patients severely affected. The hip, knee and other joints may be totally replaced with artificial devices, and the relief this gives (particularly in the hip) may be extremely gratifying. Other orthopaedic operations are available, and each has its place. It is essential for the patient to be fully assessed in each case before a decision to operate is made. This is carried out by the orthopaedic surgeon.
A hip replacement in which the head of the thigh bone is replaced by an artificial one, restoring mobility to the patient are popular and the frequency of these operations is advancing each year, and it seems only a matter time before some appliance is available for practically every joint of the body. The outlook generally is often favourable. Weight-bearing joints tend to fare the worst, particularly the hip. Strangely the knee often escapes from excessive disability, which is remarkable, for it is a constant weight-bearer. Generally speaking, it seems that practically every joint is now amenable to some form beneficial therapy.