Osteoarthritis is a disorder of the joints characterized by degeneration of the articulation complex – cartilage, subchondral bone and synovium – causing, most notably, pain and stiffness.
It mainly affects weight-bearing joints such as the knee, hip and hands. The cartilaginous breakdown leads to narrowing of joint space and contact between the two ends of the bones composing one joint, causing mechanical stress and the associated palette of symptoms.
Classification is made according to the underlying cause and divided into:
- Primary/idiopathic OA – when there is no identifiable cause
- Secondary OA – known disorders e.g. hemochromatosis, congenital disorders of joints, diabetes.
The resulting pathology does not differ between these two types.
Worldwide, there is a large and increasing impact of osteoarthritis and over 500 million people are affected by this condition.[5]
The most common risk factors involved in the pathogenesis of OA include age > 55, female sex, obesity, joint overload due to trauma or chronic repeated activity.
There is strong correlation to genetic factors, as seen in up to 60% of all OA cases. The polygenic inheritance implies that multiple genes are involved and severity of the disease is dependent on the interactions of the different genetic factors.
The symptomatology of this condition is broad. Pain is the most prominent symptom during or after exertion and it is relieved by rest. Joint stiffness and restricted range of motion are common, especially in the morning lasting less than 30 minutes, or after resting. A crackling noise called “crepitus” may be heard upon movement of the arthritic joint. Although any joint can be affected, they are usually asymmetrically involved, which is an important sign for the differentiation of other arthritic disorders.
These symptoms are greatly aggravated by activity or vigorous exercise, although rest is a relieving action, the disease may eventually progress to the point where the pain is so intense that it wakes one up during the night.
Its diagnosis is predominantly based on the patient's history, typical clinical features and it is supported by radiological evidence of joint degeneration. The radiographic signs show irregular joint space narrowing and a reduction of the cartilaginous zone in the articulation. Osteophytes, which are bone spurs, are very common to be present in these arthritic areas.
Further testing such as performing an arthroscopy or arthrocentesis is typically unnecessary.
Currently, there is no cure for OA and once diagnosed it will likely worsen over time. The treatment of this disorder is symptomatic and consists of minimizing pain using nonsteroidal anti-inflammatory drugs (NSAIDs) and possibly intra-articular glucocorticoid injections, lifestyle changes such as exercising, diet and keeping the patient active. Surgical management might be indicated if conservative measures fail, e.g. complete or partial joint replacement with an endoprosthesis.
The best way to prevent OA is by maintaining healthy habits such as regular exercising, being active every day, controlling blood sugar levels and preventing any joint injury. In addition, it is recommended to limit the work done by the affected joints.
The condition has no cure for the moment and therefore cannot be reversed. The prognosis will vary upon the comorbidities of each patient and the goal is to slow the progression of the disease by controlling both symptoms and comorbidities. Simple lifestyle changes will improve the prognosis.
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