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Arthritis used to be a disease of the elderly, now it affects younger and younger patients. Osteoarthritis is primarily pain and limitation of joint mobility. The problem starts with damage to the cartilage, and it can end up being disability. What are the causes and symptoms of osteoarthritis? How is the treatment going?

Osteoarthritisor the populararthrosis(Latinarthrosis deformans, morbus degenerativus articulorum, osteoarthrosis, osteoarthritisa in Polishosteoarthritis ) is a chronic and irreversible disease. There is no single definition of osteoarthritis, but experts agree that the cause of the ailment is the imbalance between damage and reconstruction within the articular cartilage. The factors that open the way to joint degeneration are: excessive overloading of the joint and deterioration of the quality of the components that build the joint. If this happens, the causes of osteoarthritis can be divided into those that are beyond our control and those that are beyond our control.

Arthritis: Symptoms

It is assumed that the first symptoms of osteoarthritis appear between the ages of 40 and 60, but they can be seen more and more often in much younger people.

We should be disturbed by all kinds of creaking, crackling, grinding in the joints, as well as severe pain when carrying a load, e.g. when climbing stairs, getting up from a chair, while standing.

Cartilage damage is not always associated with discomfort (e.g. many athletes do not feel pain), so the diagnosis of arthrosis is sometimes too late.

The characteristic of arthrosis is that at first the symptoms occur only during movement (starting pain, starting stiffness), later also appear at rest and at night, and most often affect one or more joints, although some patients suffer from pain multi-joint.

Here are four characteristic symptoms that, together with a radiological examination, allow you to make a diagnosis:

  • pain- in osteoarthritis pain is usually felt only in the affected joint (sometimes the patient may feel it in the groin or in the nearby joint, e.g. knee pain in the case ofdegeneration of the hip joint), occurs at the beginning of movement (starting pain, e.g. when getting out of bed or chair) and during movement and intensifies at the end of the day, and disappears during rest
  • joint stiffness- comes in two varieties: morning stiffness, which disappears a few minutes after waking up, and starting stiffness, appearing during the day after periods of immobility
  • restriction of mobility- problems related to the mobility of the joint worsen over time, it is more and more difficult to, for example, bend or straighten the knee, and what is worse, the movement in the joint may be suddenly blocked by fragments of broken cartilage or bone spurs; the more the joint is damaged, the more the muscles around it weaken and the disability worsens
  • crackles- when uneven articular surfaces rub against each other during movement
  • distortion and extension of contours- results from a change in the axis of the joint, as well as the formation of bone outgrowths (osteophytes) and exudate

Arthritis: causes

Professionals divide osteoarthritis into two forms:

  • primary (idiopathic) , the cause of which is unknown, the probability of its occurrence increases with age
  • secondarywhich has a specific cause - these may be abnormalities in the structure of the joint, its mechanical damage, chronic and systemic diseases, e.g. diabetes or other joint diseases, e.g. RA

In the course of degenerative disease, the following can be distinguished:

  • periods of stabilization - constant intensification of symptoms that occur only with movement
  • exacerbation periods - joint pain and stiffness are increased and also occur at rest and at night; joints are swollen and fluid accumulates inside them as a result of inflammation

There are a number of factors that cause the destruction of articular cartilage and lead to the onset of osteoarthritis, some of which we can influence, others not.

The primary causes of degeneration are unknown and we have no influence on them. It is said about:

  • genetic tendencies,
  • poor chemical composition of the synovial fluid,
  • insufficient blood supply to joints,
  • the influence of various diseases, incl. diabetes and hormonal disorders, especially hypothyroidism.

We also have no influence on age and gender - it is known that the probability of OA increases with age and is higher in women, especially after the menopause.

However, by eliminating the following factors, we can prevent the development of the disease or delay itspeech:

  • overweight or obese - weight loss reduces the risk of disease
  • muscle weakness around the joint - trained muscles stabilize the joint better
  • occupational factors - long-term joint overload (kneeling or bending knees, lifting heavy objects, repeated hand movements), here the only solution may be to change jobs, which is not always easy
  • practicing sports - some disciplines (not necessarily competitive) are associated with more frequent injuries and injuries
  • disorders of the joint structure - some disorders of the joint structure can be corrected through rehabilitation, surgical treatment and the use of orthoses or insoles
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Prevent Injury

Moderate movement adjusted to our abilities best serves the joints. It is important not to twist them, but only move them in physiological planes. A bicycle is perfect, and if you are swimming, you can use your back or crawl (we twist the joints in the frog).

You also have to avoid injuries and exercise your muscles systematically, get rid of overweight and obesity, correct asymmetrical overloads of the spine (e.g., adjust the length of the legs with a pad in the shoe), wear knee pads, wear shock-absorbing footwear, do not excessively exploit the pond in one position.

Arthritis: treatment

Treatment of osteoarthritis is multifaceted and depends largely on the stage of the disease.

Non-pharmacological treatment of joint degeneration

Non-pharmacological treatment plays a very important role in the treatment of osteoarthritis. It not only slows down the degradation of articular cartilage, but also significantly reduces the symptoms of the disease and the number of medications taken.

It includes:

  • maintaining a he althy weight - each additional kilogram increases the risk of disease, and then its faster and more severe course
  • physiotherapy - exercises well-chosen by a physiotherapist help you stay fit and reduce pain
  • thermotherapy
    • cryotherapy: both physical therapy and ordinary home-made ice packs reduce pain and inflammation symptoms,
    • thermotherapy: warm compresses also reduce pain and relax muscles
  • relieving the joint - orthopedic insoles, orthoses, walking sticks or walkers stabilize the joint
  • immobilization - in periods of significant exacerbation of the disease with symptoms of arthritis, however, immobilization should not be prolonged due to the risk ofmuscle wasting
  • "facilitators" - architectural solutions and devices that help relieve the joints in everyday life

Education and support also play an important role - both from the doctor, patient organizations and those closest to them.

Drug treatment

Drug treatment is primarily aimed at combating pain. The oral drug of first choice when pain is mild or moderate is paracetamol, which, although less effective than NSAIDs, is safer.

If the use of paracetamol does not bring the desired effects or the patient is in the period of exacerbation of the disease, non-steroidal anti-inflammatory drugs (e.g. diclofenac, ibuprofen, ketoprofen, naproxen, nimesulide) are administered.

Since they have a lot of side effects, you should always follow the recommended doses and always use only one drug from this group. In acute exacerbations it may be necessary to administer opioids.

Some people cannot take large doses of painkillers or anti-inflammatory pills for various reasons. For this reason, they are recommended topical preparations with analgesic and anti-inflammatory properties in the form of a spray or gel.

Sometimes preparations containing glucosamine and chondroitin can be effective - there is no evidence that they cure or even inhibit the progress of the disease, but sometimes they reduce pain.

If the pain is very troublesome, the doctor may suggest a joint puncture, often with the simultaneous administration of a drug - a steroid or hyaluronic acid (viscosupplementation), and recently also stem cells - inside the joint. Usually, after such a procedure, the symptoms disappear for a long time.

Surgical treatments for arthrosis

Cartilage does not regenerate, but modern surgery restores the normal anatomy of the joint, using the phenomenal repair abilities of our body. Surgical treatment of arthrosis usually involves the knee and hip joints.

  • Most procedures are performed with the laparoscopic method (arthroscopy), which allows for the removal of damaged or grown cartilage elements in a minimally invasive way. The tissue is stimulated to grow with the method of point microfractures of bone devoid of cartilage. Where the blood flows out, a clot forms which becomes fibrous cartilage over time. It has worse properties than hyaline cartilage, but it can replace it from poverty.
  • Mosaicoplasty - two bone fragments with cartilage are changed: sick and he althy, cut from a less strategically important place of the same joint; where there was a defect, cartilage is formedfibrous, and after a few months the correct cartilage surface is rebuilt.
  • Great hopes are associated with transplants. Cartilage cells are harvested from a he althy joint (e.g. the elbow when treating the knee) and multiplied in the laboratory. Then, a periosteum patch cut from the tibia is sewn into the defect site. Cartilage cells (chondrocytes) are injected under the patch, which over time becomes normal cartilage.
  • The entire cartilage grown outside the body is also implanted from chondrocytes multiplied on a special biological rack. The doctor adjusts the material obtained in this way to the size and shape of the lesion.
  • When the cartilage is completely damaged, metal joint prostheses are inserted and polyethylene, ceramic or metal replace the cartilage.
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Go to the doctor as soon as possible if:

  • there will be an exacerbation of symptoms, especially pain - in addition to administering stronger drugs, a puncture may be necessary
  • after the joint puncture, there was a significant increase in pain, swelling and increased joint warming or fever, these may be symptoms of infection, but remember that joint pain up to 24 hours after the puncture is normal
  • the symptoms of the disease worsen despite rehabilitation, elimination of risk factors, supportive treatment - perhaps it's time to think about surgery
  • new disturbing symptoms appear, e.g. pain in many joints, weakness, fever, unjustified weight loss
  • there was pain in the popliteal or calf area - a popliteal cyst may have ruptured, accompanying osteoarthritis; or deep vein thrombosis may have occurred

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Spine, bones, joints