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Most Effective Ways To Treat Osteoarthritis[OA]-Stagewise

Most Effective  Ways To Osteoarthritis[OA] – Medications

In my last article on Osteoarthritis, I had written about the preventive aspect of the disease- in this article, I will be discussing the medication aspect.

How to treat Osteoarthritis with Medicines-

Before we jump on to the treatment part of osteoarthritis, let’s have a brief look at the picture shown below-

Picture showing changes observed in Osteoarthritis

Now let us see how these changes appear in an X-ray picture of an Osteoarthritis joint-

 

Right knee joint xray showing osteoarthritis changes
X-ray picture of osteoarthritis in right knee joint

The 4 stages of OA-

Before we go on with the medication for osteoarthritis, let us quickly recall the various stages of OA as shown below-

  • Normal Knee joint parts

Why is the staging of OA so important?

Different stages of OA have slightly different modes of treatment. In this article, I intend to inform you on both non-medical and medical line of treatment of all stages except the 4th stage. Stage 4 osteoarthritis mostly requires surgery, especially in the knees,

The stage-wise treatment is as given below:-

A] Stage 1-

In this stage, the treatment is mostly non-medical. Meaning that very few medications are prescribed and they are mostly nutraceuticals. I mostly stress on exercises to relieve the stiffness in OA.

What do I advise my patients?

Medications are bare minimal at this stage. This is what I advise my patients:-

a] Exercises-

  1. Brisk walking for at least 30 to 45 minutes for knee OA.
  2. For early OA of hands, an exercise in a bowl of warm water is very effective[see below]
    • Exercise for Hand OA in warm water
  3. Hip OA pains in the early stages are quite disturbing and exercise can help relieve pain gradually by strengthening the muscles and other structures supporting the hips. Here are 10 exercises which can help relieve pain as well as strengthen the muscles-watch this short video-
  4. For early OA of the spine, popularly known as spondylitis/spondylosis[Cervical{neck} and Lumbar{ lower back}], some of the exercises shown above work very well.
  5. Neck OA or cervical spondylitis pain can be relieved by these exercises as shown below-
    • Neck Exercise No.1
      Neck Exercise No.1
  6. For OA of the lower back, I suggest this simple exercise-
    Exercise For OA of Back
    A simple exercise for OA of Back

    Here is one more short video that shows that exercise helps in a lot in Osteoarthritis –

Are there any items to reduce/ease the pain?

Apart from exercises, I have used these items to relieve pain and stiffness in my knee joint-Kneecap for Osteoarthritis

A good pair of Knee caps for Knee Osteoarthritis
A good pair of Knee Caps for Osteoarthritis [Click Here for details]

A pair of self-heating Knee straps for Osteoarthritis
A pair of Self-heating Knee Straps for Osteoarthritis[Topurchase Click Here]
Both these items help in relieving pain and stiffness in osteoarthritis of the knees. They can be worn while walking. The self-heating knee straps can be removed after getting sufficient heat-it should not be worn while sleeping. These straps contain a substance called tourmaline which heats up when in contact with our skin. The magnets in the strap help in healing the damaged cartilage.

  1. For Stage1 OA of the neck spine or Cervical spondylitis, I usually prescribe a Cervical collar to prevent  excessive movement [as shown below ]     
    Cervical collar for neck spondylitis
    Cervical collar for neck spondylitis[Click here to buy]
  2. Similarly, for pain or back spasm, I have prescribed a lumbosacral [LS] belt and a heating pad to some of my patients.  They give very good relief from stiffness and pain. Have a look-
    Heating pad for backache
    Heating pad for chronic backache due to OA of the lumbar spine.[Click Here to purchase]

b] Medications-

Pain in joints[hands, hips, knees, or the back] is the sole reason why patients visit me for treatment at my Clinic.

Medicines are prescribed mostly to relieve pain, stiffness, and swelling if any. However, they should be taken only under the supervision of your healthcare provider. These are some of the medicines which I regularly prescribe-

1] Non-steroidal Anti-inflammatory Drugs[NSAID]-

Drugs like diclofenac sodium [Voveran], naproxen[Naprosyn], ibuprofen[Brufen], nimesulide[Nise/Nimulid] etotodolac[Proxym ER 300] etc., come under NSAIDs[pronounced N-seds].

These medicines have got the ability to reduce pain as well as inflammation of the joints in Osteoarthritis. They should always be consumed after food, preferably with a little milk because they have the tendency to cause acidity and gastritis.

2] Proteolytic Enzymes-

A very good class of drugs-they have the ability to reduce swelling by breaking down the proteins which cause inflammation in OA. Examples of proteolytic enzymes are-

  • Serratiopeptidase[ Emanzen, Cipzen]
  • Trypsin  Chymotrypsin[Chymoral, Enzoflam CT]
  • Bromelain, Rutoside[these two can be used with trypsin chymotrypsin for better effect]. These are enzymes derived from the plants with excellent anti-inflammatory and antioxidant activities.

All of the above medicines, when combined with NSAIDs, have a very good pain-relieving and anti-inflammatory effect in Osteoarthritis.

3] Nutraceuticals-

Nutraceuticals[word derived from nutrition and pharmaceuticals] are substances that are derived from food that we eat, albeit in a concentrated form. They have been combined together in a tablet form for consumption. These are some of the nutraceuticals that I recommend regularly to my patients with Stage 1 OA-

a]Glucosamine Sulfate, Chondroitin Sulfate, and MSM[Methyl-Sulofonyl-Methane] -a boon for Osteoarthritis treatment-

All the above-mentioned substances are present naturally in the cartilages[read about it here] in most of our joints. They are a group of substances called Proteoglycans and they help in building and constantly repairing damaged cartilage. Thus consuming them becomes a part of Osteoarthritis treatment.

b] Curcumin, Omega 3 fatty acids –

Curcumin is easily available in our food as turmeric. Omega 3 fatty acids are available in fish oils as well as flaxseed oil and soybean oil.

These nutrients have both anti-inflammatories as well as painkilling properties. These are available in purified powdered form and are used for fortifying glucosamine and chondroitin tablets.

c] Collagen-

This is a protein that is found in skin, nails, tendons, bone, etc. Out of this, that found in the cartilage is called Undenatured Type II collagen. This collagen helps by relieving pain and stiffness, and improving mobility of the joints. They are used in conjunction with the above 2 mentioned nutraceuticals.

 How do these nutraceuticals work in Osteoarthritis?

All these nutraceuticals are derived from cartilages of animals like cows, pigs, etc. They can also be manufactured artificially.

Most of these have similar properties and they help to-

  • Reduce pain and inflammation
  • Build new cartilage
  • Repair the damaged cartilage

These medicines are available as Jointace C2+, Durajoint in the medical stores, and can be purchased without a prescription. However, I would advise you to consult your family physician regarding dosage which can vary from person to person.

Do I recommend Nutraceuticals for OA?

Yes, I do, and that too strongly.

There are many contrasting views regarding the use of these substances in the treatment of OA. But my experience is that they are very good. In my previous article on preventive management of OA, I had mentioned that I was diagnosed with knee OA Stage 2 in December 2016 after which I was advised to undergo TKR[total knee replacement] surgery after 2 years. I was practically limping while walking at that time.

What else do I recommend?
  1. Oils and liniments or rubefacients- Massaging at the site of joint pains with liniments and oils give relief in the form of providing warmth to the joint. Many such herbal oils are available in the market place and they provide excellent relief. I have personally used liniments like Arnopen[Phytopharma], Pain Relief[20 Microns], and ointments like Arthrella[Charak]. That brings me to the next medication-
  2. Ayurvedic preparations- The above-mentioned companies producing liniments also produce tablets and capsules which they claim to be effective. They contain ingredients like Boswellia Serrata, Curcumin, etc., which help in reducing pain and inflammation, albeit gradually. I recommend them to patients who are afraid to consume allopathic pain killers because of their side effects.

Here is a very good article that will help you overcome pain of Arthritis.

Finally, I would recommend you to listen to this interesting 🤔 podcast- link

How did I  treat my knee Osteoarthritis?

I followed this method to reduce pain and stiffness and I advise my patients to do the same.

  1. Exercise to reduce my weight-I was 15% above my ideal body weight of 72 kg. I realized that this was putting tremendous stress on my knees.[For every extra Kg of body weight, the stress on knees increases by four folds]. Brisk walking for 45 to 6o minutes daily for 5 to 6 days a week helped me reduce this excess weight by 50%.   I started noticing the effect it had on my knee pain-it had almost disappeared.
  2.  Proxym ER 300 once a day and Zymogesic DS twice a day were taken to relieve pain and swelling. One month later the pain improved substantially.

What more did I do for my Knee Osteoarthritis?

With the above two regimens, I added a nutraceutical-Jointace C2+- which I am having to date. My pains, as well as limp, have gone and I still walk briskly daily.

This how I beat OA of my knees. I have pushed my TKR till further date i.e. as and when my OA pops up again or becomes unbearable.

There are a host of companies providing nutraceuticals for Osteoarthritis with different combinations. Here are some of the commercially available nutraceuticals for OA- Click Here.

To know more about these nutraceuticals click here

B] Stage 2 OA-

This stage usually occurs in the 30s and 40s. Treatment of this stage is the same as that of Stage 1 with an increased period of anti-inflammatory and proteolytic medication.

During this stage, I advise my patients a few more things to do-

  1. Avoid squatting. Squatting causes more wear and tear of an already degenerating knee and hip joint.
  2. Carry out quadriceps muscles strenghtening exercise- it helps reduce pain as well as increase mobility [ read here]
  3. Replace the Indian style commode by a western style one- this has the same effect as avoiding squatting.

I also prescribe a Calcium and Vitamin D supplement as I have observed changes of Osteoporosis[brittle bones] in these patients.

C] Stage 3 OA-

As we age, the metabolic process in our body slows down. This stage mostly occurs in the early 40s and 50s. The pain starts becoming unbearable. The disability increases.

The joint gets deformed due to fraying of cartilage[shown below]-

Bowed legs in osteoarthritis of Right Knee
Osteoarthritis -Right Knee showing bowing of legs

 

At this stage, I recommend all the medications in Stage I & II OA along with-

  1. Calcium supplements- to increase the density of bones around the joint
  2. Wearing of braces to correct the bowing of joints and use of a cane for support while walking[as shown below]-

These are very helpful to maintain balance in Stage 3 OA as patients tend to lose balance and can easily fall causing injury in the form of bone fracture as at this stage there is an increase of porosity of bones due to calcium deficiency. This is especially more so in women of post-menopausal age.

Braces to prevent splaying in knee Osteoatrhritis
Braces to prevent splaying of the knee joint in Osteoarthritis 
Walking stick for OA of knees
Walking stick to help relieve pain in Osteoarthritis of knee

D] Stage 4 OA-

In this stage, the cartilage is almost absent[as shown in the X-ray picture at the beginning of the article]. The pain is more severe and patients have sleep disturbance.

There is no point in continuing the nutraceuticals. So along with anti-inflammatory pain killers, I recommend additional narcotic pain killers like Tramadol[Tramazac], Tapentadol[Tapnex ER 50], and liniments and oils.

These medications help in improving the quality of sleep as well as relieving pain substantially.

At this stage, I usually recommend that patients should go for TKR  i.e. Total Knee replacement.

What is TKR?

TKR means replacing the damaged knee joint or hip joint by cutting the bones[ femur and tibia] at the joint level and replaced with artificial parts or prosthesis. By undergoing this operation, the patient gets tremendous relief from pain. The effectiveness of the operation depends on many factors such as-

  • Age of the patient-the more aged the patient, less effective is the replacement
  • Weight of the patient-obesity and overweightedness causes failure of TKR in most cases
  • Bone density of femur and tibia- Very important as the strength of the new joint depends on the strength of bones holding it.
What’s the latest news in the treatment of OA?

Research is on for a pain killer for Stage 3 and 4 OA. One such drug which is doing the rounds is Tanezumab- an injection that is administered subcutaneously[below the skin] in a dosage of 5mg/week.

Another interesting piece of news is that research is going on for using stem cells to regenerate the degenerated joint tissue of Osteoarthritis. For details, Click Here to read.

This medication though showing great promise, is still under clinical trials. If approved, it can be a boon to those who could not be operated.

With this, I come to the end of my series of articles on Osteoarthritis. If you have any questions or queries, you can join me by discussing the topic in the comment section of the blog.

Be sure to provide your e-mail address so that I can contact you personally to help you sort out your OA problems.

For more on Osteoarthritis, you can Read Here

And for all things to do about pain management Read here.

To learn about other people’s experiences Click here.

I take a multivitamin, I take extra C, I take chondroitin and glucosamine for my joints, I take calcium for my bones. And by the way, weight-bearing exercises can help ward off osteoporosis and yoga helps ward off arthritis. Raquel Welch Click To Tweet

 

 

 

 

Osteoarthritis- Part 2- Management-Prevention

MANAGEMENT OF OSTEOARTHRITIS(OA)-Prevention

Author Photo

Introduction-

In this article, we will learn the management of osteoarthritis-its prevention in the first place, and if you are already into it, how to manage it depending upon the various stages. In my last post, I have discussed what happens in Osteoarthritis.

According to the WHO, 9.6% of men and 18% of women above 60 years of age have osteoarthritis all over the world. The scenario in India is that OA is the second most prevalent arthritis with figures of 22% to 39% in a population suffering from arthritis of any kind.

Out of these, nearly 45% of women aged above 65 years have symptoms, while 70% of those above 65 years also show changes in their X-rays of the affected joint/s.

Here is where the management of osteoarthritis, particularly its prevention comes into play.

What did I do to prevent the progression of my Osteoarthritis?

In December 2016 I was having difficulty climbing stairs, even though I stayed on the first floor of the building. I noticed that I had put on weight more than 10 kg. Even though my diet was as it was before I had put on weight.

I was also getting pain in the knees while climbing down. I was getting the feeling of something grating inside my knee. A time came when I had to take the support of a friend to walk me home, even though the distance was only a few furlongs from my clinic.

I was then advised by a friend of mine, who runs a pathology lab to get some blood tests done. It was then that I found out that I had Hypothyroidism which was the cause of my weight gain.

Later on, I went on to get my knee X-rays which showed that I had early signs of Osteoarthritis. Next, I sought the help of a senior orthopedic surgeon friend of mine who confirmed the OA and advised me to come for Total Knee Replacement[TKR] surgery after 2 years.

Hearing about TKR, I decided that I should do something to prevent the further progression of my osteoarthritis and I began learning more about it.

So what did I do next?

This prompted me to write an article on Osteoarthritis management so that I can help people to overcome the difficulties faced by them when they get OA. In my first article, I have described how OA happens and after doing some research into it, I have come out with ways to prevent it as well as treat it if you get it.

As said above, after I was advised TKR, I went about treating myself after getting relief from pain. At that time I was walking[rather limping] with difficulty. So I searched on Amazon and purchased-

    1. A pair of good quality knee caps which I am using even today while I go for my morning walk.
    2. A pair of self-heating knee straps, which helped me get relief from constant pain.

I was advised not to stop walking. The reason being, walking prevented stiffness of the joint as well as improved the lubrication of my knee joint and circulation of blood to the joints.

As was in the early stage of osteoarthritis, I took some nutraceutical capsules which helped me to regenerate the cartilage in my joints to some extent and prevented further damage. I will come to this in the treatment part of the article.

How to Prevent  OA:-

These are a few measures to prevent OA:-

1.Regular exercise like brisk walking/cycling-

Brisk Walking for Good Health
A Brisk Walk in the Park

In today’s busy life, people have a sedentary lifestyle wherein they barely walk. Because of the time shortage due to the heavy working schedule and deadline given to them, people prefer to travel to work even if it is a short distance to cover.

This results in the muscles and bones not getting the much-needed exercise to keep tuned up. We also put on more weight. As we age, this causes muscles to stiffen, giving rise to cramps in the calves and pain in the knee joints leading to osteoarthritis.

Brisk walking can prevent this, at the same time having beneficial effects on other parts of the body, including your mind.

Other important exercises that can prevent osteoarthritis are cycling and swimming.

Man using bicycle as exercise
Cycling for good health

Some other benefits of exercise in Osteoarthritis-

According to research, apart from strengthening our muscles and joints, exercise also helps in –

  1. Reducing stress on your knee joints. Research has shown that 1 kg reduction in weight can reduce the pressure on your knee joint by 9 kg. That means, if you reduce 5 kg weight, the stress on your knees reduce by a whopping 45 kg, thereby reducing pain and inflammation of osteoarthritis substantially.
  2. Body-weight has a direct impact on the health of your knee joint. A person with normal BMI has approximately 3 to 4 percent chance of getting OA whereas the one with BMI in the range of 30 to 35 ( grossly obese) has almost 20 percent chance of getting OA.
  3. Increasing hormones like endorphins sand melatonin. Endorphins are natural pain killers and melatonin helps in getting good sleep.

Both exercises like cycling and swimming help in reducing pain as well as building your quadriceps muscles as shown in the picture below-[click the picture to know how it works]

Quadricep Muscle of the Thigh
Quadricep Muscle of the thigh holding the bones of the knee joint

To know more about the benefits of walking, Click here1 & 2

2. Reduce weight-

It is very important to reduce your weight and bring it to your Ideal Body-weight if you are grossly overweight.

Bodyweight has a direct impact on the health of your knee joint. A person with normal BMI has approximately 3 to 4 percent chance of getting OA whereas the one with BMI in the range of 30 to 35 ( grossly obese) has almost 20 percent chance of getting OA.

First, calculate your ideal body weight by using this gadget

Just put in your height in centimeters and click the submit button. This will show your ideal body weight. Below this will be a range of this weight depending upon your build.

Next, calculate how much weight you have to lose by subtracting this weight from your present weight. You will know the excess weight you are carrying which may be a probable cause of your Osteoarthritis pain and/swelling.

How can you do this?

This is a plan which I follow daily-

    • After my morning rituals after getting up, I go for a walk. The time of the walk and the distance covered varies from day-to-day. A look at the screenshot shown below will give you an idea of how I do it –
Screenshot of the steps covered by walking
Screenshot of Steps covered by walking
    • I avoid taking pain killers for my knee pain unless it becomes unbearable. Then I use some safe pain killer like tramadol ( Ultracet) temporarily. Having pain is a signal that something is wrong with the joint that should not be neglected. At the same time, a range of joint movement should be carried out to keep that joint moving.
    • I have strengthened my quads( quadriceps muscles) by doing these exercises-
  • Avoid squatting on the floor if you feel you are going in for OA. This is known to damage the cartilage of the knee joint.
  • Use Western-style commode instead of an Indian style toilet as shown below.

This will also prevent damage to the cartilage.

Remember, exercise builds strong muscles and bones in the long run,  so do it even if there is a slight pain. This pain will disappear in the course of time.

Having said this, in the early stages of arthritis( see the stages of OA here) we should not slow down but try some exercise like stationary bike cycling or walking in a swimming pool. While walking,  you can listen to some podcasts on OA – this will encourage you how to deal with the OA pain.

Work out in an open-air gym –

Open_air Gym for increasing muscle mass
Open Air Gym

It is important to increase muscle mass surrounding the joint. In most parks, we are provided with open-air gyms that are gentle on our ailing joints and at the same time helping us to gain muscle mass. Make a point to use them regularly.

For more about exercise for OA, you can visit this website.

3. Eating right-

‘What we eat is what we become ‘ is a saying which is true to its last word. Many a time we like to binge on our favorite food without thinking of the consequences of eating the wrong type of food. Eating a well- balanced diet will help you overcome-

  • Unwanted weight gain
  • Thereby reducing the load on affected joints
  • And ultimately, reduction in joint pains.

So, eating the right types of foods and in the right quantity goes a long way in preventing the progress of osteoarthritis. Your food should be a proper balance of all the macronutrients as well as vitamins and minerals.

How do I know how much to eat-

Depending upon your age and weight, I would suggest you get your energy requirements right. First, you should calculate your BMR [click here] and then calculate your energy requirement as per the table given below:-

Calculation of your daily energy requirement based on your activity and BMR
Your total Energy Requirement depending on your activity.

After calculating the amount of energy you need, break it up into 4 to 5 portions viz. breakfast, brunch, lunch,  evening tea, dinner- and allot the food quantity accordingly. For example,  if your total energy requirements are 2200 calories per day, you can divide it as follows-

  1. Breakfast- 20%- 440 cals
  2. Brunch- 10%- 220 cals
  3. Lunch- 40%- 880 cals
  4. Tea- 10%- 220 cals
  5. Dinner- 20% – 440 cals.

This way, you will be able to reduce the workload on your digestive system and also get a restful sleep at night.

Which foods should I eat or avoid-

There are a variety of foods that you can enjoy in osteoarthritis. And there are some types of foods that you should avoid to prevent flare-ups of inflammation in OA. This website will show you the best choices- the good as well as the bad ones- Click Here.

Friends, apart from my clinical experience, a lot of research has gone into writing this article. In the course of writing, I have referred 2 books which have given me many an insight to Osteoarthritis.

I would like to share the name of books which I have referred here-

Books about arthritis
Books about arthritis

You can get these books on Amazon as a Paperback or as a Kindle ebook-

Book on Osteoarthritis
Book on Osteoarthritis

This book is available free on Kindle Unlimited if you are a member and can be downloaded on the free kindle app on your smartphone, tablet, or desktop.
Having said this, I  invite you to share with me your overall personal experience of preventing osteoarthritis if either you or relative is suffering from it.

For further information on Osteoarthritis, you can visit some or all of these sites:-

 1.Creaky joints.org

2. Living with Arthritis

3. Beating OA blog

You can also learn a lot more about Osteoarthritis by listening to this podcast on the topic here.

X-ray picture of osteoarthritis of the knee
Arthritis -Part 2 – Osteoarthritis-Signs and Symptoms

                     What is Osteoarthritis?

Hi Friends,

In my first post on Arthritis,  at the conclusion, I had mentioned that my next topic will be on a joint disease called Osteoarthritis.

In this article, I shall be discussing what is osteoarthritis all about and what are its signs and symptoms. Let us now go back to the previous article, back to the structure of the joint.

Osteoarthritis is a degenerative joint disease involving the cartilage part of the joint. This results in the two bones of the joint grating against each other causing severe pain on movement. Some times there is swelling of the surrounding soft tissue like the muscles causing stiffness of the joints.

This causes-

a] pain in movement, sometimes at rest

b] a feeling of the bones grating. This can be felt like creaking, especially in the knees.

The cartilage gets worn out eventually and the joint may get deformed resulting in disability.

 A look at the picture[click on it for a larger view] will show you that at the end part of bones facing each other there is a part called Articular Cartilage.

Different parts of a human joint
Normal human joint

What is Cartilage?

Cartilage is, in common man’s language, gristle. It is a tissue that:-

1] is elastic, tough and durable

2] separates two ends of the bone from directly touching each other

3] does not have a blood supply.

It gets its nutrition and oxygen from the fluid[synovial] in the joint cavity. As an example, this picture of a chicken leg below shows exactly how the cartilage looks like-Picture showing cartilage in a chicken leg

 

What happens when we move our joints?

Movements of the joint results in alternate compression and relaxation of the cartilage.

An increase in pressure compresses the cartilage. This squeezes out the fluid along with waste material from the cartilage.

During relaxation, the opposite occurs- fluid and nutrients get absorbed by the cartilage.

So, the health of our cartilage depends upon the regular use of our joints. In other words, regular exercise can keep your joints as well as your cartilage healthy.  

So, what happens in Osteoarthritis?

As we age, changes start occurring in almost all parts of our body such as wrinkling of the skin, greying of hair, etc.

A change in the structure of our joints is also observed. This leads to the following changes-

There is a reduction of the lubricating synovial fluid leading to the grittiness of the joints.

The cartilage supporting the joint starts getting frayed and eventually disappears partially or fully.

This results in the bony ends touching each other. The bony ends of the joint contain sensory nerves. When the bones start rubbing against each other, we get pain.

This results in a crippling sort of disability called subluxation[see the pictures below] in medical terms i.e. a part of the joint sways towards the part where the cartilage is lost.

The picture on the left-hand shows the X-ray of a normal structure of a healthy knee joint and on the right, a knee joint affected by Osteoarthritis.

X-ray of a Normal Knee Joint
X-ray of A Normal Knee Joint
X-ray of Knee Joint affected by Osteoarthritis
X-ray of Osteoarthritis of the Knee Joint

 

Note the reduction in joint space with mild subluxation on the inner side of the affected joint.[More when we come to OA of the Knee joint]

 

 

 

Forms of Osteoarthritis

There are 3 forms of osteoarthritis mostly noticed in different people, notably-

1] The Fingers:-

These are visible as knotty growths in the 2nd and 3rd joints. They are painless but they alter the cosmetic appearance of the hand, as shown in this picture below-

Osteoarthritis of hands showing knotty deformity in second and third joints of fingers
Knotty deformity in OA of fingers

This is the picture of a 70-year-old male patient who had undergone knee replacement for osteoarthritis 5 years back. Recently he noticed changes in the fingers of both hands in the second and third joints along with pain and stiffness.

Note the knotty appearance of the second joint of the index and middle fingers.

These swellings are also known as Heberden’s node, named after the British surgeon who first described it.

 

2] The Vertebral Column:-

The vertebral column is formed by a set of bones called vertebrae.

This starts from the base of the skull to the small of the back, ending in between the two buttocks.

The vertebral column is made up of –

7 vertebrae in the neck[ cervical vertebrae]

11 in the chest[ dorsal vertebrae]

5 in the trunk[lumbar vertebrae]

and 1 single large fused vertebra called sacrum at the end of the column.

The Intervertebral Disc

In between two vertebrae, there is a disc space[as shown in the two x-ray pictures to the left and right below, of the trunk or lumbar vertebrae]. This is formed by a fibrocartilagenous structure called the intervertebral disc.

Space in between two lumbar vertebrae -the normal disc space
X-ray of Lumbar vertebral column showing normal disc space
X-ray picture of normal Lumbar spine taken from the side
X-ray picture of normal Lumbar spine taken from the side

In our lifetime, we move our back and neck many times every day. You can notice this when somebody is speaking-watch the number of times he or she move their neck. These movements cause a condition called cervical spondylosis.

Normal movements like forward and backward bending, over some time, causes degeneration of this intervertebral disc, leading to a reduction in disc space. This causes compression of the spinal nerve roots giving rise to pain on movement of the neck which is termed cervical radiculopathy.

X-ray picture showing a reduction in disc space of lumbar vertebrae
X-ray picture showing a reduction in disc space of lumbar vertebrae

What happens when the disc is worn out?

This causes the loss of the disc space,[as shown in this x-ray picture above] eventually causing the vertebrae to override against each other. This causes pain and formation of new bone spurs called osteophytes.

Sometimes there is a fusion of the two vertebrae causing stiffness in the neck or the lower back.

What happens next?

As the condition progresses, there is more compression of the nerve roots that come out from the spinal cord through the gaps in between two vertebrae.

This can cause tingling and numbness in the neck and the lower extremities.

All these changes put together are called Lumbar Spondylitis or Spondylosis in the back and the legs.

A similar change occurs in the vertebrae of the neck also which causes problems in the arms and parts of the chest supplied by the nerves coming out from the spinal cord in the neck. This is called Cervical spondylitis.

3] The Weight-Bearing Joints

In our body, the major joints that bear the brunt of our body weight are the hip joint, knee joint, and ankle. Because of the constant use of these joints and an increase in our body weight, there occur degenerative changes of the cartilage. These joints then lose their cartilage totally until the bones touch each other.

What happens next?

With movement, and because there is little or no cartilage, the bones grind against each other and this causes the pain of osteoarthritis. There is the formation of new bone called osteophytes. These new growths try to give support to the joint by increasing the area of the joint, which then appears as swelling of the joints. Over some time, the ends of bone touching each other become smooth and the pain lessens or disappear. This is called eburnation. 

How does this look?

As the joint gets splayed, in the knee joint, there is movement of the bones-either to the inner or outer side of the joint. There is a bowing of the leg. The pictures shown below will give you an idea of how this deformity appears to our eyes.

Bowed legs in osteoarthritis of Right Knee
Osteoarthritis -Right Knee

This is a picture of the knee joints showing advanced osteoarthritis in an 87-year-old person.

Right knee joint xray showing osteoarthritis changes
X-ray picture of osteoarthritis in right knee joint

On the right is the X-ray of the same affected joint.

Note the splaying of the right knee giving rise to a bow-legged appearance. There is also swelling surrounding the joint- this is due to bursitis[inflammation of the bursa].

You can also note the new bone formation. This is called lipping, as it appears like a lip.

As the days go by, this will become more splayed and this patient may either need the support of a cane for walking or he will have to undergo total knee replacement operation.

You can also note the increased porosity of the bones. This condition is due to calcium deficiency and is called Osteoporosis[ brittle bone- more about this in my future article] and is a common cause of fractures of the bones in the old age.

For more on causes of Osteoarthritis, please listen to this podcast here

Osteoarthritis[OA]- Signs and Symptoms

Now that we have understood different types of OA, we now proceed to learn its signs and symptoms.

Osteoarthritis progresses in stages and each stage has its own signs and symptoms. The different stages in its development can be understood by studying these diagrams of the development of OA in a knee joint shown below:-

Stage 1 OA-

Stage 1 osteoarthritis
Osteoarthritis stage 1

There is minimal loss of cartilage. The pain in this sage is also minimal. The movement of the joint is not restricted.

Stage 2 OA-

Stage 2 osteoarthritis
Osteoarthritis stage 2

In this stage, the first signs of wear in the cartilage can be seen. It begins to break down and cracks appear on the cartilage. The joint space starts narrowing and pain and swelling due to fluid accumulation occurs. Here the patient may or may not complain of the stiffness of the joint in the mornings. Movements of the joint are slightly restricted.

Stage 3 OA-

Stage 3 osteoarthritis
Osteoarthritis stage 3

In this stage, the cracks in the cartilage start expanding and the bones start touching each other. There is increased pain and more fluid accumulation. This is called effusion. The swelling of the joint is visible[ as seen in the picture knee joint of the patient shown above]. Movement of the joint is very painful and he has to take the support of a cane for moving about.

 

Stage 4 OA-

Stage 4 osteoarthritis
Osteoarthritis stage 4

In this stage, the cartilage is almost totally frayed, so much so that the two opposite bones rest on each other.

There is excruciating pain on movement initially and as it becomes unbearable, the doctor may advise total knee replacement[TKR] operation.

If the patient bears the pain, after some time, the ends of the bones become smooth with the appearance of the osteophytes and the pain may disappear totally.

You may have one or two types of the above-mentioned osteoarthritis at the same time.

So, you see, Osteoarthritis is quite a common condition that accompanies aging and wear and tear of the cartilage of the joint involved. This you may have observed in people you have around you like parents, grandparents or family friends.

Having said this, we will learn all about how to manage osteoarthritis in my next post. In that post, I will be discussing the investigations and treatment part of osteoarthritis. So, stay tuned in for my next article.

Some useful links on Osteoarthritis-

1] NIAMS

2] Curearthritis

3] Medicinenet.com

4] Jointaction.info

 

You can also watch this video to know more  about Osteoarthritis-

 

If you found this article useful, you can share it by clicking the quote given below-

Knowing what to expect in Osteoarthritis, one can delay its effect by taking proper care of the affected joint by its proper use, meaning reducing wear and tear. Click To Tweet
WHAT IS ARTHRITIS? KNOW ALL ABOUT IT HERE
Joints in our body have been formed to hold bones together; let's take care of them and prevent Arthritis Click To Tweet

Hello Friends,

Before I start my article on Arthritis, I would like to give you a brief idea on the Musculoskeletal system of our body which is responsible for-

1] Mobility i.e. the ability to move our body;

2] Protection to inner organs of the body.

The musculoskeletal system can be likened to that of frame of a building for eg. the columns and the pillars which support the walls, the doors, and the windows of a room.

Similarly, the bones, the ligaments, muscle, etc., form a sort of protective structure which shields the internal organs such as the lungs and heart[the rib cage], the liver, kidney bladder, etc.,[ the abdomen and pelvis], the brain, eyes, etc.[the skull] and so on and so forth.

Just like the damage which occurs in the structure of a building can weaken and shorten its life, so does the damage of the parts of our skeletal system can lead to crippling, pain and shortening of our life span.

In my 35 years of medical practice, I have come across patients having different forms of joint disease, preferably known as ARTHRITIS.

What is arthritis?

The word arthritis is derived from two words-“arthron”-meaning joint in Greek and “itis”- meaning inflammation. So, arthritis simply means inflammation of joints.

What is a joint?

There are about 206 bones in our body. These bones are held together by various structures like the muscle, ligaments, tendons, cartilage, etc. to form a joint. So, a joint is two or more bones held together by these structures to allow movement.  Depending on different sites like the hands, legs neck, etc. they are named as wrist, elbow, knee, etc.

The different types of joint in our body are:-

1] Hinge Joints:- eg. elbow, knee, small joints of  fingers

2] Ball and Socket Joints:- eg. shoulder and hip joints

3]Pivot Joints:- eg. spine

4] Cartilaginous Joints:- eg. Ribs with the central Breast bone[sternum]

5] Fibrous Joints:- eg. wrist, ankle, skull.

Before we dig into different types of arthritis, we should understand the structure of a normal joint. The picture shown below is a cross-section of a typical joint that explains the different structures involved in the making of a normal joint.

Different parts of a normal human joint
TYPICAL JOINT STRUCTURE

The table given below shows the function of the major joint parts shown in the picture above:-

Serial No.

Parts of Joints What it Contains How it Works What Happens with Age
1 Joint Cartilage Protein[chondroitin sulfate, keratin] and water-there is no blood supply Acts as a shock absorber Water reduces, so does shock absorbing property
2 Synovial Fluid Viscous Liquid Lubricates the Joint Reduces in quantity
3 Intraarticular Disc Mostly protein. Gets oxygen from synovial fluid Acts as a shock absorber Shrinks
4 Joint Capsule Fibrous structure containing nerves, blood, and lymphatic vessels Connects bones, encompasses the joint Shrinks
5 Synovial Membrane Contains 2 types of cells:-

Type A

Type B

Lines the joint capsule.

Type A cells remove particulate matter;

Type B cells secrete synovial fluid

Thickens and degenerates
6 Ligaments Same as a joint capsule but thicker Stabilizes the joint Shrinks
7 Muscle Bundles of cells called Myofibrils Helps in the movement of the joint by contracting and relaxing Shrinks
8 Tendon The thickened end part of muscle Attaches muscle to bone Remains unchanged
9 Bursa Hollow sacs containing a small amount of synovial fluid Helps tendon and muscle move smoothly during joint movement Shrinks

When we speak about Arthritis, we are usually referring to the pain in single or multiple joints and their surrounding tissues.

So, depending on the type of structure involved, we have about 8 types of major arthritis.

Table 1 below defines the different types of arthritis and the body part/s involved:-

The most common arthritis that is encountered is Rheumatoid and Osteoarthritis. The picture shown below shows what happens in these 2 types of arthritis:-

 

Picture showing difference between Rheumatoid and Osteoarthritis
Rheumatoid and Osteoarthritis[click on the picture to enlarge]

We will now see how the bones and joints get affected due to different joint diseases. Take a look-

Different types of arthritis of foot
Arthritis of joints of toes of the foot- RA-Rheumatoid PSA-Psoriatic OA-Osteoarthritis RED color shows part of a joint and bone affected

We shall learn more about arthritis and its management in my subsequent articles.

My next post will be a detailed study of OSTEOARTHRITIS its types, signs and symptoms.

Hope this brief introductory post has helped you understand what is arthritis.

Your suggestions and comments on this article are welcome.

 

WHAT IS OBESITY?
Healthy Lifestyle Leads to a Healthy Life and this can be done by Maintaining an Optimum Body Weight. Click To Tweet

Hi Friends,

Today I am going to discuss a very important topic- Obesity

If you look around most of us are getting fatter or putting on weight by the day. Why is this happening?

Today’s day-to-day life revolves around eating fast-food (which has loads of calories in it) and a sedentary lifestyle (wherein we tend to sit more and walk less for eg.using vehicles for short-distance travel, sitting more in front of computers, etc.). We tend to eat less healthy food (a balanced diet) which used to keep our ancestors fit and trim.

Walking to work was the norm in those days. This new lifestyle of relative inactivity and eating junk foods adds more than necessary calories to our body which gets converted into fats surrounding different parts of our body like our abdomen (trunks),hips(buttocks),blood vessels (arteries of heart) etc.,which in turn make us look shapeless and ugly, breathless while walking, climbing stairs, developing high blood pressure and conditions like diabetes. This condition is called OBESITY.

Obesity can lead to:-

1) Hypertension (high B. P.)

2)Diabetes

3)Osteoarthritis of knees

4] Non-alcoholic Fatty Liver disease [NFLD]

and so on and so forth.

These illnesses can lead to expenses that cannot be foretold but at the same time are avoidable. If you click on the picture shown below, it will show you all the effects Obesity has on different parts of our body.

Obesity side-effects
Side-effects of Obesity

In my next post, I will be discussing the different parameters of obesity and the ways to tackle it.

Dr. K. P. V. Rao's Health Blogs
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