Osteoarthritis ( OA ) is a type of joint disease that results from the breakdown of joint cartilage and bone underneath. The most common symptoms are joint pain and stiffness. Initially, symptoms can occur only after exercise, but over time can become constant. Other symptoms may include joint swelling, decreased range of motion, and, when the back is affected, weakness or numbness in the arms and legs. The most commonly involved joints are those near the tips of the fingers, at the base of the thumb, neck, lower back, knees, and hips. Joints on one side of the body are often more affected than others. Usually the symptoms come for years. It can affect normal work and daily activities. Unlike other types of arthritis, only the joints are usually affected.
Causes include previous joint injury, abnormal joint or limb developments, and inherited factors. The risk is greater in those who are overweight, have one leg of a different length, and have a job that results in a high level of joint stress. Osteoarthritis is believed to be caused by mechanical stresses on joint inflammatory processes and low levels. It develops as the cartilage is lost and the underlying bone becomes affected. Because pain can complicate exercise, muscle loss can occur. Diagnosis is usually based on signs and symptoms, with medical imaging and other tests that are sometimes used to support or rule out other problems. In contrast to rheumatoid arthritis, which is primarily an inflammatory condition, in osteoarthritis, the joints usually do not become hot or red.
Treatments include exercise, efforts to reduce joint stress, support groups, and pain medications. Efforts to reduce joint stress include rest and use of sticks. Weight loss can help those who are overweight. Pain medications may include paracetamol (acetaminophen) as well as NSAIDs such as naproxen or ibuprofen. The long-term use of opioids is generally discouraged because of a lack of information about the benefits and risks of addiction and other side effects. If pain interferes with normal life despite other treatments, joint replacement surgery may be helpful. Artificial connections usually last 10 to 15 years.
Osteoarthritis is the most common form of arthritis, affecting approximately 237 million (3.3% of the population). Among those over 60, about 10% of men and 18% of women were affected. That is the cause of about 2% years of life with disability. In Australia, about 1.9 million people are affected, and in the United States, 30 to 53 million people are affected. It becomes more common in both sexes as people get older.
Video Osteoarthritis
Signs and symptoms
The main symptoms are pain, causing loss of ability and often stiffness. Pain is usually exacerbated by prolonged activity and relieved by rest. The most common stiffness occurs in the morning, and usually lasts less than thirty minutes after starting daily activities, but may return after a period of inactivity. Osteoarthritis can cause crackling (called "crepitus") when the affected joint is moved, especially the shoulders and knee joints. Someone may also complain about joint locking and joint instability. These symptoms will affect their daily activities due to pain and stiffness. Some people report an increase in pain associated with cold temperatures, high humidity, or decreased air pressure, but studies have mixed results.
Osteoarthritis generally affects the hands, legs, spine, and joints of large loads, such as the hips and knees, although in theory, every joint in the body can be affected. As osteoarthritis develops, movement patterns (such as gait), are usually affected. Osteoarthritis is the most common cause of knee joint effusion.
In smaller joints, such as on the fingers, hard bone enlargement, called the Heberden node (in the distal interphalangeal joint) or the Bouchard node (in the proximal interphalangeal joint), may form, and although not always painful, fingers significantly. Osteoarthritis of the toes can be a factor that causes the formation of bunions, making them red or swollen.
Maps Osteoarthritis
Risk factors
Damage caused by mechanical stress with inadequate self-repair by the joints is believed to be a major cause of osteoarthritis. These sources of stress may include bone misalignment caused by congenital or pathogenic causes; mechanical injury; overweight; loss of strength in the joint supporting muscles; and peripheral nerve disorders, leading to sudden or uncoordinated movements. But sport, including running without injury, has not been found to increase risk. Nor is a cracked knuckle of someone found to play a role.
Primary
Numerous studies have shown that there is a greater prevalence of disease among siblings and especially identical twins, indicating hereditary basis. Although a single factor is generally not sufficient to cause disease, about half of the variations in susceptibility have been assigned to genetic factors.
As early human ancestors evolved into bipeds, changes occur in the pelvis, hip and spine joints that increase the risk of osteoarthritis. Additionally, genetic variations that increase the risk may not be selected because the problem usually occurs only after reproductive success.
The development of osteoarthritis correlates with a history of previous joint injury and with obesity, especially with respect to the knee. Since the correlation with obesity has been observed not only for the knee but also for weightless joints and loss of body fat more closely related to relieving symptoms than weight loss, it has been suggested that there may be metabolic. link to body fat compared to mechanical loading only.
Changes in sex hormone levels can play a role in the development of osteoarthritis because it is more common among post-menopausal women than among men of the same age. A study of rats found a natural female hormone to be protective while a male hormone injection dihydrotestosterone reduces protection.
Jobs
Increased risk of developing knee and hip osteoarthritis is found among those who work with manual handling (eg lifting), having physically demanding work, walking at work, and having a climbing task at work (eg, climbing stairs or stairs). With osteoarthritis of the hip in particular, an increased risk of progression over time is found among those who work in crooked or crooked positions. For knee osteoarthritis in particular, an increased risk is found in those who work in kneeling or squatting positions, weight lifting in combination with kneeling or squatting positions, and standing up. Women and men have the same occupational risks for the development of osteoarthritis.
Secondary
This type of osteoarthritis is caused by other factors but the resulting pathology is similar to that of primary osteoarthritis:
- Alkaptonuria
- Congenital joint disorders
- Diabetes doubles the risk of having joint replacement because osteoarthritis and people with diabetes have joint replacement at a younger age than those without diabetes.
- Ehlers-Danlos Syndrome
- Hemochromatosis and Wilson's disease
- Inflammatory diseases (such as Perthes disease), (Lyme disease), and all forms of chronic arthritis (eg, costochondritis, gout, and rheumatoid arthritis). In uric acid, uric acid crystals cause cartilage to degenerate at a faster rate.
- Injury to joints or ligaments (such as ACLs), as a result of accident or orthopedic surgery.
- Ligament damage or instability may be a factor.
- Marfan syndrome
- Obesity
- Shared infection
Pathophysiology
While osteoarthritis is a degenerative joint disease that can cause cartilage loss and morphological damage to other joint tissues, smoother biochemical changes occur in the early stages of development of osteoarthritis. The water content of healthy cartilage is balanced by a compression force that pushes water out and hydrostatic and osmotic pressure that attracts incoming water. Collagen fibers exert compressive strength, while the Gibbs-Donnan effect and the rattan proteoglycans create osmotic pressures that tend to attract incoming water.
However, during the onset of osteoarthritis, the collagen matrix becomes more disorganized and there is a decrease in proteoglycan content in cartilage. The decomposition of collagen fibers results in a net increase in moisture content. This increase occurs because while there is a loss of proteoglycans as a whole (and thus a decreased osmotic pull), this is proportional to the loss of collagen. Without the proteoglycan protective effect, collagen fibers from cartilage can become susceptible to degradation and aggravate degeneration. Inflammation of the synovium (joint cavity) and adjacent joint capsule may also occur, although often mild (compared with synovial inflammation occurring in rheumatoid arthritis). This can happen because the product breakdown of the cartilage is released into the synovial space, and the cells lining a joint effort to remove it.
Other structures inside the joint may also be affected. The ligaments in the joints become thickened and fibrotic and the menisci can become damaged and faded. Menisci can be completely absent when someone has joint replacement. New bone growth, called "spurs" or osteophytes, can form on the edges of the joint, possibly in an attempt to improve the compatibility of the surface of articular cartilage in the absence of meniscus. The volume of subchondral bone increases and becomes less mineralized (hypomineralization). All of these changes may cause the problem to work. Pain in osteoarthritic joints has been associated with thickened synovium and subchondral bone lesions.
Diagnosis
Diagnosis is made with reasonable certainty based on history and clinical examination. X-rays can confirm the diagnosis. Typical changes seen in X-rays include: narrowing of joint space, subchondral sclerosis (increased bone formation around joints), formation of subcondral cysts, and osteophytes. Plain films may not correlate with findings on physical examination or with pain levels. Usually other imaging techniques are not needed to diagnose osteoarthritis clinically.
In 1990, the American College of Rheumatology, using data from multi-center studies, developed a set of criteria for the diagnosis of osteoarthritis of the hands based on the enlargement of hard tissue and certain joint swelling. This criterion was found to be 92% sensitive and 98% specific for hand osteoarthritis compared to other entities such as rheumatoid arthritis and spondyloarthropathies.
Associated pathologies whose names may be confusing with osteoarthritis include pseudo-arthrosis. It comes from the Greek root pseudo - , which means "wrong", and arthr - , which means "together", together with the ending -osis used for interference. Radiographic diagnosis results in a diagnosis of fractures within the joint, which should not be equated with osteoarthritis which is a degenerative pathology that affects the high incidence of the distal phalangeal joint of female patients. A polished ivory appearance may also develop on affected joints, reflecting a change called eburnation.
Classification
A number of classification systems are used for gradations of osteoarthritis:
- WOMAC scale, taking into account the pain, stiffness and functional constraints.
- The Kellgren-Lawrence scoring scale for knee osteoarthritis. It only uses the projection radiography feature.
- TÃÆ'¶nnis classification for osteoarthritis of the hip joint, also using only radiographic projection features.
- Knee Injury and Score Result of Osteoarthritis (KOOS) and Hip Disability and Osteoarthritis Results Score (HOOS).
Osteoarthritis can be classified as primary or secondary depending on whether or not there are identifiable causes.
Both primary generalized nodal osteoarthritis and erosive osteoarthritis (EoA, also called inflammation of osteoarthritis) are sub-sets of primary osteoarthritis. EOA is a more rare, and more aggressive form of inflammatory osteoarthritis that often affects the distal interphalangeal joints of the hands and has an articular erosive change in x-rays.
Osteoarthritis can be classified by affected joints:
- Hands:
- Trapeziometacarpal osteoarthritis
- Wrist (osteoarthritis of the wrist)
- Vertebral column (spondylosis)
- Arthrosis of facet joints
- Osteoporosis of the hips
- Knee osteoarthritis
Management
Lifestyle modifications (such as weight loss and exercise) and analgesics are the mainstay of care. Acetaminophen (also known as paracetamol) is recommended first line with NSAIDs that are used in addition to therapy only if pain relief is inadequate. This is due to the relative safety of acetaminophen.
Lifestyle changes
For people who are overweight, weight loss can be an important factor. Patient education has proven useful in self-management of arthritis. It relieves pain, improves function, reduces stiffness and fatigue, and reduces medical use. Patient education can provide pain relief on average 20% more when compared with NSAID alone in patients with osteoarthritis of the hip.
Physical measurements
Moderate exercise may be helpful in relation to pain and functioning in those with knee and hip osteoarthritis. These exercises should be done at least three times per week. While some evidence supports specific physical therapy, evidence for a composite program is limited. Providing clear advice, making fun exercises, and convincing people about the importance of doing the exercises can result in greater benefits and more participation. There is not enough evidence to determine the effectiveness of massage therapy. Evidence for manual therapy can not be inferred. Functional training, gait, and balance have been recommended to overcome feelings of position, balance, and strength in individuals with lower extremity arthritis as this may contribute to a higher rate of decline in older individuals. For people with osteoarthritis of the hands, exercise can provide small benefits to improve hand function, reduce pain, and reduce finger joint stiffness.
The neutral wedge and neutral sole wedge seems to be useless in knee osteoarthritis. Knee amplifier can help but its usefulness has also been debated. For management of heat pain can be used to relieve stiffness, and cold can relieve muscle spasms and pain. Among people with hip and knee osteoarthritis, exercise in water can reduce pain and disability, and improve quality of life in the short term. Also therapeutic exercise programs such as aerobics and walking reduce pain and improve physical functioning up to 6 months after the end of the program for people with knee osteoarthritis.
Medication
By mouth
Paracetamol pain medication is the first-line treatment for osteoarthritis. However, a review of 2015 found acetaminophen has only short-term benefits. For the effectiveness of mild to moderate symptoms similar to non-steroidal anti-inflammatory drugs (NSAIDs), although for more severe symptoms NSAIDs may be more effective. NSAIDs such as naproxen, while more effective in severe cases, are associated with greater side effects, such as gastrointestinal bleeding. Diclofenac is probably the most effective NSAID.
Another class of NSAIDs, COX-2 selective inhibitors (such as celecoxib) are as effective as nonselective NSAIDs, and have lower levels of adverse gastrointestinal effects, but higher rates of cardiovascular disease such as myocardial infarction. They are also more expensive than non-specific NSAIDs. Benefits and risks vary in individuals and require consideration when making treatment decisions, and further studies comparing NSAIDS and COX-2 selective inhibitors are needed. NSAIDs are applied topically effectively for a small number of people. The selective COX-2 rofecoxib inhibitor was removed from the market in 2004, as cardiovascular events were associated with long-term use.
Failure to achieve the desired pain reliever in osteoarthritis after 2 weeks should trigger a dose review and pain medication. Opioids by mouth, including weak opioids such as tramadol and stronger opioids, are also often prescribed. Their accuracy is uncertain, and opioids are often recommended only when first-line therapy has failed or is contraindicated. This is because the benefits are small and the risk of side effects is relatively large. Oral steroids are not recommended in the treatment of osteoarthritis.
The use of oral antibiotic doxycycline to treat osteoarthritis is not associated with clinical improvement in joint function or pain. Any small benefits associated with the potential of doxycycline therapy to address joint space constriction are unclear, and any benefit is proportional to the potential harm from side effects.
Topic
There are several NSAIDs available for topical use, including diclofenac. A Cochrane review from 2016 concluded that sufficient evidence is only available for the use of topical diclofenac and ketoprofen in people over the age of 40 with painful knee arthritis. Transdermal opioid pain medications are usually not recommended in the treatment of osteoarthritis. The use of topical capsaicin to treat osteoarthritis is still controversial, as some reviews find benefit while others do not.
Shared injection
Glucocorticoid combined injection (such as hydrocortisone) causes short-term pain relief that can last between weeks and months. Hyaluronic acid injections have not resulted in improvement compared with placebo for knee arthritis, but increase the risk of further pain. In osteoarthritis of the ankle, evidence is unclear. The effectiveness of platelet rich plasma injections is unclear; there are suggestions that such injections improve function but not pain, and are associated with increased risk.
Cochrane review in 2015 found that intra-articular knee injectable knee injection did not benefit the quality of life and had no effect on knee joints; Clinical effects one to six weeks after the injection can not be clearly determined because of poor learning quality. Another 2015 study reported negative effects of intra-articular corticosteroid injections at higher doses, and a 2017 trial showed a decrease in cartilage thickness with intramuscular triamcinolone every 12 weeks for 2 years compared with placebo. A 2018 study found that intra-articular triamcinolone was associated with increased intraocular pressure.
Surgery
If the impact of osteoarthritis symptoms on quality of life is significant and more conservative management is ineffective, joint replacement surgery or resurfacing may be recommended. Evidence supports joint replacement for both knee and hip as it is clinically effective, and cost-effective. Surgery to transfer the articular cartilage from the non-weight-bearing area to the damaged area is one possible procedure that has some success, but there is the problem of getting cartilage transferred to integrate well with the cartilage at the transfer site.
Osteotomy may be useful in people with knee osteoarthritis, but it has not been well studied and it is unclear whether it is more effective than non-surgical treatments or other types of surgery. Arthroscopic surgery is largely discouraged, as it does not improve the outcome of knee osteoarthritis, and can cause harm.
For people who have osteoarthritis shoulder and do not respond to a pharmaceutical approach, surgical options include shoulder hemiarthroplasty (replace joints), and total shoulder arthroplasty (replace joints).
Alternative medicine
Glucosamine and chondroitin
The effectiveness of glucosamine is controversial. Reviews have found it the same or slightly better than placebo. Differences may exist between glucosamine sulfate and glucosamine hydrochloride, with glucosamine sulfate showing benefits and no glucosamine hydrochloride. The evidence for glucosamine sulfate has an effect on the development of osteoarthritis is somewhat unclear and if now may be simple. The Osteoarthritis Research Society International recommends that glucosamine be discontinued if no effects are observed after six months and the National Institute for Health and Nursing Excellence no longer recommends its use. Despite the difficulty in determining the efficacy of glucosamine, it remains a viable treatment option. The European Society for Clinical and Economic Aspects Osteoporosis and Osteoarthritis (ESCEO) recommends glucosamine sulfate and chondroitin sulfate for knee osteoarthritis. Its use as a therapy for osteoarthritis is usually safe.
The 2015 Cochrane review of chondroitin clinical trials found that most had low quality, but there was some evidence of short-term improvement in pain and few adverse effects; does not seem to improve or maintain the health of affected joints.
Other drugs
Avocado-soybean unsaponifiables (ASU) is an extract made from avocado oil and soybean oil that is sold under many brand names worldwide as a dietary supplement and as a medicine in France. A Cochrane 2014 review found that while ASU may help relieve pain in the short term for some people with osteoarthritis, it does not seem to improve or maintain the health of affected joints. This study records a two-year high-quality clinical trial comparing ASU with chondroitin, which has an uncertain effectiveness in osteoarthritis; The study found no difference between the two. The study also found that although ASU appears to be safe, it has not been adequately studied for its security to be determined.
Devil's claws, curcumin, phytodolor, SKI306X and s-adenosyl methionine (SAMe) may be effective in increasing pain. There is transient evidence to support cat's claws, hyaluronan, methylsulfonylmethane (MSM), and hip roses. Some high quality research from Boswellia serrata shows a consistent, but small increase, in pain and function.
There is little evidence supporting the benefits for some supplements, including: Ayurvedic herbal preparations under the brand name Articulin F and Eazmov; Duhuo Jisheng Wan, Chinese herbal preparations; fish liver oil; Ginger; gitadyl herbal preparations; omega-3 fatty acids; brand-name products of Reumalax; nettle; vitamins A, C, and E in combination; vitamin E itself; vitamin K; vitamin D; collagen; and willow bark. There is not enough evidence to make recommendations about the safety and efficacy of this treatment.
Regular use of dietary supplement s-adenosyl methionine is not recommended because there are not enough high quality tests performed to evaluate its effect.
Acupuncture and other interventions
While acupuncture leads to improvements in pain relief, these small and perhaps important enhancements are questionable. Waiting for controlled trial lists for osteoarthritis of peripheral joints does show clinically relevant benefits, but this may be due to a placebo effect. Acupuncture does not seem to produce long-term benefits.
While electrostimulation techniques such as TENS have been used for twenty years to treat osteoarthritis in the knee, there is no conclusive evidence to suggest that it reduces pain or disability. A Cochrane review of low-grade laser therapy found unclear evidence about the benefits, while other reviews found short-term pain relief for osteoarthritic knees.
Further research is needed to determine whether balnotherapy for osteoarthritis (mineral bath or spa treatment) improves a person's quality of life or ability to function. The use of ice or cold packs may be useful, but more research is needed. There is no evidence of the benefits of placing heat packs on the joints.
There is low quality evidence that therapeutic ultrasound may be beneficial for people with knee osteoarthritis, but more research is needed to confirm and determine the degree and significance of this potential benefit.
There is weak evidence to suggest that electromagnetic field treatment can produce moderate pain relief, but further research is needed and it is not known whether electromagnetic field treatment can improve the quality of life or function.
Epidemiology
Globally, in 2010, about 250 million people had knee osteoarthritis (3.6% of the population). Osteoarthritis of the hip affects about 0.85% of the population.
In 2004, global osteoarthritis caused moderate to severe disability in 43.4 million people. Together, knee and hip osteoarthritis has a rank for global disability among the 291 conditions of the assessed disease.
United States
In 2012, osteoarthritis affects 52.5 million people in the United States, about 50% of whom are 65 years of age or older. It is estimated that 80% of the population has radiographic evidence of osteoarthritis by age 65, although only 60% of those will have symptoms. The rate of osteoarthritis in the United States is estimated to be 78 million (26%) adults by 2040.
In the United States, there are about 964,000 hospitalizations for osteoarthritis in 2011, a fixed rate of 31 per 10,000 population. With a combined cost of $ 14.8 billion ($ 15,400 per stay), it is the second most expensive condition seen in US hospitals fixed in 2011. With payers, it is the second most expensive condition billed to Medicare and insurance personal.
History
Evidence for osteoarthritis found in the fossil record is studied by paleopathologists, ancient disease specialists and injuries. Osteoarthritis has been reported in large carnivorous dinosaur fossils Allosaurus fragilis .
Human knee osteoarthritis may have doubled since the mid-20th century, per study of the skeleton.
Etymology
Osteoarthritis comes from the prefix osteo - (from Ancient Greece: ?????? , translit.Ã, ostÃÆ' Â © on , lit.Ã, 'bone') combined with arthritis (from , lit. 'from or in combination' ), derived from arthr - (from ?????? , ÃÆ'¡rthron , lit. 'joints, limb ') and -itis (from - - ???? , - ÃÆ'®tis , lit. 'related to' ), i the last hiran is finally associated with inflammation. The -itis of osteoarthritis can be considered misleading because inflammation is not a prominent feature. Some doctors refer to this condition as osteoarthrosis to indicate the lack of an inflammatory response, the suffix -osis (from > , - sis , turned on. '(not normal), conditions, or actions ') refers only to the pathosis itself.
Research
There is an ongoing effort to determine if there are agents that alter the results in osteoarthritis. Sprifermin is one of the drug candidates. There is also transient evidence that strontium ranelate can decrease degeneration in osteoarthritis and improve yield.
As well as trying to find disease-modifying agents for osteoarthritis, there is growing evidence that a system-based approach is needed to find the cause of osteoarthritis. Changes can occur before clinical disease is proven because of abnormalities in biomechanics, biology or joint structures that influence them to develop clinical disease. Such research focuses on defining early pre-osteoarthritis changes using biological, mechanical, and osteoarthritis risk markers, emphasizing a multidisciplinary approach, and seeking personalized interventions that can reverse the risk of osteoarthritis in healthy joints before illness becomes apparent.
Gene transfer strategies aim to target disease processes rather than symptoms.
Cell-mediated gene therapy is being studied. One version is approved in South Korea for the treatment of moderate knee osteoarthritis. By 2017, it was not approved in the United States, where it was developed. This drug is given intra-articular.
Biomarkers
The guidelines outline the requirements for the inclusion of soluble biomarkers in osteoarthritis clinical trials published in 2015, but to date no biomarkers have been validated for osteoarthritis. A systematic review of 2015 biomarkers for osteoarthritis looking for molecules that can be used for risk assessment found 37 different biochemical markers of bone and cartilage turnover in 25 publications. The strongest evidence is for urinary C-terminal telopeptide of type II collagen (uCTX-II) as a prognostic marker for the development of osteoarthritis of the knee and protein oligomer oligomer protein serum (COMP) as a prognostic marker for the incidence of knee and hip osteoarthritis. A review of biomarkers in osteoarthritis of the hip also found association with uCTX-II. The level of procollagen II C-terminal propeptide (PIICP) reflects the synthesis of type II collagen in the body and in the level of PIICP joint fluid can be used as a prognostic marker for early osteoarthritis.
One problem with the use of specific type II collagen biomarkers from articular cartilage breakdown is that the amount of cartilage decreases (disappears) over time with disease progression. As a result, a patient can ultimately have advanced osteoarthritis with none of these biomarkers detected in their urine. Another problem with systemic biomarkers is that patients may develop osteoarthritis in several joints at different stages of the disease at the same time, so that biomarker sources can not be determined. Some other collagen-splitting products in synovial fluid correlate with each other after an acute injury (known to cause secondary osteoarthritis) but not correlated with severity of injury.
References
External links
- American College of Rheumatology Factsheet in OA
- The Arthritis Foundation
- National Institute of Arthritis and Musculoskeletal and Skin Diseases
Source of the article : Wikipedia
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