Degenerative Joint Diseases (Osteoarthritis)

Degenerative Joint Diseases (Osteoarthritis)
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Degenerative Joint Diseases

Osteoarthritis is the most common joint disease known in the world.

It is a degenerative joint disease characterized by regional loss of cartilage, bone changes in the area under the cartilage and at the edges of the joint, thickening of the joint capsule surrounding the joint, and accompanying varying degrees of synovitis, the inflammation of the joint membrane.

  • Osteoarthritis is the most common joint problem that causes physical disability in the world.
  • It affects all races and both sexes.
  • The age of onset is usually over 40 years.
  • In more than 80% of individuals over 55 years of age, it is detected when a film is taken.
  • The frequency of clinical and radiological screening is:
    • <30 years old individuals: 1.2%
    • Around 40 years old: 10%
    • > 60 years old individuals: More than 50%

Most Commonly Affected Joints

  • Cervical and lumbar spine (neck and lumbar vertebrae)
  • Carpometacarpal joint (base of the thumb)
  • Proximal interphalangeal joints
  • Distal interphalangeal joints
  • Hip
  • Knee
  • Subtalar joint
  • Metatarsophalangeal joint

Rarely Affected Joints

  • Shoulder
  • Wrist
  • Elbow
  • Metacarpophalangeal joints

What Are The Risk Factors For Osteoarthritis?

  • Advanced age
  • Female gender
  • Genetics
  • Obesity
  • Diet
  • Lack of osteoporosis
  • Occupation
  • Sporting activities
  • Previous injury
  • Mechanical factors
  • Proprioceptive deficits
  • Muscle weakness
  • Acromegaly
  • Calcium crystal deposition disease

What Should We Know About Exercise In Osteoarthritis?

  • There is an increased risk of osteoarthritis development in neuroanatomically normal joints if insufficient exercise is not done.
  • The risk of osteoarthritis development in neuroanatomically normal joints does not increase if exposed to repetitive low-intensity recreational exercises.
  • The risk of osteoarthritis development in neuroanatomically abnormal joints increases if exposed to repetitive low-intensity recreational exercises.
  • The risk of osteoarthritis development in neuroanatomically normal joints increases if exposed to repetitive high-intensity exercises.

In summary, if your joint is healthy and you do not exercise at all, you are at an increased risk of osteoarthritis. Light exercises do not increase the risk of osteoarthritis in healthy joints. If your joint is healthy but you are overdoing sports, your risk of osteoarthritis has increased.

Even low-intensity exercise in a joint that has been damaged for any reason is a risk factor for osteoarthritis.

 

Not everyone with osteoarthritis is affected in their daily life. What are the risk factors for disability development in people with osteoarthritis, that is, restriction of daily living activities?

  • Other risk factors include
  • Impaired proprioception (body awareness)
  • Joint malalignment
  • Reduced range of motion
  • Reduced aerobic fitness
  • The presence of comorbidities (other diseases such as hypertension and diabetes)

In the classification of osteoarthritis, we divide the disease into primary and secondary.

 

  • Primary osteoarthritis is a type of osteoarthritis that is not caused by any underlying medical condition. It can be localized to one or more joints, such as the hands, feet, hips, knees, or spine.
  • Secondary osteoarthritis is a type of osteoarthritis that is caused by an underlying medical condition, such as an injury, congenital or developmental disorder, calcium pyrophosphate dihydrate deposition disease (CPPD), other bone and joint diseases (osteonecrosis, rheumatoid arthritis, gout, septic arthritis, Paget’s disease), or other diseases (diabetes mellitus, acromegaly, hypothyroidism, neuropathic arthropathy).

We can also classify the disease according to the joint involved, as monoarticular (in one joint), oligoarticular (in a few joints), or polyarticular (widespread, in many joints).

The main areas of involvement within the joint vary from joint to joint.

  • In the hip: superolateral, medial, or concentric
  • In the knee: medial, lateral, or patellofemoral
  • In the hand: IP joints and 1st CMC joint
  • In the spine: facet joints or intervertebral joints
  • If we look at how osteoarthritis develops, we can talk about 2 basic mechanisms that lead to its onset.
  • Osteoartrit patogeneziDamage to normal articular cartilage by physical forces: by macrotrauma or by repetitive microtrauma. Release of destructive enzymes from chondrocytes (cartilage cells) and formation of an inadequate repair response.
  • Cartilage that is initially defective/damaged cannot provide an adequate response to normal joint loading: type II collagen gene defect, ochronotic cartilage

What Are The Complaints That Patients With Osteoarthritis Come To Us With?

  • Pain: increases with activity and decreases with rest.
  • Swelling
  • Stiffness

What Do We Find When We Examine Patients With Osteoarthritis?

  • Crepitus (popping or crunching sound)
  • Bone growth
  • Reduced range of motion
  • Pain on palpation
  • Deformity

What Do We See On X-rays Of Patients With Osteoarthritis?

  • Asymmetric narrowing of the joint space
  • Sclerosis (eburnation) of the subchondral bone
  • Marginal osteophytes at the joint margins
  • Subchondral cysts

What Are The Expectations From Laboratory Tests In Our Patients With Osteoarthritis?

  • There is no specific diagnostic test for osteoarthritis in laboratory tests. The purpose of the tests is to make a differential diagnosis, that is to exclude other diseases.
  • In particular, in joints where we detect swelling, we aim to exclude inflammatory rheumatic diseases or infection by examining the fluid (synovial fluid analysis) taken from the swollen joint.

In patients with suspected osteoarthritis, especially those with hip or knee involvement, the following laboratory investigations are recommended if possible.

  • Erythrocyte sedimentation rate (ESR)
  • Rheumatoid Factor
  • Synovial fluid analysis
  • Radiographic imaging of the affected joint

Osteoarthritis is diagnosed by physical examination findings, laboratory and imaging modalities together with the presence of typical symptoms. It is important to make a differential diagnosis for idiopathic OA. There is no sensitive or specific diagnostic clinical finding. If there is involvement of rarely affected joints, an underlying cause should be investigated. If articular cartilage calcification (chondrocalcinosis) is present, it should be remembered that this may be a clue to an endocrine, metabolic or hereditary disease predisposing to osteoarthritis.

Severe acute joint pain is a rare presentation for osteoarthritis. In this case, synovial aspiration is recommended so that a differential diagnosis can be made.

Treatment of osteoarthritis is individualised.

What Are The Treatment Goals?

  • Informing the patient
  • Reducing complaints
  • Facilitating daily life
  • Slowing down structural damage and/or progression

What Is Done To Achieve These Goals?

  • Education and preventive measures
  • Psychological support
  • Physical therapy and exercise
  • Assistive devices (orthotics, shoes, walking aids)
  •  Systemic drug therapies
  • Intraarticular (joint) drug therapies
  • Topical (externally applied) drug therapies
  •  Hydrotherapy and spa treatment
  •  Surgical treatment
  •  Education and preventive measures
    • Understanding the factors that cause excessive joint loading
      • Avoiding activities that place excessive load on the affected joint
      • Hip and knee osteoarthritis: avoiding prolonged standing, not kneeling on the knee
    • Weight loss and other dietary recommendations
      • 5A 5-kilogram weight loss leads to a 50% reduction in the risk of symptomatic knee osteoarthritis

The Place Of Physical Therapy In The Treatment Of Osteoarthritis, And When Is Physical Therapy Recommended?

  • Joint range of motion limitation
  • Muscle atrophy and joint instability
  • Joint malalignment and abnormal joint use
  • Physical therapy is recommended if the symptoms are severe and do not respond to other treatments.
  • What are the goals of physical therapy?
    • To maintain and improve joint range of motion
    • To increase and maintain muscle strength
    • To correct joint biomechanics to prevent overload
    • To relieve pain, stiffness, and other symptoms

When We Say Pharmacological Treatment, What Treatments Does It Include?

  • Simple pain relievers: acetaminophen
  • Local applications: Heat-cold applications
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Opioids and antidepressants
  • Joint injections: steroids, ozone, hyaluronic acid, prp, etc.
  • Dietary supplements
  • Food supplements
  • Disease-modifying osteoarthritis drugs (DMARDs)

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