Osteoarthritis

What is Osteoarthritis?

OSTEO – BONE
ARTHRO – JOINT
ITIS – INFLAMMATION

Osteoarthritis is defined as an Inflammation of the bone & joint characterized by joint degeneration, pain & functional limitation. So it’s an inflammatory degenerative arthritis. Historically, osteoarthritis (OA) was known as a “wear and tear” of the articular cartilage. But actually, it is a disease of the entire joint, including bone, cartilage, ligaments, muscles, and the tissues lining the joint (the synovium).

How common is Osteoarthritis?

In 2019, Safiri S reported data from the Global Burden of Disease (GBD) study showing that osteoarthritis (OA) affected many people worldwide.

The age-standardized prevalence of OA was 3,754 cases per 100,000 people, and the annual incidence was 181 cases per 100,000, both showing an increase since 1990.
The Years Lived with Disability (YLD) rate due to OA was 118.8 per 100,000, a 9.6% increase from 1990.
OA was more common in women than men and became more frequent with age.

Types of Osteoarthritis:

It can be classified into two categories: primary osteoarthritis and secondary osteoarthritis.

Primary OA – It is generally age-related/genetic. As joints age, the water content of cartilage increases while the collagen and other proteins that make up cartilage are broken down. Bone remodelling occurs over time in the degenerative joint, forming spurs and bone cysts.

Secondary OA – It is related to injury or other diseases, such as metabolic diseases. Other causes could include trauma, post-surgical complications, congenital abnormalities, hormonal disorders, gout, rheumatoid arthritis, and other inflammatory disorders.

What are the 4 stages of Osteoarthritis?

Stage 1 (Early Arthritis)

Stage one is considered early or doubtful OA. It is an asymptomatic stage. But inside the joint, there will be inflammation and initiation of cartilage degradation. However, at this point, the space between the joints wouldn’t narrow.

Stage 2 (Moderate Arthritis)

During stage two, bone spurs grow and become painful. The space between joints may begin to narrow a little. There will be a remarkable breakdown of the cartilage

Stage 3 (Advanced Arthritis)

In stage three, the cartilage between the bones begins to show signs of wear, along with that, other structures of that joint also get affected. The space between joints becomes visibly narrower. More bone spurs may develop, and they can enlarge.

Stage 4 (Severe)

There might be a complete loss of cartilage. The space between the joints is much smaller, and there is less synovial fluid to lubricate the joints. The bone spurs are much larger. Deformities may occur in this stage.

What are the 5 common Osteoarthritis symptoms?

Joint Pain during activity/ joint loading (load-induced pain)
Morning stiffness < 30 minutes
Limited joint Range of Motion & joint swelling
Clicking or popping sound (crepitus) during movements
Muscle weakness/ wasting around the joint

What is the main cause of osteoarthritis?

OA is largely influenced by age, genetics, and lifestyle factors. The risk factors that contribute to the development of OA include,

Age. The risk of developing OA increases with age as cartilage naturally wears down over time. But nowadays, young people are also affected by OA due to the following factors.
Joint injury. Previous joint injuries, such as fractures or ligament tears, can increase the risk of OA later in life.
Overuse. Using the same joints over and over in a job or sport can result in OA.
Obesity: Excess weight adds stress and pressure on a joint; additionally, fat cells promote inflammation and accelerate OA.
Musculoskeletal abnormalities: Abnormal joint alignment or deformities can cause uneven stress on joints and lead to OA over time
Weak muscles: Weak muscles around a joint can lead to instability and an increased risk of joint damage, which can contribute to OA
Genetics: People with family members who have OA are more likely to develop it.
Gender: Women are more likely to develop OA than men.
Lifestyle: A sedentary lifestyle increases the risk of OA by accelerating inflammation.
Other Medical Conditions: Certain conditions, like diabetes, metabolic syndrome, and other joint disorders, can increase the risk of developing OA.

Is Osteoarthritis lifelong?

Yes. Osteoarthritis is a preventable & treatable disease, but not a curable condition. So we can manage and live happily without flaring up the symptoms in our entire life through proper Physical therapy rehabilitation.

How is Osteoarthritis Diagnosed?

In diagnosis, history plays a major role, then we can confirm the diagnosis with the help of physical examination and investigations.

Diagnostic features:

Frequent joint pain
Pain during activity (load-induced pain)
Pain will subside with rest
Morning stiffness < 30 minutes
Joint swelling
Limited joint ROM
Palpable crepitus
Presence of any Risk factors
Muscle weakness around the joint.
Deformities may be seen in the end stage.

Other Investigation

1) Blood test

Elevated Erythrocyte Sedimentation Rate (ESR)
Elevated C-reactive protein
Reduced vitamin D

2) X-ray

It’s not necessary to diagnose OA by X-ray.
History, physical examination & blood test are sufficient to confirm Osteoarthritis.
To rule out other pathologies/ for differential diagnosis, we can prescribe an X-ray.
Because x-ray changes will psychologically depress the patient, it will affect their quality of life & lead to kinesiophobia.

How is Osteoarthritis treated?

Treatment goals for osteoarthritis are to minimize both pain and functional loss. Comprehensive management of the disease involves both conservative and surgical treatment.

Conservative Treatment:

1) Pharmacological Treatment

Anti-inflammatory medications (NSAIDs)

- Weak opioids & steroids
- Intra-articular injections

Chondro-productive agents

Platelet-rich plasma (PRP) injection

Stem cell injection

2)Physiotherapy Treatment:

Physical therapy treatments should not be based on the stages of Osteoarthritis. It’s always based on the patient’s symptoms, perspective of pain, functional limitations, and their mental well-being.
The main goal of physical therapy treatments is to address the root cause. So in Osteoarthritis, treatment should focus on reducing the body’s inflammation and improving their quality of life.

Therapeutic exercise:

For all people with osteoarthritis, we need to offer tailored therapeutic exercise based on their needs and goals.
Adequate Joint loading is very much essential for cartilage health, regeneration, and bone health.
Educate the patients that even though exercise may initially cause some pain or discomfort, it will be beneficial for their joints. Long-term adherence to exercise increases its benefits by reducing pain, increasing function, and improving quality of life.
Consider combining therapeutic exercise with an education programme and behaviour change approaches in a structured treatment to achieve better outcomes.

Weight management

Weight loss will improve their quality of life and physical function, and reduce pain
Any amount of weight loss is likely to be beneficial, but losing 10% of their body weight is likely to be better than losing 5%.

Other Treatment Approaches

If discussing manual therapy, electrotherapy, acupuncture, and other quackery treatments (Dry needling, cupping), there is not enough evidence to support their use alone for managing osteoarthritis.

Surgical Treatment

Total/partial joint Replacement (Arthroplasty):

Consider referring people with osteoarthritis for joint replacement if their joint symptoms (such as pain, stiffness, reduced function, or progressive joint deformity) are substantially impacting their quality of life and non-surgical management (for example, therapeutic exercise, weight loss, or pain relief) is ineffective or unsuitable.

Total Joint Replacement
Partial Joint Replacement

Joint fusion (Arthrodesis):

It is a surgical procedure that permanently joins all the bones in a joint, often used to treat severe osteoarthritis when other treatments fail, particularly in the foot, ankle, and spine.