Osteoarthritis – the difficulty of moving

Today’s article is about one of the most debilitating diseases of the joints, with a global prevalence of over 10% in patients over 60 years old and is the leading cause of total hip and knee replacement. (1)

Osteoarthritis is a common joint disease, especially in women, characterized by the destruction of cartilage, which extends to all structures of the joint, including synovial tissue and bone.

The occurrence of osteoarthritis

Currently, the mechanisms of the disease are not fully known, but have become of interest in research. One hypothesis is that, with the loss of knee cartilage thickness, the two bones of the articulation (knee, hip, etc) no longer slip in place correctly, leading to pain or immobility.

The etiology is multifactorial

The destruction of cartilage is closely related to a number of factors, such as age, genetic factors, metabolic disorders (obesity, hormonal status, recreational activities) and the various mechanical stresses, accidents, muscle weakness, joint fragility, anatomical abnormality or sequelae (fractures, neglected sprains, dislocations, dislocation of the meniscus). Other diseases, such as rheumatoid arthritis, condrocalcinoza, osteonecrosis are thought to be involved in fostering the emergence of this disease.

Osteoarthritis is common in those over 65 years

Only 3% of the population under 45 years old is affected by osteoarthritis, the percentage increases dramatically in patients over 80 years of age (from 70 to 80% of patients in this population).

The frequency of the disease varies depending on its location in the body

Spine osteoarthritis is mostly common in the 65-75 years age group (70 – 75% of patients), but remains the “quietest” in terms of signs and symptoms.

Osteoarthritis of the fingers has an incidence of 60% in elderly patients and can lead to irreversible deformations in the fingers and hands. It is painful and disabling, limiting mobility and dexterity.

Osteoarthritis of the knee and hip has a prevalence of between 10-30% in patients aged 65-75 years. This type of osteoarthritis is painful, presenting signs and symptoms because it affects large joints that bear the weight of the entire body.

Shoulders, elbow, wrist and ankle are rarely affected.

Obese people have double the risk of developing osteoarthritis in the hands compared to people with a normal BMI!

Disease diagnosis is based on clinical examination and radiography of the joints

  • Standard radiography – imaging method of choice, easy to obtain.
  • Computed tomography (CT scan) – rarely used in the diagnosis of primary osteoarthritis applied in the diagnosis of malignancy from the patellofemoral joint, the foot and ankle.
  • Magnetic resonance imaging (MRI) – allows direct visualization of articular cartilage and other tissues, and is used in case of suspicion of an associated pathology following surgery.
  • Ultrasonography – used to monitor cartilage degeneration, when administering injections in less accessible areas for classic imagistics.
  • Bone scan – allows early diagnosis of osteoarthritis of the hand and differentiation of osteomiletă osteoarthritis and bone metastases.

It is recommended that you do a medical examination (rheumatologist) every 1-2 years. In older patients (over 60 years) an exam is recommended every 6 months-1 year because of higher prevalence of osteoarthritis in this age group.

The disease evolution is unpredictable

Evolution is fast and patients may require prosthesis, for example ones for hip or knee. In some cases you can have a slow evolution, over many years, without inducing a major handicap.

Two phases of the disease have been described, succeeding unpredictable: the chronic phase varies daily discomfort, pain is moderate, interspersed with acute attacks of painful swelling of the joints accompanied usually during the day and overnight.

During the chronic phase it is recommended to maintain regular physical activity with rest periods.

The second phase, called the acute phase, is characterised by 3 particular symptoms: inflmmation, warmth and sharp pain of the affected articulation. These symptoms can last from a few hours, days up to weeks. If the symptoms last more than 6 months, we are talking about an acute osteoarthritis.

Non-pharmacologic therapy:

  • Patient education;
  • Weight loss;
  • Specific physical exercises affected joint;
  • Avoiding to carry weight;
  • Using a stick, especially in painful crises;
  • Using orthopedic shoes, in case of knee osteoarthritis.

Osteoarthritis media

Pharmacological treatment is symptomatic. There is no effective clinically proven therapy  that can protect cartilage from damage!

Drug treatment should always be adapted to the different types of pain and in association with the non-pharmacolgic therapy.

Pharmacological therapy for osteoarthritis:

  • Topical analgesic application (capsaicin) or oral (paracetamol, opioids in serious cases);
  • Anti-inflammatory drugs (NSAIDs) with oral or dermal application;
  • Intra-articular corticosteroid injection administration;
  • Hyaluronic acid by intra-articular administration, plays an important role in the recovery of the synovial fluid;
  • Supplements: chondroitin sulfate, glucosamine sulfate. (2)

Surgery includes:

  • Arthroscopy -for examining injuries;
  • Osteotomy – for bone resection;
  • Arthroplasty – to play a joint spondylitis movements, particularly of the hip and knee.

Non-pharmacological treatment is very important in patients with osteoarthritis! Coupled with symptomatic treatment can greatly improve the lives of patients and decrease hospitalizations caused by the disease.

Another important aspect in patients suffering from osteoarthritis is the need to maintain a positive mental state. Given that it is a disease that can cause major disability, patients run the risk of depression, be anxious to suffer from insomnia and develop other problems linked to poor mental state.

Communication, information, discussions with relatives and medical professionals (doctors, pharmacists, etc.) are important issues that should not be neglected!

The Pharmacists,

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(1) Zhang Y, Jordan JM. Epidemiology of Osteoarthritis. Clinics in geriatric medicine. 2010

(2) D. Uebelhart, Clinical review of chondroitin sulfate in osteoarthritis, Osteoarthritis and Cartilage, 2008

(3) Osteoarthritis, NYTime Health

Andrei Baiceanu and Nicoleta Spinu are the authors of this article. The creator for the cover image is Xenia Morgun.

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