OSTEOARTHRITIS

What is osteoarthritis and how does it occur?

Osteoarthritis, popularly known as calcification, is the most common joint disease caused by deterioration in the structure of the cartilage tissue in the joints, thinning and wear of the cartilage tissue.

In osteoarthritis, the bone under the cartilage, which becomes thinner and loses its protective properties, thickens, and bone protrusions called osteophytes form on the edges of the joint. The synovial membrane surrounding the joint thickens and the amount of synovial fluid increases. This is swelling of the joint. The joint capsule and the ligaments supporting the joint contract to support the damaged joint and protect it from harmful movements. This process gets out of control after a while and a vicious cycle begins. As a result, limitation of movement and adhesions in the joint develop, and in the later period, shape changes develop.

What are the Causes and Risk Factors?

• Age is the most important risk factor in the development of OA. Especially after the age of 45, the rate of OA development increases as a result of decreased muscle strength supporting the joint with advancing age, impaired joint biomechanics, and wear and tear in the cartilage structure.
• Gender, especially in the older patient group with severe course, the female gender is more affected in OA developing in the knee and hand joints.
• Familial predisposition, OA is not an inherited disease. Some types of OA, for example, in the perimenopausal period and the form involving many joints show a familial tendency, and familial predisposition can also be observed in the type that starts at an early age and wears out the joint.
• Obesity is an important risk factor for OA. In people who weigh more than the ideal body weight, the joint wears out in a shorter time with excessive load on the joint, deformity and limitation of movement develop in a short time, and obesity increases even more with the decrease in daily movement. In obese people with osteoarthritis, even a very small weight loss greatly reduces the complaints. For example, losing 5 kg reduces the load on the knee by 15-20 kg. Because during normal walking, the load on the knee is 3.5 times your body weight.
• Hypermobility; The joint can move more than its normal movement. This extra movement ability damages the joint and surrounding tissue.
• Weakness of the muscle tissue around the joint; increases the load on the joint and early deformation occurs with wear and tear.
• Trauma; A serious injury to a joint or surgery on the joint may cause osteoarthritis in this area in the following years as it disrupts the cartilage structure and surface of the joint. In rheumatic diseases, joints are subjected to wear and tear above the normal process.  Therefore, some congenital or childhood joint abnormalities, such as Perthes' disease in the hips, can also lead to osteoarthritis later on.
•  Normal activity and exercise are not bad for the joints, they are extremely good and do not cause osteoarthritis. However, difficult and repetitive activities can cause joints to hurt. This explains why osteoarthritis is more common in people with physically demanding jobs, such as farmers (hip osteoarthritis) and professional footballers (knee osteoarthritis). 

How often is it observed?

OA is the most common joint disease. When taken as a whole, OA, which usually starts at the age of 45, affects 10-20% of people over the age of 65. It is the main source of pain and disability in old age.

Diagnosis and Clinical Course

The diagnosis is made with swelling in the joint, sound coming from the joint, detection of pain with movement, limitation in movements and anamnesis taken from the patient in the evaluation of the joint in physical examination. Further imaging of the joint with radiography or, if necessary, MRI, CT is performed. It is typical to see thinning of the articular cartilage and narrowing of the joint space, new bone formations called osteophytes on the joint edges.

Clinical course;

It is a disease that can involve all body joints. Knee, hip, foot joints, which are the most weight-bearing joints, hand joints that are used a lot in daily life and the joints of the waist - neck region in the spine are affected.

Knee Joint Osteoarthritis;

Osteoarthritis of the knee joint is more common in women and is seen especially after the age of 50. Overweight, past knee traumas, previous operations are the factors that increase the risk of osteoarthritis in the joint the most. Usually both knee joints are involved, the first symptom is pain and sometimes limitation of movement is added to this.  In advanced cases, daily life activities such as climbing up and down stairs, sitting, squatting are significantly restricted due to deformities.

Osteoarthritis of the hip joint;

Osteoarthritis of the hip joint is seen equally in men and women, mostly after the age of 40. Unilateral involvement is more common. Osteoarthritis may develop at an advanced age in patients with congenital hip dislocation or in those who have had a disease involving the rheumatic joint in the previous period.

Osteoarthritis of the hand joints;

Hand joints are the most used joints in daily life. The joints are small, but the restricted joint due to osteoarthritis negatively affects daily life.

Osteoarthritis of the foot joints;

It is most commonly observed in the joint at the root of the big toe. Painful swelling occurs in this joint and the joint becomes stiff and difficulty in walking may occur in later periods. This is called hallux rigidus.

Osteoarthritis affecting the spine;

Osteoarthritis of the lumbar and cervical region is especially common. Clinically, pain, limitation of movement, and sometimes pain radiating to the arms and legs are observed in these regions.

In spinal arthrosis, bone and discal structure wears out.

What should I expect if I have osteoarthritis?

• It is not a disease that always gets worse.
• Sometimes it is milder, sometimes more vigorous.
• Except for advanced cases, people continue their normal lives.
• Quality of life is not restricted with timely treatment.

What are the symptoms of osteoarthritis?

Osteoarthritis is a process that develops slowly over the years and is part of normal ageing.  It can involve almost all joints.  In some people, the process is slow and calm, but in some individuals it is more noisy and deformities develop in a short time. The severity of the disease varies even in people of the same age and with the same joint involvement. The disease may remain unchanged for years or it may become active and then calm down again.

The main symptoms are pain and limitation of movement. Pain increases during and after intensive use of the joint and decreases with rest. The stiffness seen after resting opens in a short time with the movement of the joint. Especially in superficial joints such as the knee joint, sound may be heard from the joint due to the deteriorated cartilage surface.

In some advanced cases, pain is observed not only during movement but also at rest. In these cases, activities of daily living are mostly restricted.

Treatment Methods

• Patient education,
• Joint protection and energy saving techniques,
• Use of assistive devices when necessary,
• Medication
• Physiotherapy and rehabilitation programmes,
• Surgical treatment when necessary.

Patient education;

There is no definitive treatment for osteoarthritis. Part of the disease is joint wear and tear that develops with normal aging. The aim is to prevent the rapid and bad course of the disease and the restriction of the vital activities of the people.

In researches, the incidence of osteoarthritis in people with low education level has been found to be high. With the education of the patients, the disease can be detected early and necessary precautions can be taken without significant wear and tear in the joint.

To protect the joint;

Reducing the pressure on the joint;

• Maintaining the ideal weight,
• Activities during the day should be organised, work should be done by resting, not continuously.
• Joints should be protected and movements that strain the joints should be avoided.
• Orthopedic, stable shoes that can absorb shock should be preferred.

Activity and exercise;

• Movements that damage the joints should be avoided.
• Strengthening the muscles and tendons around the joint will reduce the load on the joint.
• Muscles should be strengthened with exercises suitable for the joint.
• It is important to reduce the intensity of daily life activities and spread them throughout the day.

Benefits of exercise;

• Increases the usability of the joint by reducing weakness in the joint.
• Protects the joint from further damage, prevents wear and tear.
• Prevents disability and improves quality of life.

Energy saving in daily life;

• It is the establishment of a balance between physical activity and rest.
• It is not laziness.
• Performing unnecessary movements during the day brings more harm than good.
• If joint rest is necessary, the pace of daily life should be reduced accordingly.
• If a long-term activity is to be done, sitting in a suitable position should be preferred instead of standing.
• Place the materials you need frequently in places you can access easily.
• If possible, use lifts or ramps instead of stairs.
• Do not sit or kneel on the floor.
• Reduce the weights in your hands and carry them in a balanced way.

Use of assistive devices and medication;

People should use assistive devices such as knee braces, corsets, canes that support the joint when necessary.