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Osteoarthritis

Everything you need to know about the disease

• What is osteoarthritis?
• What is a joint?
• Is osteoarthritis common?
• What are the joints most affected by osteoarthritis?
• What is the most common symptom of osteoarthritis?
• Aside from pain, what are the most common symptoms caused by osteoarthritis?
• What are the causes of osteoarthritis?
• How is osteoarthritis diagnosed?
• Is osteoarthritis a crippling disease?
• How can we prevent the progressive wear and tear of joints with osteoarthritis?
• Is physical activity beneficial for osteoarthritis?
• What is the treatment for osteoarthritis?
• What is chondroprotection?
• What is a chondroprotective drug?
• How do chondroprotective drugs work?
• Which orally administered chondroprotectors are available?
• Osteoarthritis Myths




What is osteoarthritis?

Osteoarthritis is a chronic disease of the locomotor system caused by the degeneration or wear and tear of joints. It is one of the most common aging processes, in particular during the second stage of life, and in general it is progressive, affecting the articulations of the vertebral column as well as knees, hands and hip, in particular in the joints that bear the body’s weight.




What is a joint?

Joints are the structures connecting two bones: elbow, knee, hip, etc. The joint cartilage is the key tissue in a joint, for it covers the joint surfaces of the bones’ tips. The functions of the cartilage include facilitating the “sliding” of the joint surfaces and to act as a shock absorber of the forces acting inside the joint.


Is Osteoarthritis a common disease?

Osteoarthritis is a common condition that becomes more prevalent as we age. At age 35, 50% of people have symptoms of this condition. This figure climbs to 80% after age 55, and to 85% after age 65. There is a remarkable difference between sexes, with 29.4% of men and 52.3% of women being affected.


What are the joints most affected by osteoarthritis?

The most common locations of osteoarthritis are: knees (gonarthrosis), certain joints in the hands (distal and proximal interphalangeal joints, rhisarthrosis), hips (Coxarthrosis) and small spinal joints (spondyloarthritis)


What are the most common symptoms of osteoarthritis?

Although pain is the most common symptom of osteoarthritis, there are painless variants of this disease. Osteoarthritis-associated pain is easy to identify: it begins with movement and ceases when resting. Osteoarthritis is a chronic disease that alternates periods without pain in which the patient can carry out normal physical activities (according to their age and physical condition) with periods of joint pain.


Aside from pain, what are the other symptoms of osteoarthritis?

Along with pain, the patient might hear “cracks” when moving the affected joint. He may occasionally suffer from intermittent joint effusion (presence of fluid in the affected joint). In advanced osteoarthritis there may be a limitation of the mobility of the joint as well as deformities (such as nodules on the fingers).


What are the causes of osteoarthritis?

The exact causes of osteoarthritis are still unknown, although there are risk factors associated with its onset. Age is a factor that is correlated with the onset of osteoarthritis. Repetitive joint motions may cause joint overload. This is why certain jobs (hairdressers, construction workers, etc) and certain sports are associated with the onset of osteoarthritis in certain joints. Obesity may not cause the development of osteoarthritis, but it can make it worse in certain joints (knees). Genetic factors have been associated with certain types of osteoarthritis. Older fractures may also favor the onset of osteoarthritis.


How is osteoarthritis diagnosed?

Osteoarthritis is diagnosed by its symptoms and by complimentary X-ray imaging. The most frequent findings of x-rays are the wear and tear of the joints. It is important to point out subsequent x-rays are not helpful, because the images will not contribute new data or change the treatment. Blood tests are not useful for the diagnosis of osteoarthritis. They are useful only to reject diagnoses associated with other rheumatic diseases.


Is osteoarthritis a crippling disease?

In most cases it is not an incapacitating disease, and although there isn’t a cure, we have at our disposal efficient therapies to improve pain, mobility and delay the disease’s progression.


How can we prevent the progressive wear and tear of joints caused by osteoarthritis?

Osteoarthritis joints suffer from a certain degree of wear and tear, and, therefore, we must use them carefully, avoiding overload and excess effort.
Use other stronger, less damaged joints, and engage in moderate exercise during the painless phases. Rest during pain outbreaks.
Use canes, crutches or walkers to relieve our joints from extra weight.
It is very important to avoid the overload caused by excess weight (obesity). Losing weight can be useful to improve the symptoms of osteoarthritis.


Is physical activity good for osteoarthritis?

Physical activity is highly beneficial for osteoarthritis: walk, bicycle riding, swim, in a regular, moderate way (several times per week for about 30 minutes). If the physical activity causes intense pain or pain that lasts for more than one hour after finishing it we must decrease its intensity. Watch out! If there is a pain outbreak, we need to take a rest.


What are the treatments for osteoarthritis?

As for the pharmacologic treatment for osteoarthritis, there isn’t currently any curative drug, but we have at our disposal drugs that improve pain and joint mobility and which can delay the progression of the osteoarthritis process. Therefore, it is absurd to suffer pain and do nothing-pain can be improved.

Moderate exercise, such as walking on flat terrain or bicycle riding is positive for knee and hip osteoarthritis; hand exercise is positive for finger osteoarthritis.

Pain-causing exercises must be avoided. We can’t engage in exercise during days of intense pain. It is best to take a few days rest. When knee or hip osteoarthritis hinders mobility, pain is intense and it cannot be improved with drugs, it is time to think about a surgical intervention. Before taking that decision, however, we must take into account the age and general health of the patient.


What is Chondroprotection?

Chondroprotection is the ensemble of actions aiming at preventing, delaying or repairing degenerative injuries in the joints. These measures are the following:

  • Avoid joint damage: sports injuries, joint diseases, all types of trauma
  • Protect the joint and delay its wear and tear: avoid being overweight, proper postures when sitting or working, moderate physical exercise to strengthen the muscles.
  • Undertake surgery or follow a medical treatment (analgesics, anti inflammatory or chondroprotector drugs) to treat inflammatory processes and joint cartilage injuries.

What is a chondroprotective drug?

Chondroprotective drugs are those drugs that protect the joint cartilage, subchondral bone and synovial membrane, which are the structures forming the joint. These drugs encompass the ones that preserve the cartilage and delay the progression of osteoarthritis.


How do chondroprotective drugs work?

The beneficial effects of a chondroprotective treatment are the following:

  • Improvement of pain and mobility
  • Less analgesic and anti-inflammatory drugs needed
  • Delay of the osteoarthritis’ progression

Chondroprotective drugs improve pain and functional limitation in osteoarthritis two to three weeks after the beginning of the treatment. Its effect lasts sometime after ending the treatment. Therefore, chondroprotectors are slow acting, durable drugs.


What orally-administered chondroprotectors are available?

This group of drugs includes chondroitin sulfate, glucosamine and diacerein. These are safe drugs that can be taken over long periods of time. The European League against Rheumatic Diseases (EULAR) and the Spanish Rheumatology Society (SER) endorse the efficacy and safety of chondroprotectors for the treatment of osteoarthritis.


Osteoarthritis Myths

“Osteoarthritis myths” are erroneous ideas about the treatment of this disease most commonly found by physicians in the daily relationship with patients.


Osteoarthritis is caused by age

Age is no excuse to stop caring about oneself. This passive and resigned attitude, sometimes all too common among senior citizens, is unhealthy, among other things because wellness (that is, quality of life and good health) must be achieved on a day by day basis, with effort, and not by adopting a passive attitude, more so when we know that we have osteoarthritis treatments that can improve pain and mobility and delay the deterioration of the joints. Furthermore, there are other causes of osteoarthritis apart from age: previous joint deformity, prior traumas, intense physical activity, type of job, systemic diseases, obesity, or early menopause, among others.

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There is nothing you can do to stop osteoarthritis

Again, that negative outlook. Stop it. There is always something that can be done. It is true that until not so long ago it was thought that the progression of osteoarthritis could not be stopped, but medicine has made great advances over the last years. Nowadays, many osteoarthritis-related problems can be fixed, and at least improved by using a treatment based on cartilage-protecting drugs (chondroprotectors) such as chondroitin sulfate and glucosamine sulfate.

I can’t follow a treatment against osteoarthritis because pills cause me heartburn

You are probably talking about anti-inflammatory drugs, of which there are a number of variants. They cause gastrointestinal side effects that require the use of gastric protectors to avoid further problems such as bleeding, but it is untrue that there is no alternative to anti-inflammatory drugs. In fact, these are as much and more efficient to improve pain, and have less risks. These are paracetamol and chondroprotector drugs (cartilage protectors) such as chondroitin sulfate and glucosamine sulfate. The latter, however, could delay the disease’s progression. Chondroitin sulfate has been proved to reduce the need for analgesics and anti inflammatory drugs, thus having a beneficial effect for those persons who must take several different drugs.

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I have always been an athlete, how come I have osteoarthritis?

Competitive sports may trigger the onset of osteoarthritis through repetitive use and overload of all elements forming the joint, in particular that of ligaments and cartilage. Competitive sports sometimes exceed the capacity of joint resistance. Moderate exercise aimed at preserving mobility and joint function is very different from engaging in competitive sports.

 

Rest is good for osteoarthritis

No. In fact, the opposite is true: a joint that does not move ossifies and loses its mobility and strength more easily. We need, however, to adapt exercise to the degree of osteoarthritis and to the joint in particular. Walking and swimming are, in general, recommended exercises, although any other exercise that can be carried out without pain might be adequate.

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I won't improve with massage therapy alone

Most massage just relax the muscles and ligaments surrounding the joint. That effect is temporary and cannot replace a conventional medical treatment focusing on gaining mobility and to strengthen muscles. Keep in mind that the true problem of osteoarthritis lays deep inside the joint, where fingers can’t reach, not in the muscles. Massages are useful for pain relief and relaxation, but not as a standard treatment.

 

Osteoarthritis does not improve no matter how many medicines you take

The myth of osteoarthritis as a “lifelong bane” for the patient suffering it belongs to the past. The classical pharmacological treatments (paracetamol/acetaminophin, anti-inflammatory drugs), as well as the most modern products (cartilage protectors), together with advice for your everyday life, will undoubtedly help you improving your joint health.


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Doctor, my back aches, I need an X-ray!

Back aches are one of the most common ailments in humans, I might say, from the very moment that we began to walk on two feet. And among back pains, low back pain is, by and large, the most common. X-rays are only useful when your family physician suspects that there is spinal cord compression, or nerve root issues, which is not common. Your doctor is well aware that doing x-rays, in particular of the spine, will not help with your problem. On the contrary, it will expose you to an important amount of radiation that might have negative consequences.

 

Doctor, why should I use a cane? I’m not that old!

Why not, if it can be useful? Canes are a sign of wisdom. If Kings, Emperors or Pharaohs looked ennobled with them, why not you? Canes are perhaps the oldest tool of mankind, much older than, for instance, fire or arrow heads. There is a reason for that. Do not discard canes so lightly. They are useful to protect knees and hips from overload charges, thus improving pain and mobility and reducing the risk of falls.

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Doctor, I need an appointment with a traumatologist

A traumatologist is perfectly capable of treating osteoarthritis, but there is another doctor who specializes in joint diseases such as osteoarthritis: the rheumatologist. If your familial physician gives you an appointment with a rheumatologist, this is because he believes that your case will be best treated by that specialist.