Osteoarthritis: Causes, Symptoms, and Treatment

Osteoarthritis: Causes, Symptoms, and Treatment

Osteoarthritis (OA) is a chronic disease that affects the joints, particularly the knees, hips, hands, and spine. It occurs when the cartilage in the joints degenerates, causing pain, stiffness, and limited mobility.

Classification of Osteoarthritis:

• Primary: Occurs due to the natural aging process of the joints, with no clear cause.

• Secondary: Caused by other factors such as injury, obesity, endocrine disorders, metabolic disorders, genetics, etc.

Functional Symptoms of Osteoarthritis:

• Joint pain: Pain usually occurs after exercise and gradually subsides during rest.

• Morning stiffness: Stiffness in the joints lasting less than 10 minutes after waking up.

• Limited mobility: Reduced range of motion in the joint, making movement difficult.

Joint Deformity in Osteoarthritis:

• Late stage: Due to cartilage destruction, subchondral bone, joint capsule, ligaments, and soft tissues around the joint.

• Types of deformities: Misalignment, instability, limb shortening.

• Heberden’s nodes: Protrusion at the distal interphalangeal joints.

• Bouchard’s nodes: Protrusion at the proximal interphalangeal joints.

Characteristics of Synovial Fluid in Osteoarthritis:

• Minimal changes: The number of cells in the synovial fluid is usually less than 1000.

• Absence of microcrystals.

Early and Late Manifestations on X-ray:

• Early manifestation: Bone spurs at the bone margins.

• Late manifestation: Subchondral bone sclerosis, joint space narrowing.

Stages of Lesions on X-ray According to Kellgren and Lawrence:

• Stage 0: No degeneration.

• Stage 1: Suspected joint space narrowing and bone spurs.

• Stage 2: Mild: Clear bone spurs, possible minimal joint space narrowing.

• Stage 3: Moderate: Multiple bone spurs, significant narrowing, possible bone head deformities.

• Stage 4: Severe: Large bone spurs, severe narrowing, clear deformities.

Role of Imaging Techniques:

• MRI: Less commonly used, only for evaluating disc and spinal canal lesions in OA of the spine.

• Ultrasound: Detects mild effusion, synovial membrane hyperplasia, and bone spurs.

• Arthroscopy: Has both diagnostic and therapeutic significance.

Definitive Diagnosis of Osteoarthritis:

• Medical history: Mechanical pain, joint clicking, crepitus.

• X-ray: Joint space narrowing, subchondral bone sclerosis, bone spurs.

• Blood tests, synovial fluid analysis: Minimal or no inflammation.

• General condition: No significant changes, no accompanying lesions.

Treatment Options:

• Non-pharmacological treatment:

• Avoid activities that increase joint loading.

• Weight loss, use of assistive devices to reduce load and distribute weight evenly.

• Alignment correction or posture correction.

• Pharmacological treatment:

• Pain relief: NSAIDs.

• Anti-degenerative drugs:

• Glucosamine, chondroitin.

• Diacerin: Inhibits IL-1.

• Unsaponifiable extract of avocado and soybean oil.

• Intra-articular corticosteroid injections: Used in cases of inflammation and joint effusion.

• Intra-articular hyaluronic acid injections.

• Arthroscopy.

• Use of platelet-rich plasma and stem cells.

Note: Osteoarthritis treatment should be performed under the guidance of a specialist.