Osteoarthritis is often described as wear and tear in the joints. It’s not an inflammatory condition like rheumatoid arthritis, and it occurs in the synovial joints, and it’s a combination of genetic factors, overuse and injury to the joint.
Risk factors for osteoarthritis include obesity, increased age, occupation, particularly occupations where there’s a high usage of particular joints, trauma to the joint being female, and also a family history of osteoarthritis, it’s thought to be the result of an imbalance between the cartilage being worn down and the chondrocytes repairing that cartilage, and this leads to structural issues within the joint that causes more wear and tear and pain.
These abnormalities can be seen on an x ray, and the key mnemonic for remembering the four key x ray changes in osteoarthritis is loss loss. So l stands for loss of joint space. So the joint space in the joint becomes narrower and the bones come closer to each other. O is for osteophytes and osteophytes are little spurs of bone that come out of either end at the joint.
The first s is for subarticular sclerosis, and this is increased density of the bone along the joint line where the bones come in contact with each other and the second s is for subcondrial cysts, and these are small fluid fill holes in the bone along the joint line. Xray changes do not necessarily correlate with the symptoms, so you might find significant xray changes.
Incidentally, in someone who doesn’t have symptoms. Equally, someone with severe symptoms of osteoarthritis might only have mild x ray changes. So how does it present? Osteoarthritis presents with joint pain and stiffness. This pain and stiffness tends to be worsened by activity. In contrast to inflammatory arthritis, where activity tends to improve the symptoms, it leads to deformity of the joints, instability of the joints, and reduced function in the joints.
So which joints are commonly affected? Well, the knees and the hips are key joints that often get affected with osteoarthritis. It can also affect the sacro iliac joints where the spinal column meets the pelvis. It typically affects the distal interphalangeal joints of the hands, the dips at the ends of the fingers, the carpometicarpal joint at the base of the thumb, or the CMC joint at the base of the thumb, the wrist, and then the cervical spine, which we often call cervical spondylosis.
Let’s talk about some of the signs that you might see when you examine the hands of somebody who has osteoarthritis. The first is Haberdon’s nodes, and these occur in the dip joints or the distal interphalangeal joints of the hands at the end of the fingers. The next is Bouchard’s nodes, which are seen in the proximal interphalangeal joints of the fingers. So this is the second joint.
From the end of the finger, you can see squaring at the base of the thumb, and this is at the carpometacarpal joint or the CMC joint. There might be a weak or reduced grip and also a reduced range of motion in the fingers. The carpometacarpal joint at the base of the thumb is a saddle joint with the metacarpal bone of the thumb sat on the trapezius bone, using it like a saddle, and it gets a lot of use from day to day activities.
And this makes it very prone to wear and tear when it’s used for complex movements. And this is why the carpimetacarpal joint is a key joint that suffers with osteoarthritis in people that use their hands a lot. Let’s talk about diagnosis. Well, the nice guidelines from 2014 suggest that a diagnosis can be made without investigations if the patient’s over 45, if they have typical activity related pain, and they don’t have any morning stiffness or stiffness lasting less than 30 minutes.
If they have stiffness in the morning that lasts more than 30 minutes, you need to think about more of an inflammatory cause. X rays can be helpful for checking the severity and confirming the diagnosis, but they’re not always necessary if the presentation is typical. Finally, let’s talk about management.
It’s important to start with patient education about the condition and advise them on lifestyle changes like losing weight if they’re overweight, and this helps reduce the load on the joint. Physiotherapy to improve the strength and support of the joints. And also, occupational therapy can be helpful in terms of how to maximize the function of the remaining joint.
And orthotics can be used to help support activities and function as well. We can use a stepwise approach to analgesia to help control the symptoms. The first line would be starting with oral paracetamol and a topical nonsteroidal antiinflammatory like topical ibuprofen or topical diclophenic. You can also use topical capsaicin, which is chili pepper extract that causes a warmth around the joint and helps to improve symptoms.
The second step is to add oral nonsteroidal antiinflammatory medications like ibuprofen or naproxen. And also consider prescribing a proton pump inhibitor to protect their stomach, such as a meprazole, whilst they’re using the nsaids. It’s better to use nsaids intermittently rather than continuously because of the risk of affecting the stomach lining, affecting the kidneys and so on.
Third line you may consider opiate medication like codeine and morphine. However, these should be used very cautiously as they have significant side effects and patients also develop dependence and withdrawal. They also don’t work for chronic pain because they’re useful for a couple of weeks and then they stop having an analgesic effect and the patient becomes dependent on them without actually getting any benefit.
The two final things to talk about is intraarticular steroid injections, which can provide temporary reduction in inflammation and improve the symptoms, and the other is joint replacement which can be used in severe cases and the hips and the knees are the most commonly replaced joints. Thanks for watching this video. If you found it helpful, please consider giving it a thumbs up and subscribing to follow the channel and find out.
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Osteoarthritis is a degenerative type of joint disease. It’s the most common type of arthritis and it affects over 32 million people in the United States. Osteoarthritis affects the cartilage, the bones, the ligaments and the tendons. Osteoarthritis is a noninflammatory type of arthritis. It’s characterized by causing pain and stiffness. It can result in limitation of motion of joints so that they don’t go through their full range of motion.
And it affects the small joints, such as the small joints in the hands. It also can affect the joint at the base of the thumb. It frequently involves the feet, especially the big toe, and it can involve larger joints such as the hips or the knees. It can also involve the spine. What is the difference between arthritis and osteoarthritis? Arthritis is an umbrella term and osteoarthritis is one of the types of arthritis and it’s different from other types of arthritis because osteoarthritis is noninflammatory.
What are the symptoms of osteoarthritis? The signs of osteoarthritis include bony enlargement of joints, swelling of joints, tenderness to palpation of joints, reduced range of motion, painful range of motion, and crepitous, which is a kind of crackling sound when the joint is put through the range of motion, and this is most commonly seen at the knees. What causes osteoarthritis?
Some things that predispose patients to osteoarthritis include overuse or repetitive motion of joints, prior injury of joints, abnormality of joints, and genetics. One study has revealed that the lifetime risk for a person to develop osteoarthritis of the knee is almost 50% and to develop osteoarthritis of the hip is about 25%. What are the risk factors for osteoarthritis?
The risk factors for osteoarthritis include age, sex, abnormal joint, prior injury to joint, obesity, diabetes and genetics. Some women in particular may notice that they have nodal osteoarthritis or knobby knuckles that affects the joints just beneath the fingernails and the middle row of joints in the hands, and they may realize that their hands look very similar to the way their mother’s hands appeared.
What can I do to prevent osteoarthritis? While we can’t prevent osteoarthritis from occurring and we don’t have medications to prevent it from progressing, we do have medications to treat the symptoms. The goal with treatment is to improve a patient’s function as well as enjoyment of daily activities. How does it feel to have osteoarthritis? Osteoarthritis causes pain and stiffness, and it can affect your ability to do daily activities.
For people who have osteoarthritis of the hands, they may notice that it’s difficult to open a jar or to peel carrots. They might find it helpful to have assistive devices to perform these activities. People with osteoarthritis in the knee or the hip can experience pain with walking and it can limit how much walking they wish to do. How is osteoarthritis diagnosed? Physical examination will be performed as part of your office visit.
The doctor will want to evaluate the joints that are particularly troublesome to you. The doctor, however, is aware that these joints cause pain and will keep this in mind as the doctor puts your joints through range of motion and presses on your joints to get an adequate assessment of the type of arthritis you’re experiencing. X rays can be used to support the diagnosis of osteoarthritis and to determine the degree of involvement of the joint.
It’s important for the doctor to get a good assessment of the cause of your pain so that your symptoms can be adequately treated. How is osteoarthritis treated? The goals for treatment are to reduce symptoms, especially pain and stiffness, and to improve or maintain function.
Nonpharmacological treatments include exercise for strengthening weight loss, occupational therapy, physical therapy, use of assistive devices such as a cane or walker, warm water pool exercises, a hot tub, paraffin, baths for hands, ice, supportive footwear, a neck pillow, and good mattress support during sleep. Exercise helps to strengthen the muscles around the joints and, for instance, in people who have arthritis of the knee.
Walking is an excellent form of exercise to strengthen the muscles around the knee. It’s important to keep moving. You should keep moving, but listen to your body. If you start experiencing pain or discomfort while exercising, you should stop what you’re doing. Studies have shown that with weight loss, patients experience less pain and improved function.
Weight loss is something that can be done on your own or you may benefit from a consultation with a dietitian or nutritionist, your doctor may refer you to see an occupational therapist or a physical therapist. Often occupational therapists focus on the upper extremity joints and you may see an occupational therapist to get a splint for your thumb.
If you are affected by osteoarthritis at the base of the thumb, physical therapy can be helpful for strengthening exercises and range of motion exercises for joints affected by osteoarthritis. Additionally, for people with osteoarthritis of the back, physical therapy can be an important part of the treatment. The focus will be on core strengthening.
The other thing that a physical therapist can help you with is guiding you with assistive devices. Some patients benefit from the use of a cane or a walker. It’s important to be sure that the assistive device fits you well and that you’re using it properly. Some people continue to experience discomfort and loss of function despite all the different nonpharmacological methods we’ve discussed.
Those patients may benefit from medications, and while many of the medications are available over the counter, it’s important for you to talk to your doctor about what medication might be right for you. Pharmacological treatments include analgesics such as nonsteroidal antiinflammatory drugs, which can be tablets or topical ointment, acetaminophen and a prescription medication called duloxetine for pain.
Some patients have found glucosamine with chondroitin sulfate to be helpful, but the results of medical studies on this medication are mixed. Other pharmacological measures include intraarticular steroid injections and intraarticular high aluronic acid injections. When should I get surgery? Some patients try all of these treatments and still experience pain and discomfort.
Their daily lives are significantly affected by their osteoarthritis. These patients should talk to their doctor about a referral to an orthopedic surgeon to consider joint replacement surgery, also called joint arthroplasty. For more information, check out the links below for the American College of Rheumatology and the Arthritis foundation.
Osteoarthritis is not aware and tear of the cartilage. The cartilage is this layer that protects the bones. Today, I will explain to you what osteoarthritis is and what you can do to prevent it and improve the pain from it. So let’s talk about osteoarthritis. Osteoarthritis is a condition that affects the cartilage, that protects the bones, but it’s not caused by putting too much weight on the joint, using the joint, moving the joint, or exercising that joint. We used to think that too much weight was the cause of osteoarthritis because the most affected joints are knees and hips.
But the true cause of osteoarthritis is not that the person is using the joint too much. People can have osteoarthritis in any joint of the body, even the shoulders, the hands, the fingers, the neck, anywhere. Osteoarthritis is caused by a slow, low grade chronic inflammation. Inflammation means that the immune system is sending cells, and they produce substances that destroy the cartilage.
But what causes this chronic inflammation and does antiinflammatory work? Well, nobody knows exactly what causes this chronic inflammation. There are genetic factors involved. There is new knowledge that the fat tissue in our body, known as adipose tissue, produce adipokines. The first adipokine was discovered in 1994, and it’s called leptin.
Now, scientists have discovered more than 100 types of adipokines. These adipokines are produced in the fat tissue of our body. So obesity leads to osteoarthritis, but not because it puts more weight on the joints. If that was the case, obese people would have osteoarthritis only in the weight bearing joints, but they also have OA in the hands, neck, and other joints of the body.
The adipokines, when in excess, they create a proinflammatory state in the body. Then this proinflammation is what starts destroying the cartilage. Little by little. We know that obese people who lose weight improve their symptoms of osteoarthritis. And the reason is not because they are putting less weight on the joints, but probably because they are producing less adipokines.
Before I continue, please remember that this video is for educational purposes only and is not intended to replace medical advice. And if you have osteoarthritis, please talk to your doctor. And if there is an emergency, please go to the nearest emergency department or call an ambulance.
This takes us to the second factor that helps osteoarthritis, movement. You probably heard me saying this many times, motion is lotion. Yes. Moving the joint, putting weight on the joint, using the cartilage is really good for the health of the cartilage. I use the analogy of honey. If the honey is crystallized and cold, it’s sticky. But if you stir it up and warm it a little bit, it gets fluid and clear.
That’s what the synovial fluid in our joints does. The more we move, the more synovial fluid is produced, and the nutrition to the cartilage is brought by the synovial fluid. When the person puts weight on the joint, the cartilage absorbs the nutrients that are in the synovial fluid. Astronauts who go to space do not put weight on their joints because there is no gravity in space and their joints have less fluid and the cartilage is thinner.
On the other hand, people who practice sports and do a lot of physical activity have thicker cartilages in the joints they use most. This shows that moving the joints is good for a healthy cartilage. I have various other videos showing exercises for osteotrides of the hips and knees, dancing, going up and downstairs, and for osteoporosis. Third, the pain that people feel from a joint with osteoarthritis is not a good measure of how much damage there is in the joint.
A person can have very tiny osteoarthritis and a lot of pain. Another person can have super severe osteoarthritis and do not have any pain at all. Here are some examples. Look at this neck x ray. There is almost no osteoarthritis, but the person has a lot of pain. Why is that? This person may have other problems around the bones. It could be the pains coming from the muscles, like myofacial trigger points.
But it can also be that there is a little bit of pain coming from the osteoarthritis. But when these painful impulses enter the spinal cord and passes through the brain stem and goes to the brain cortex, it is amplified. That is because this person has central sensitization. Their pain system is sensitized, so their pain is amplified. Not only that, but this person may also have lost the ability to block the pain.
Did you know that we have our own endogenous pharmacy? Our brain is able to suppress pain by releasing powerful opioids like endorphins, encephalins and dinorphines. But some people have lost the ability to suppress pain. So in this case, this small painful impulse from this tiny osteoarthritis gets amplified in the spinal cord.
It gets amplified in the brain cortex and is not suppressed here in the brain stem. So guess what? The person interprets this pain has very intense pain. And yes, they feel it. It is real pain, but the volume is turned up. Here is another person. This is a 92 year old male who fell, hit his head, was taken to emergency and they x rayed his head and neck. Fortunately, he did not have any neck fracture or head injury.
But the neck x ray showed very severe osteoarthritis. It lost the normal curvature. There are lots of osteophytes, no disc space and the facet joints are very narrow. So this is terrible. Severe advanced osteoarthritis of the neck. But did you know that this person never had any neck pain, not even one day of his life? Yeah. So here, what is the solution to this problem?
If you have pain and you were told that this is due to osteoarthritis, here are some practical things for you to do. First, think seriously about losing weight. Even if you lose a few pounds or a few kilograms, the number of adipocymes your body will produce will reduce immensely and maybe this will reduce the progression of your osteoarthritis. Second, start exercising.
The more you move, the better the nutrition to your joints. I highly recommend water exercises. You can move in all directions. There is resistance and cardio training and you can relax in the water. But if you do not have access to a pool, a lake or a beach, then just start moving, dancing, playing sports, walking, biking, anything. Remember, motion is lotion.
Third, it is important to avoid central sensitization. There are many mind body therapies that help to reach train the pain system. You may watch my other video where I talk about these therapies. And last, eat healthy, especially an antiinflammatory diet. This means more fish, olive oil, omega three fruits, vegetables and less processed foods, white flour and sugars. Go to Home
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