Also known as osteoarthritis, it is a disease that affects the joints.
The surfaces inside the joints are damaged so they do not move as well as they should.
When a joint develops osteoarthritis, the part of the cartilage that covers the ends of the bones becomes rough gradually and becomes thinner.
The bone at the edge of the joint grows outward, forming bone spurs called osteophytes.
The synovial membrane (the inner layer of the joint capsule that produces the synovial fluid) can thicken and cause excess fluid to swell the joint.
Also, the capsule and ligaments (resistant bands that support the bones) slowly thicken and contract to make the joint more stable.
Effects of degenerative osteoarthritis on the body
The knees, hips, hands, lower back and neck are the most affected, but osteoarthritis can occur in any joint.
Normally, both knees are affected, unless the degenerative osteoarthritis has been caused by an injury or other condition.
There will be pain when walking, especially uphill.
The knees can be locked in position, which makes straightening the leg difficult. The knee can make a soft, grated sound when used.
Anything that requires movement of the hip joint causes problems, such as getting in or out of a car or putting on shoes and socks.
Pain in the hip is common, but some patients with degenerative osteoarthritis of the hip experience pain in the knee rather than in the hip or, less commonly, in the thighs, ankles and buttocks.
The pain is often felt while walking, but may be present when you rest.
Degenerative osteoarthritis can affect:
The base of the thumb.
The upper joint of the fingers, closest to the nail.
The middle joint of the fingers.
The fingers may be stiff, swollen and painful. Protuberances may develop in the joints of the fingers.
In some cases, the pain in the fingers diminishes and eventually disappears, while the swelling and protrusions remain.
The fingers may bend slightly to the sides in the affected joints. Bulks filled with fluid or cysts may appear on the back of the fingers. These are often painful.
A bulge may develop where the base of the thumb attaches to the wrist. This can make typing, turning the keys and opening the window caps difficult and painful.
If the stiffness and swelling of the joint last more than 2 weeks, the person should consult a doctor.
Those who are already taking medications for degenerative osteoarthritis should contact a health professional if they experience nausea, constipation, drowsiness, abdominal discomfort or black or tarry stools.
Causes of degenerative osteoarthritis
There are many factors that can increase the risk of osteoarthritis:
Age: osteoarthritis starts from 40 years of age and older. We do not fully understand why it is more common in older people, but it could be because it weakens the muscles and the body is less able to heal itself.
Gender: for most joints, especially the knees and hands, degenerative osteoarthritis is more common and more serious in women.
Obesity: overweight is an important factor in the cause of degenerative osteoarthritis, especially in the knee.
Joint injuries: a serious injury or the operation of a joint can lead to osteoarthritis. Normal activity and exercise do not cause osteoarthritis, but doing very demanding physical activities can increase the risk.
Genetic factors: Nodal osteoarthritis, which affects especially the hands of middle-aged women, occurs strongly in families, although it is not yet clear which genes are involved.
And some rare forms of osteoarthritis, which start at younger ages, are linked to genes that affect collagen (an essential part of cartilage).
Genetic factors play a minor role, but it is still important in osteoarthritis of the hip and knee.
Degenerative osteoarthritis is more common among women than men, especially after age 50.
Symptoms are more likely to appear after age 40, but may affect younger people after a traumatic blow or sports injury, especially in the knee, or as a result of another joint condition.
Having defects in the joints or cartilage from birth significantly increases the risk of eventually developing osteoarthritis.
Obesity puts more pressure on the joints that support weight and increases the risk.
Works that involve repetitive movements in a particular joint make degenerative osteoarthritis more likely.
Some diseases and conditions that increase the possibility of developing degenerative osteoarthritis are:
Paget’s disease of bone.
Malalignment of the knee, hip and ankle or unevenness in the limb.
Hereditary genetic factors may play a role in 50 to 65 percent of cases of hand, hip and knee osteoarthritis, but exact genes have not yet been identified.
Diet may play a role Research suggests that people with a lower level of vitamin D intake have an increased risk of degenerative osteoarthritis, while those with a low vitamin C intake may progress more rapidly.
Low levels of vitamin K and selenium may also contribute, but all of these dietary factors need further investigation to confirm their relevance.
Symptoms of degenerative osteoarthritis
Symptoms of osteoarthritis may include:
Sensation of friction or friction (crepitus) when moving the joint.
Hard or soft swelling
Abnormality in the use of joints, which can make certain activities difficult (for example, climbing stairs).
A doctor will ask the patient about the symptoms and perform a physical exam.
There is no definitive test that can diagnose degenerative osteoarthritis, but imaging tests can show if damage has occurred.
Tests may include:
X-rays: These can reveal bone spurs around a joint, or a narrow space within a joint, suggesting that the cartilage is breaking.
Magnetic resonance imaging: this can help the doctor determine what causes the pain.
Joint fluid analysis: also known as arthrocentesis, this involves the use of a sterile needle to remove fluid from an inflamed joint, for analysis in a laboratory.
If there are uric acid crystals, this may indicate gout. This test can also determine if there is inflammation or an infection.
Blood tests: can help rule out other conditions, such as rheumatoid arthritis.
Treatment of degenerative osteoarthritis
There is no cure for degenerative osteoarthritis, but treatment can help relieve symptoms and maintain joint movement.
Interventions include exercise, manual therapy, lifestyle modification and medications.
The medication can not reverse the damage, but it can help reduce the pain.
Acetaminophen (paracetamol, Tylenol): these can relieve pain in patients with mild to moderate symptoms.
High doses can cause liver damage, especially if the patient consumes alcohol regularly, so it is important to follow the recommended dose.
Acetaminophen can also affect the functioning of other medications, so it is important that patients inform the doctor if they are taking it.
Nonsteroidal anti-inflammatory drugs (NSAIDs): If paracetamol is not effective in controlling pain, the doctor may prescribe a stronger pain reliever, which may include ibuprofen, aspirin, or diclofenac.
Some topical NSAIDs can be applied directly to the skin of affected joints.
Some topical OTC NSAIDs are very effective in reducing pain and swelling in the joints of the knees or hands.
Patients should consult with their doctor about taking NSAIDs, as they are not suitable for some people, for example, those who have asthma or a peptic ulcer.
Tramadol (Ultram): This is a prescription pain reliever that does not reduce swelling but provides effective pain relief with fewer side effects than NSAIDs.
It is usually used for short-term acute flares and can be prescribed along with paracetamol for more powerful pain relief.
Codeine: this can help with more severe symptoms.
There is a risk of dependence, but in cases of severe pain, this may be an option. Side effects may include constipation and drowsiness.
Capsaicin cream: This medication blocks the nerves that send pain messages. It can help patients with degenerative osteoarthritis in their hands or knees that do not respond well to topical NSAIDs.
Pain relief is not immediate, and it can take 2 weeks to a month for the medication to have full effect.
A small amount of capsaicin cream is applied to the affected joints four times a day and no more than once every 4 hours.
The first application can cause a burning sensation, but, after some uses, that sensation disappears.
The capsaicin cream is made of chili peppers. If it comes in contact with the eyes, mouth, nose or genitals, there will be no harm, but it will probably cause pain. It should not be applied to broken or inflamed skin, and hands should be washed after use.
Avoid taking a warm bath or shower before or after applying the cream.
Intraarticular cortisone injections: Severe pain can be treated by injecting a medication, usually a corticosteroid, directly into the joint site.
These are effective in relieving pain and swelling, but they can usually be applied only once every 4 months in a single joint.
Too many intra-articular injections can damage the joint, and excessive use of corticosteroids increases the risk of osteoporosis and other adverse effects.
Transcutaneous electrical nerve stimulation (TENS): applies an electric current through the skin. It controls pain by numbing some of the nerve endings of the spinal cord. A TENS unit is usually connected to the skin using two or more electrodes.
Thermotherapy: uses warm and cold temperatures to help reduce joint pain and stiffness.
A bottle of hot water filled with cold or hot water, or hot and cold packs, may be applied to the affected area. Hot and cold packs can be chilled in a freezer or heated in a microwave.
Manual therapy: performed by a physiotherapist. Stretching techniques help keep joints flexible. Not using the affected joint can weaken the muscles, making the stiffness of osteoarthritis even worse.
Problems with the lower extremities
People whose hips, knees or feet are affected can benefit from special footwear or shoe insoles.
Some cushioning soles can reduce the pressure on the joints. Special templates can help distribute body weight more evenly.
The use of orthopedic leg braces, or holding a cane on the opposite side of the body to the affected leg, can help.
A splint can help the patient rest a painful joint. A splint is a piece of rigid material that provides support for the joints or bones.
Surgery is usually not necessary, but it may be useful if degenerative osteoarthritis affects the hips, knees, joints and the base of the thumbs.
It is usually only recommended if other therapies have been ineffective or if one of the joints is severely damaged.
Arthroplasty or total joint replacement: the damaged parts are surgically removed and a prosthesis or artificial joint, made of metal and plastic, is inserted.
The joints most commonly replaced are the hip and knee joints, but the implants can also replace the joints in the shoulder, finger, ankle and elbow.
Arthroplasty is generally effective, improves appearance and function and allows the patient to use the joint actively and painlessly.
There is a small risk of infection and bleeding. Sometimes, a joint may become loose or wear out, and eventually needs to be replaced.
Arthrodesis: the joint can be realigned, stabilized or surgically fixed to promote a bone fusion. This increases stability and reduces pain.
If the ankle joint is fused, the patient can gain weight without pain, but will not have flexibility.
Osteotomy: The surgeon adds or removes a small section of bone above or below the knee joint. This can realign the leg so that the patient’s weight no longer focuses on the damaged part of the joint.
It can be used in patients who are too young for knee replacement surgery.
The osteotomy can help relieve symptoms significantly, but knee replacement surgery may be necessary later.
A range of strategies can help relieve the symptoms of degenerative osteoarthritis. A doctor or physiotherapist can offer advice on changes in lifestyle.
Exercise and weight control
Exercise is a key part of the treatment of degenerative osteoarthritis. This can help keep the patient moving, prevent weight gain, build muscles and reduce stress.
Patients can exercise at home or in a gym, many of which are easy to help people with arthritis.
The patient should follow the program carefully and do the appropriate exercises in the correct way, to avoid damage.
The plan will probably focus on improving:
Flexibility and range of movement.
Strength and muscle tone.
Physical condition and endurance, for example, swimming, walking or riding a bicycle.
Exercising in a pool is a good way to avoid putting extra pressure on the joints.
Exercise can also help the patient lose weight, reducing stress on the joints, especially in the lower extremities.
Other ways to control symptoms include adjustments to the furniture, such as lifting a chair and devices for daily activities, for example, a lever that facilitates the opening of a tap.
A physiotherapist can advise on what is available.
Mobility problems can cause stress and an increased risk of trips and falls, with subsequent injuries.
Work can become difficult, leading to frustration, irritability and depression. An occupational therapist can help, and employers can sometimes make adjustments.
Septic arthritis is an inflammation of the joints caused by bacteria. Joint replacement surgery slightly increases the risk of infection.
This is a medical emergency, and hospitalization is necessary. The treatment consists of antibiotic medications and drainage of fluid from the joint joint of the joint.