Arthritis focus
Joints
Two opposing bones meet in the joints, their tips covered with cartilage and contained by the joint capsule, lubricated by the synovial fluid and joined by the muscular ligaments. These are highly vascularized areas rich in nerve endings.
Arthritis
Arthrosis or osteoarthritis is a chronic and degenerative joint disease characterized by injury and gradual loss of articular cartilage. It can affect any joint, but mainly affects the hands, knees, hips and spine and gradually tends to get worse over time. It originates from a defect in the physiological balance that alternates degradation processes with regenerative processes of the articular cartilage.
Symptoms are typically pain, stiffness, loss of normal joint mobility and joint deformation, caused by the formation of new connective tissue and osteophytes on the affected marginal areas. The synovial membrane also undergoes severe changes, which appear hyperemic (strong blood flow) and hypertrophic (increased volume), while the capsule is edematous (fluid retention) and fibrosclerotic. In osteoarthritis, the hyaluronic acid present in the joints undergoes a loss of molecular weight and concentration. In addition, its production is also reduced.
Idiopathic Idiopathic osteoarthritis and secondary osteoarthritis
Two types of osteoarthritis are distinguished: One is an “idiopathic” or “primitive”, which doesn’t present any identifiable cause of disease. It can be localized, is limited to one or two joints, or generalized, and affects three or more joints. The other is a “secondary”, caused due to trauma and joint changes at birth or during growth, or due to bone or joint diseases, such as rheumatoid arthritis or others.
The main factors of risk
The main predisposing risk factors are:
- Age: the disease is rare before the age of 40, while about 80% of people over 55 show radiological signs of osteoarthritis, while not complaining of symptoms or joint limitation;
- Female sex: women develop the disease 2-3 times more often than men;
- Obesity: the only modifiable risk factor. Weight loss very positively affects the risk of osteoarthritis.
Obese women are more likely to develop osteoarthritis of the knee and hip and have a risk of developing osteoarthritis of the hands 2-3 times greater than women at a normal weight. Obesity also plays a key role in worsening pain and disability in patients with osteoarthritis, which on the contrary benefits greatly from weight loss.
Other risk factors
Physical activity or exhausting work
Moderate and regular exercise in people with normal joints seems to protect againstosteoarthritis.
Genetic factors
Studies in twins or family members of patients with osteoarthritis suggest that genetic factors are a fundamental risk factor for this degenerative disease and are estimated to represent 40-65% of the risk of osteoarthritis of the hand and knee, 50% of the risk of coxarthrosis (hip arthrosis) and 70% of the risk of spondyloarthrosis (vertebral arthrosis). There are also differences in race.
Hormonal factors
It seems quite certain that the climaterium (menopause) can accompany the onset of
osteoarthritis in women, even if how much the estrogens protect the cartilage
hasn’t been fully demonstrated yet on a scientific level.
Circulation
Some diseases of the venous circulatory system seem to affect gonarthrosis (osteoarthritis of the knees) and lower extremities.
Metabolic factors
Some endocrine diseases such as acromegaly or hypothyroidism can lead to degeneration of the cartilaginous matrix favoring the onset of osteoarthritis.
Climate
Climate is not a risk factor, however cold and humidity can play a negative role on the symptomatology of osteoarthritis, while, on the contrary, hot and dry climates can help.
Symptoms
All symptoms and clinical signs that occur are localized in the affected joint and are: pain, restriction of movement, stiffness, joint deformity.
Joint pain and stiffness after immobilization (night sleep, for example) are the prevalent
symptoms of osteoarthritis, being related to the inflammatory phase that characterizes the pathology.
On an objective examination, the disease presents limitations of joint movements, joint deformation, as well as, possibly, other signs such as cracks and crackles secondary to the mobilization of the limbs.
In the joints two opposing bones converge, their tip covered with cartilage and contained by the joint capsule, lubricated by synovial fluid and joined by muscle ligaments. These areas are highly vascularized and rich in nerve endings and this only amplifies the main symptom, that is pain. The intensity of this symptom also changes according to the stage of the disease.
Ultimately, the pain tolerance threshold is extremely variable in different subjects but easily verifiable by the doctor.
Therapy
Osteoarthritis has different types of treatment according to the therapeutic needs: taking drugs, physical-rehabilitation care and surgical interventions, to which must be added rest, which however should not be prolonged for a long time because it can be counterproductive, especially in the case of elderly individuals.
Drugs can be distinguished into symptomatic drugs and “antirheumatic” drugs.
The symptomatic drugs are analgesics, and non-steroidal anti-inflammatory drugs, rapid on pain and effective on the phlogosis, but at risk of side effects, and corticosteroids, more known as cortisone, which can be indicated generally at low dosage, only if there is an intense inflammatory and edematous reaction, and in a intraarticular way, only if there is intraarticular effusion (but this entails a high risk of side effects).
The antirheumatic drugs, called sysadoa (symptomatic slow acting drugs for osteoarthitis), are natural drugs with slow action and almost completely free of side effects. These include hyaluronic acid which, injected intrarticularly, has a positive effect on the symptoms, with effects that can last for a few months. This depends on the fact that the synovial fluid, in subjects under normal conditions, contains high amounts of hyaluronic acid and therefore the intrarticular intake in patients suffering from osteoarthritis, returns an acceptable physiological picture.
In cases with a severe inflammatory component, hydroxychloroquine, an immuno-modulating drug, is also indicated.
Among the physical treatments, those of the antalgic type are recommended, in particular the TENS or spa treatments such as mud therapy.
Among the surgical treatments most used today are: arthroscopic synovectomy, indicated for subjects suffering from inflammatory osteoarthritis that does not respond to other treatments or arthroprosthesis, indicated for subjects complaining of pain and severe functional limitation not controlled by pharmacological and non-pharmacological therapy.
Tibial osteotomy surgery of knee realignment, which can shift the pressure on the healthier cartilage, may be recommended in younger and active patients.
