Osteoarthritis

The arthritis is a chronic joint involvement, and noninflammatory degenerative origin. It is the most common disease of the locomotor system. Its prevalence increases with age, 80% of the population older than 75 years have some radiological sign of osteoarthritis. It affects both sexes equally.

What is osteoarthritis

Primary osteoarthritis is a degenerative disease, influenced by several risk factors:

• Obesity: it is related to knee and hip osteoarthritis as a consequence of overload.
• Heredity: it is related to some type of polyarticular form.
• Osteoporosis : with an inverse relationship.
• Smoking: some studies say that smoking has a protective effect on the development of osteoarthritis.
• Mechanical factors: trauma, sports and work activities with risk of joint overload.

There is also another less frequent type of osteoarthritis called secondary:

• Due to mechanical incongruity of the joint.
• For inflammatory joint disease.
• For diseases of endocrine origin.
• For metabolic diseases.

Peripheral osteoarthritis

The origin of osteoarthritis is in the degeneration of the articular hyaline cartilage with three phenomena:

1. Destruction of cartilage: thinning and fissure formation.
2. Remodeling or new formation of bone (osteophytes).
3. Secondary synovitis.

Central osteoarthritis

In the spine, osteoarthritis is caused by two different mechanisms that occur at the same time:

• Osteoarthritis of the apophyseal and uncinate joints: these are joints with hyaline cartilage just like the peripheral ones.
• Degeneration of the intervertebral discs: with sclerosis of the vertebral platforms and marginal osteophytes.

Symptoms of osteoarthritis

Osteoarthritis appears most frequently in the following joints:

• In the fingers: distal and proximal interphalangeal joints.
• In the trapeziometacarpal (rhizarthrosis).
• In the first metatarsophalagic.
• Coxofemoral.
• Knee.
• Cervical and lumbar spine.

On the contrary, there is usually no osteoarthritis in: carpus, elbows, shoulders, ankles and metacarpophalangeals.

The most frequent symptoms and signs are:

• Mechanical pain: that increases with movement and decreases with rest.
• Stiffness after immobility.
• Decreased mobility.
• Functional limitation.
• Pain on pressure in the joint and its limits.
• Swelling.
• Cracking when performing movements.
• Decreased active and passive mobility.
• Joint instability.
• Joint deformity: Heberden’s nodules (in distal interphalangeal joints), Bouchard’s nodules (in proximal interphalangeal joints), genu varus and valgus.

How is it diagnosed?

There are no defined strict diagnostic criteria for osteoarthritis. The union of epidemiological, clinical, and radiological data allows us, in most cases, to make a certain diagnosis.

Analytical : it is normal, except in secondary osteoarthritis, where there are alterations typical of the disease that causes osteoarthritis.
Synovial fluid : it is mechanical, clear, viscous, with few cells (unlike microcrystalline arthritis ). If the osteoarthritis is very advanced, crystals can be found.
X-ray : it is usually sufficient for the diagnosis of osteoarthritis, it presents the following characteristics: non-uniform clamping of the joint interline, sclerosis of the subchondral bone, formation of osteophytes and formation of subchondral cysts.

Treatment for osteoarthritis

General measures : local heat, physiotherapy, electrotherapy , postural hygiene (avoid joint overload).
Minor pain relievers : sufficient in most cases to relieve pain.
Anti-inflammatory : in short periods of time for secondary synovitis.
Local infiltrations .
Surgery : reserved for advanced osteoarthritis that has a significant impact on the life of the patient with great functional impotence or when there is intense pain that does not subside with the previous measures. There are two types of surgery: corrective osteotomy (valgus tibia) and prosthetic, especially in the hip and knee.

How can I avoid osteoarthritis?

Avoiding joint overload, that is, not exceeding body weight and maintaining good postural hygiene: knowing how to bend down, how to sit down, how to take heavy weights, etc.