What is Osteoarthritis?
Osteoarthritis (OA) is an ageing-related degeneration of joint cartilage and bone, often affecting the middle-aged people and the elderly. It causes stiffness and pain in the hip, knee and thumb joints.
The joint cartilage is a flexibility-inducing rubbery cushion that covers bones in the joints. With the wear and tear of the body, the weakened cartilage can get damaged as one grows older. The joint cartilage gradually loses its ‘shock absorber’ qualities, with the result that bones start rubbing against each other. This friction causes osteoarthritis pain.
- Pain in joints during or after movement
- Tenderness, stiffness, loss of flexibility, the grating sensation when moving knee joints.
- Severe pain in the joints, with stiffness, inflammation due to less fluid around the joint.
- More friction in the joint and pain when moving.
- Deformity of bones in severe cases due to asymmetric loss of cartilage.
Women at greater risk:
Women are at a higher risk of osteoarthritis for the following reasons:
- Biology, genetic predisposition and hormones.
- Lower-body flexibility – Nature has designed women’s bodies to give birth and so their lower body tendons are more elastic than of the male. Female joints move more but when the joints decrease instability, they become more injury-prone.
- Wider hips – Since women’s hips are wider than their knees, knee joints are not as aligned as men’s. This causes more knee injuries and osteoarthritis.
- Family history – A family member with osteoarthritis increases the risk of another family member having it.
- Post-menopause estrogen dip – The female hormone estrogen protects the cartilage from damage. But after menopause women’s estrogen levels go down and they lose that protection. This increases the risk of osteoarthritis even if the women are on hormone-replacement therapy.
In India, most patients are at an advanced stage of arthritis by the time they seek medical help.
In initial stages such as Stage 1 and 2, physiotherapy can be sufficient for pain relief and to develop muscle power. Painkillers (under the strict supervision of doctors) can work, including taking supplements like glucosamine and chondroitin.
During the advanced osteoarthritis Stage 3 and 4, medications become less effective. An injection of hyaluronic acid along with steroid into the joint can give some relief. Once this too fails, the patient becomes dangerously dependent on painkillers for even basic movement. This is the stage that may need knee replacement surgery.
The orthopaedic surgeon decides on the need for surgery, including convincing the patient that surgery is the best option.
Successful knee replacement surgery depends on multiple factors, including keeping under control possible co-morbidities like diabetes, hypertension, cardiac, renal, or liver problems. Teamwork is needed, and this involves the surgery team, physiotherapist, and psychological counsellor, co-operation of the patient and support of the patient’s family members.
Weight control: Being overweight puts more pressure on the knees. It causes the wear and tear of the cartilage as the body ages. Excess fat can lead to the body producing a toxic protein called cytokines. This causes widespread inflammation and disrupts the working of cartilage cells.
Controlling blood sugar: Higher sugar levels affect the cartilage; diabetes increases the risk of inflammation and cartilage damage.
Regular exercise: Moderate exercise helps in the flexibility of the joints and strengthens muscles supporting the knees. Daily exercise reduces the risk of many diseases. The activity can include walking, gardening, doing active household chores, swimming for 30 minutes, five times a week.
Reduce injury risk: Reduce the risk of falling by wearing footwear that fits well, including soles of shoes having grooves to prevent slipping on a wet floor and rainy roads. Use protective gear when playing sports. Injuries to the cartilage increase the chances of osteoarthritis.
Avoid joint strain: Avoid or reduce the activity involving repetitive motions of the knee joint, such as kneeling or squatting. If such repetitive movements are unavoidable due to the nature of one’s work, then ensure sufficient rest between periods of work or exercise.
Seek medical expertise: Consult a doctor regarding the treatment and lifestyle changes when discomfort in the joints starts.
A healthy diet, sufficient sleep, reducing stress and an overall wholesome lifestyle helps to keep away many diseases including osteoarthritis.
Dr. Samarjit Khanikar, Consultant Orthopaedics, Narayana Superspeciality Hospital, Guwahati.