Osteoarthritis is a disease with multifactorial etiology, characterized by degenerative and inflammatory pathological changes in and around the joints.
Osteoarthritis, which affects people from all walks of life, causes pain, leads to loss of work power and disability, has been accepted as a natural aging and wear-and-tear disease for years. It is a disease that has attracted much less attention than it should, in our opinion, due to possible reasons such as not directly causing fatal diseases and mostly concerning the retired segment. This fatalistic view has begun to be abandoned in the last few years.
The prolongation of human life, the increase in the number, effectiveness and cost of surgical interventions applied to patients and their owners in osteoarthritis, and the economic situation of insurance institutions and states have attracted the attention of pharmaceutical factories and research laboratories and directed them to focus on the disease again. When developing technology and knowledge gained economic and social support, studies on osteoarthritis gained great momentum.
In osteoarthritis, widespread pathological changes are detected in the joint connective tissues, especially in the joint, subchondral bone, synovial fluid and capsule. The main pathology is the progressive loss of articular cartilage, accompanied by depolymerization of hyaluronic acid in synovial fluid, subchondral sclerosis, osteoarthritis formation at the joint margins and synovitis in varying degrees.
Osteoarthrosis; or “calcification” as it is commonly known among the public and its treatments:
It is a disease that starts in the 20s and continues until death. In fact, we can consider calcification (osteoarthrosis) as a physiological condition rather than a disease. As we age, just as our hair turns white and lines appear on our skin, deteriorations and changes occur in our joints. Calcification is a condition that can occur in all of us, men and women.
As of the 20s, calcification begins in the joints due to use and this progresses over time and shows its symptoms in the 40s. Complaints are seen more frequently in women than in men, and it is thought that this is due to the stronger muscle and connective tissue of men.
Where are the changes in calcification seen?
In osteoarthritis, widespread pathological changes are detected in the joint connective tissue, especially in the joint, subchondral bone, joint fluid and capsule. The main event is the progressive loss of articular cartilage, accompanied by a decrease in the content of hyaluronic acid in the synovial fluid, deterioration of the structures of the bones around the joint, and the formation of small new bone prominences.
What are the Risk Factors?
1- Genetic Factors: Family heredity
2- Hormonal Factors: Diabetes, acromegaly, gout, etc.
3- Traumatic Factors: Frequent heavy lifting, carrying loads, obesity, etc. due to occupation.
Symptoms of Arthritis:
Pain: This is the main complaint that causes the patient to see a doctor. The pain, which is also expressed as an ache, is dull and cannot be well localized. Initially mild, the pain increases over time and begins to be felt with a small movement and even at rest. Depending on the joint involved, the pain increases with certain activities and movements. For example, in osteoarthritis of the hand, squeezing something with the hand or opening a jar lid is painful.
Stiffness: Patients usually complain of stiffness when they wake up in the morning or after periods of inactivity during the day. Stiffness, like pain, is related to weather changes.
Crepitation: These are rattling sounds seen in the joints as a result of cartilage loss and irregularity of the joint surface. It is most commonly heard in the knee and less commonly in the hip.
Restriction of Movement: Occurs in later stages.
Local Tenderness
Pain on Passive Movement
Joint Enlargement: Due to Effusion, Marginal Osteophytes and Cartilage Proliferation. Muscle Atrophy around the joint may also make the joint look swollen.
Deformity and Subluxations
Radiologic Findings:
Narrowing of the Joint Space: Develops as a result of cartilage degeneration and loss.
Subchondral Bone Sclerosis
Subchondral Bone Cysts: They are oval or round in shape, ranging in size from a few mm to cm.
Osteophyte
Bone Collapse: Occurs due to compression of weakened and deformed trabeculae in the segment under pressure.
Intraarticular Ossous Bodies (Joint Mouse): Occurs due to fragmentation of the osteochondral surface.
Fundamentals of Osteoarthritis Treatment:
Education: Ensuring that the patient, their relatives and their caregivers understand the patient’s condition very well and informing them about how they can help the patient.
Improvement of symptoms: Preventing the risks they pose to the patient by controlling pain, stiffness and other symptoms.
Reducing the handicap to a minimum level: Reducing functional disability and handicap to a minimum level with appropriate rehabilitation techniques.
We can group the treatment methods applied in the treatment of osteoarthritis into 3 groups:
Non-drug treatment
Drug treatment
Surgical intervention
Non-pharmacological Treatment:
Pain: Hot and cold applications, acupuncture, TENS, whirlpool, canedian support, use of insoles in leg length inequalities
Joint Range of Motion Protection: Flexion, extension, rotational stretching exercises, lying face down
Muscle Weakness and Atrophy: Isometric exercises (abductors and quadriceps)
Daily Life Activities: Adaptive devices, ensuring that professional and other daily activities are performed properly.
Physical agents in pain control:
Hot application:
Pain and muscle spasm are reduced, collagen elasticity is increased, joint range of motion is facilitated. Muscle contraction ability is increased.
Cryotherapy:
Slows down circulation in acute inflammation, reduces edema and pain. (Cold pack and cold spray)
Hydrotherapy:
It provides a suitable environment for exercise by eliminating gravity. It provides relaxation and proprioceptive feed back. Venous pooling is prevented.
Electrotherapy:
Medium and low frequency currents are used for analgesic purposes. The most commonly used modality is TENS. Diadynamic currents and interferential currents are also used.
Massage and mobilization:
In cases where joint and soft tissue mobilization is limited, it is based on the principle of forcing the joint to a point greater than the active joint range of motion.
It should not be applied in the presence of inflammation.
Massage may be useful in relieving muscle spasm.
Exercise:
It provides inhibition of afferent pain pathways. It breaks the vicious cycle of pain-tension by contributing to relaxation.
The main goal in exercise treatment is to reduce pain while increasing function.
The balance of rest, relaxation and exercise should be well adjusted.
With exercise, joint range of motion is maintained or increased, strength, endurance and joint stability increase, fatigue decreases and a sense of well-being increases.
Movement contributes to the nutrition of the joint and cartilage and the removal of toxins.
In the presence of acute inflammation or severe muscle weakness, exercises that impose major stress on the load-bearing joints are avoided, passive exercises and rest are recommended.
Applied exercises:
Isometric exercises: Provide contraction while maintaining immobilization. Creates less mechanical stress on the joint. Recommended during the inflammation period and at the beginning of the exercise.
Dynamic exercises: Recommended in the chronic period. They are isotonic and isokinetic exercises.
Stretching and ROM exercises: They should be applied with caution in the presence of inflammation.
Aquatic exercises: The load on the joint is reduced by the elimination of gravity and the buoyancy of the water. It is beneficial in the education of patients with muscle weakness.
Aerobic exercises: Endurance is low in patients with osteoarthritis. Walking, cycling and swimming are recommended.
Occupational Therapy:
Assessed for activities of daily living and necessary equipment for work activities.
Joint protection and energy conservation are taught. It may be recommended that the patient live in a single-story house and avoid painful climbing.
• It is recommended to place toilet lift seats, sock-wearing aids, and auxiliary wall bars in the bathroom and toilet.
Walking transfer aids:
• Cane: It is the tool that contributes least to load transfer. It has the advantage of allowing rapid mobilization.
• Crutch and Cane: They are more stable than cane.
• Walker: It is the most stable walking aid. It is the most difficult to mobilize.
Pharmacological Treatment:
Drugs used in OA treatment are given to support non-drug treatment.
The basic treatment for osteoarthritis is non-drug treatment. Better results can be achieved when non-drug treatment is combined with drug treatment.
Although there is no drug treatment that prevents osteoarthritis, methods are being tried to slow down the development of joint damage or side effects.
In Drug Treatment;
Non-steroidal anti-inflammatory drugs (SOAEI)
It is done by preventing the release of lysosomal enzymes, stabilizing the lysosomal membrane, inhibiting the formation of prostaglandins, and inactivating other enzymes (proteases, etc.) that have become free.
Negative effects of SOAEI;
They inhibit protein synthesis
They inhibit collagen synthesis
They inhibit proteoglycan synthesis
Steroids:
Steroids administered into the joint negatively affect joint metabolism, completely stop mucopolysaccharide synthesis and accelerate proliferation events. Therefore, it increases degeneration in joints.
Intra-articular treatments:
Glucocorticoids
Hyaluronic acid
Morphine