Osteoarthritis

All of you must either have experienced or known someone who has experienced pain in their knees at some point. That constant dull aching pain that is present with every step a person walks has troubled many and in fact is a common factor in reducing the quality of life of a person especially as one ages.
This disease is misunderstood by many and often results in people changing their doctors frequently and also has resulted in many people turning to quacks who take advantage of a patient by charging exorbitant amount of money and by giving them spurious medicines laced with steroids which though give immediate relief to the patients, sometimes have disastrous results.
So what is this Osteoarthritis? How does it start? Whom does it affect? Is it really incurable? These are some of the queries that we would try to answer in this article.
To answer the first question, osteoarthritis is a disease of cartilage, not only of the knee but also of almost all the joints in the human body such as fingers, hip and spine. Cartilage is that smooth but tough tissue that lies between the bones at the joints that enables us to have smooth yet painless motion. This joint is lubricated with a highly viscous fluid that enables us to walk without much friction between cartilages. It is this fluid that is called as water by your neighborhood know it all. This whole structure is covered by synovium, the tissue that produces the synovial fluid.
To be truthful to you, modern science yet does not know the exact reason for the beginning of osteoarthritis however we have known certain constant associations between osteoarthritis and other factors. These are female sex, increased weight and older age. What it means is that female, obese people and elderly are all liable to develop osteoarthritis much more than those of us who are not one of these. Just look around you and you will find this assertion to be true. However this does not mean that all female, obese and elderly will get osteoarthritis. There are many a elderly who have a knee that would put an young persons knee to shame.
Another association is with repeated trauma to the knee, we shall explain how in the coming paragraphs.
How does it start? Well all of you must have seen the unraveling of a sweater. The thread once pulled out never stops until whole of the sweater is unraveled, you may try various things to prevent it or delay it but it invariably gets worse. Similar is the case of our cartilage, it is made up of very fine filamentous structures that are interwoven at the microscopic level to make a very firm but elastic and compressible cartilage. However it has one distinct weakness. It is that once its surface has been notched due to any reason, trauma or otherwise the fibers unravel, water seeps in, it begins to swell and things go downhill from here.
So how would one know that he has osteoarthritis and not something more sinister, after all there are other conditions that cause knee pain too. Rheumatoid arthritis is a very common disease of the joints that may cause knee pain and mimic osteoarthritis. It is a treatable disease that must not be neglected. One simple way is to contact the doctor for every knee pain but for those of you who are wary of seeing a doctor here is a simple differentiation, pain of osteoarthritis is very less initially and usually affects one knee more than the other, the stiffness of the joints in osteoarthritis that comes after sitting or resting for a while lasts less than half an hour. Rheumatoid arthritis on the other hands affects both sides equally and the stiffness lasts greater than half an hour.
Injury to the knee can produce pain acutely by a simple soft tissue trauma or something more troublesome like ligament or meniscal damage so it should not be neglected and a consultation with a doctor is necessary as timely intervention can be very effective. Letting things fester can cause further complications later.
A patient with osteoarthritis of the knees will complain of pain in his knees usually associated with walking. Difficulty in climbing stairs or rising from a chair, stiffness in the joints after a period of inactivity. Some patients may even complain of swelling in the joints and in later stages of the disease deformity of the knees in which the knees may bow outwards.
So, is the disease incurable? In a word yes but is it untreatable? NO. the disease is treatable. There are ways in which the progress of the disease can be slowed also there are several ways by which the pain and disability of the patients may be alleviated.
First treatment is cause specific. Obese patients should lose their weight and patients with trauma to the knee should get the underlying ligamentous or meniscal damage assessed and treated as these can lead to osteoarthritis.
For those patients who do not fall in these categories the first line of treatment is physiotherapy of the joints. Physiotherapy strengthens the muscles around the knee and thus decrease the rubbing of the cartilage to each other thereby decreasing the pain. It also keeps the joint active and prevents the formation of deformities in the joint.
Analgesics in moderation and under supervision gives good relief of pain but its injudicious use can cause gastric ulceration and damage to kidneys. This is the reason that the doctors do not recommend taking the tablets over the counter.
Certain supplementary treatments such as glucosamines and chondroitin sulphates also provide relief to some patients.
Intra-articular steroids give instantaneous relief but cause further damage to the cartilage so they should only be given under supervision of an orthopedician.
Viscosupplementation with hyaluronic acid which is a natural constituent of the synovial fluid has been found to give reliefs of upto one to three months in the patients and are very useful though limited form of treatment.
Among the surgical methods of treatment available with us, the first treatment that we prefer is an arthroscopic debridement and lavage of the knee joints. It is nothing but a cleaning up of the joint by which we introduce a scope through a small incision and pass a lot of water through it and also remove debris and loose fragments of the joints. This procedure gives relief to relatively younger patients with lesser severity of disease.
Final tool in the orthopedician's hands is a total knee replacement. Again it is a very useful tool in the patients with severe osteoarthritis , unbearable pain with deformities of the knee joint, it is a proven method with more than 99% longevity of the replacements by the 20th year. The improvements in both the implant and the operation methods have been such that this operation can be done in younger patients than was possible earlier so the patients need not wait till the condition worsens to a great extent. As the results then would not be as good as they would be at an earlier stage.
To summate, osteoarthritis is not a disease of despair and can be effectively treated by a doctor using the various modalities at his disposal but these modalities vary from patient to patient depending upon the age, severity and the associated conditions.