Joint pain is a frequent cause of pain and loss of quality of life, especially in older adults. However, it is not an exclusive disease of advanced age. It can affect anyone.
Aging is an undeniable fact, but we can modify our lives to reduce those details and actions that slowly and insidiously damage our joints.
What can you do to avoid it? We invite you to read the following article, where we will provide everything you need to know about osteoarthritis, how to avoid it and, if you suffer from it, how to alleviate its symptoms.
What is osteoarthritis?
Osteoarthritis is a degenerative condition with inflammatory elements, caused by the degradation or loss of hyaline cartilage, located in the synovial joints. But, it not only affects the cartilage, but all the components of the joint.
The word osteoarthritis is actually a synonym. Its other name is osteoarthritis, the most common joint disease worldwide. Osteoarthritis (or osteoarthritis) is, in turn, a type of arthritis.
Therefore, it is very important to recognize the difference between these terms. All osteoarthritis is a type of arthritis (inflammatory joint condition), but not all arthritis is osteoarthritis.
For example, rheumatoid arthritis is a type of arthritis, but it is not the same as osteoarthritis. In turn, osteoarthritis is a heterogeneous group of signs and symptoms, which depend on the type of joint affected and the underlying cause. Its main symptom is joint pain.
Causes of osteoarthritis
Like a good number of diseases, osteoarthritis is multifactorial. There are internal and external factors that lead to disease. Next, we will mention some of the factors related to the development of this condition.
Throughout our lives, we use our joints for virtually all movement in our bodies. Even the simple action of typing on the keyboard requires a synergy of the joints and muscles of the hand.
Mechanical stress is the main factor that leads to this disease in the joint. That is, all the weight and movements that we carry out have a direct effect on our joints.
Inside these, the cartilage prevents direct contact between the bones, avoiding friction or inflammation. This cartilage is, then, who receives a good portion of the impact of our daily movements.
Chondrocytes, the cells responsible for producing cartilage, are responsible for releasing substances (proteoglycans) that keep cartilage in good condition. But, as we age, its metabolic capacity decreases.
This decrease in proteoglycans, plus external factors (as we will see later), are the main factors that accelerate the loss of chondrocytes. Without these, the cartilage, over time, erodes.
This allows the bones of the joint to come into contact. When they do, the common symptoms that characterize osteoarthritis (pain, decreased mobility of a joint, stiffness, etc.) occur.
The relationship between body mass index (BMI) and osteoarthritis have been studied over the years. A specific study evaluated the evolution of the BMI of 594 women, over 15 years.
What they found was that a high BMI during the first year (and its elevation in subsequent years) were predictive factors in the development of bilateral knee joint pain.
The reason? Possibly the greater degree of pressure suffered by the joints (especially those of the lower limb) due to the increase in body mass. As another possible reason, obesity is, in a way, an inflammatory state.
Why? The adipocytes (fat cells) of an obese person are prone to release adipokines. These are pro-inflammatory substances, circulating in our blood, that generate chronic and insidious inflammation in our joints.
Accidents or surgeries can cause problems in the joints and their components (such as the synovial membrane, the joint capsule, ligaments, etc.). The obvious sudden mechanical stress can compromise its function.
In people who have suffered significant joint injuries (for example, by falling), they have a higher risk (20%-50%) than healthy people of developing post-traumatic osteoarthritis.
Not all stress has to be abrupt. Micro-injuries, produced by occupations or lifestyles that frequently involve bending the knees, are harmful and insidious, especially in the long term (in the short term, the effects are not appreciated).
Athletes, due to intense training over the years, are prone to osteoarthritis. The knee joints are prone to suffering in those people who practice high-impact sports, such as marathon runners or soccer players.
For decades, scientists have paid considerable attention to the possible existence of a genetic component in the genesis of this disease in affected patients.
Multiple genes have been identified, directly associated with osteoarthritis, but not exclusively with it. They are also associated with other metabolic conditions, such as excessive inflammation and obesity.
Coincidentally, both are among the main factors for the development of osteoarthritis. Again, this reinforces the idea that osteoarthritis is the result of multiple phenomena that culminate in the same point.
Among these genes, we find ADAM12, CLIP, COL11A2, IL10 and MMP3, responsible for processing proteins responsible for various biological processes.
An example is COL11A2, essential for the production of collagen that makes up, together with other compounds such as chondroitin sulfate, the extracellular matrix.
Any condition or disease that may involve the joints, regardless of which one it is, can lead, in the long term, to their degeneration. Since they accelerate the process of natural degradation of articular cartilage.
Among these, we have: genetic or acquired metabolic disorders (hemochromatosis, diabetes, Wilson’s disease), other types of inflammatory arthritis (such as rheumatoid or septic) or congenital disorders of bone or joint development.
In this sense, people who suffer from a predisposing condition should take care of infections. In the current COVID 19 pandemic, people with osteoarthritis may be even more affected.
Why? elevation of inflammatory substances in the blood (as in infections), could exacerbate breakdown within the joint capsule, worsening symptoms (eg pain or disability).
As we mentioned, the symptoms depend, to a large extent, on the degree of degeneration, the affected joint and the time in which the disease has developed.
Next, we will mention some of the most common symptoms, to help you identify this disease.
Intense joint pain
Pain is the main symptom of the disease. The person describes it as a deep and constant pain, especially when using said joint.
Pain is believed to originate from different mechanisms: activation of pain receptors at the level of the synovial membrane, fatigue of the muscles that support the joint, inflammation of the periarticular bag, psychological factors, and many more.
Inflammation is not strictly a hallmark of the disease. There are inflammatory elements (such as the presence of proinflammatory cytokines, such as IL-17), but inflammation is one more mechanism that worsens the disease and its symptoms, such as pain.
In addition to cytokines, we find enzymes, such as metalloproteinases. In a normal cellular environment, metalloproteinases break down obsolete cell molecules and structures, to be replaced with new, functional ones. In this way, a healthy cellular environment is maintained within the joint capsule.
So, a joint depends on the balance between substances that create and maintain the components of the joint in good condition and substances that are responsible for degrading metabolic “wastes”,
When one extreme exceeds the other (in this case, the degrading substances), the erosion of the synovial cartilage occurs due to the degradation of its components, such as chondroitin sulfate. Other substances involved are prostaglandin E2, IL‐1β and uric acid.
As articular cartilage erodes over time, it loses its elasticity and range of motion is diminished. In other words, an eroded knee joint cannot be fully flexed or extended.
Also, in the most serious phases, it is common to find a “scratchy” sound or crunchy sensation when moving the joint, known as crepitus.
The stiffness is accentuated in the morning, just after the person wakes up. The hours in which the person was asleep, without using the joint, makes any movement rough and painful.
In normal situations, in joints such as those of the knee, shoulder, elbow or hands, the cartilage prevents the bones that form the joint from coming into direct contact.
To put it in a certain way, the cartilage allows the “bones” to glide, without generating friction or pain. In osteoarthritis, this cartilage is constantly eroded, exposing the underlying bones.
The bare bone comes into contact with the opposite bone surface. This generates friction and mechanical stress, which activates different cellular pathways that increase the density and thickness of the bone (a process called eburnation), leading to the progress of the disease.
This excessive growth can lead to bone collapse, since the new tissue is weak and misshapen. There is appearance of subchondral cysts, product of a degenerative process.
The body, trying to repair the damage, creates new cartilage and bone tissue that protrudes into the space between the two bones. This new tissue is known as osteophytes (also called bone spurs).
Joints depend not only on cartilage to keep them in place, but on ligaments, tendons, menisci, and muscle. When the main “pillars” of the joint give way, the muscles must compensate for these structural failures.
However, this compensation is not permanent. Muscles, as we all know, tire when constantly used. This is produced by an accumulation of lactic acid, by the contraction of muscle fibers.
loss of mobility
Range of motion is a natural, functional consequence of many joint diseases. This has a direct impact on the patient’s quality of life and their ability to perform daily tasks.
Types of osteoarthritis
Osteoarthritis predominantly affects the joints that must bear the greatest weight, such as the knee, hip, lumbosacral and cervical regions of the spine and feet.
It does not mean that they cannot affect joints, such as those of the hand (the proximal and distal interphalangeal joints, and the carpometacarpal joints). Next, we will explain the different types of osteoarthritis.
Also called coxarthrosis. Initially, patients present slight fatigue when moving from one point to another, which progresses to accentuated and painful difficulty when moving.
The pain occurs after getting up, when the person has been sitting for a long time. They generally occur in people who have done physical and arduous work for a long time, soccer players, etc.
On your knees
Also called gonarthrosis. The knee joint is one of the load-bearing joints most perfectly adapted to its function. On the other hand, it is also the most vulnerable to accidental or repetitive trauma (wear and use).
The range of motion of the joint is reduced, creaking and noises that occur when the patient uses the joint can also be seen.
Under normal conditions, the lower limb has a normal resting position, which allows it to distribute the load equally, without applying too much pressure in one area or another.
This is especially in a joint that has to carry weight all the time, like the knee (so it’s no surprise that some professional athletes wear down knee cartilage more quickly than others).
In certain patients, there is a deviation from this axis or normal positioning of the lower limbs, either inward ( genu valgum ) or outward ( genu varum ). The degree of deviation is a factor taken into account when applying a treatment.
Osteoarthritis of the hand is not as frequent as the others, since they are not load-bearing joints. Despite this, it does not mean that it cannot happen.
They usually affect the distal interphalangeal joints (the joint of your finger closest to the tip). But, the joints of the thumb or the proximal interphalangeal joints (the “middle” joint of the finger) can also be affected.
Unlike the rest of osteoarthritis, the inflammation is not as accentuated and, in some cases, it is not even present. On the other hand, there may be the presence of palpable, hard and occasionally painful nodules.
These are Heberden’s nodes, which are nothing more than bone spurs at the level of the distal interphalangeal joint. If they are found in the middle (proximal) joint of the finger, they are called Bouchard’s nodes.
Also known as spondyloarthrosis. It is impossible not to emphasize the importance of the spine, in almost any movement that involves our torso. But, precisely for this reason, the spine is the most common seat of bone injuries.
Even lifting a heavy box, using the wrong maneuver or position, you find yourself injuring your spine in the long run. Not surprisingly, jobs that involve carrying excessive weight are the most common causes of injury.
At the cervical level, the C5 vertebra tends to be the most affected. It is characterized by localized pain, stiffness, and spasms of the paravertebral muscles. Because of their close proximity to the spinal cord, they can compress or injure nerves.
Also, the vertebral arteries may be compromised. If so, blood flow to the brain decreases, so patients may experience dizziness, vertigo, and headache.
Lumbar osteoarthritis, like cervical osteoarthritis, can occur after years of wear and tear and repetitive use. Generally, they affect the L3 through L5 vertebrae. The degradation of the joint can compress the nerve roots that emerge from the spine.
In this sense, there is pain, stiffness, radicular pain or sciatica (a pain that extends to the leg, calf and even to the foot). Also, there may be drowsiness, tingling, and weakness of the leg and calf muscles.
Treatment for osteoarthritis
The treatment for osteoarthritis depends, to a large extent, on the degree of degeneration, the site of the lesion (knee or hip, for example) and the characteristics of the patient (age, sex, personal and/or family history).
Next, we will show you some treatments commonly used to calm the symptoms and repair the cause of this debilitating disorder.
Among the recommendations for the treatments to be used, drawn up by the American College of Rheumatology , is the pharmacological one, aimed at appeasing the symptoms of pain and inflammation.
Non-steroidal anti-inflammatory drugs are generally recommended, either topical or oral, intra-articular corticosteroid injections (if in the knee), acetaminophen, pain relievers (topical or opioid).
Many of these medications, despite their effectiveness, cannot cure the cause of osteoarthritis, nor do they permanently reduce symptoms. Its purpose is to decrease morbidity and avoid complications (for example, antidepressants).
The administration of glucosamines, such as chondroitin sulfate, has shown short-term benefits, but none in the long-term that can improve pain or joint function.
Surgical interventions are generally used in patients whose pathologies are resistant to pharmacological treatments. There are several options, each designed with a series of situations in mind.
First, we have arthroscopy. The surgeon makes a small cut, the size of a buttonhole, and introduces a thin tube connected to a video camera, which allows viewing the interior of the joint capsule, in high definition.
Now, the surgeon can take a good look at the joint problem and manage to solve it, without causing much damage to the joint. It is used to treat damaged or torn cartilage and ligaments, broken bone fragments, implant placement, etc.
However, surgery is not magical. Its effectiveness depends, in large part, on the skill of the surgeon. It is recommended to treat specific problems. Extensive injuries, where the disease state is severe, such as a severely degenerated knee, other alternatives are recommended.
On the other hand, we have arthroplasty. It is much more invasive, it consists of removing the damaged articular surface and placing a metal or plastic prosthesis.
Arthroplasty is considered as the last measure. It relieves pain and even helps to partially recover joint function. If there is no kind of complication, a prosthesis can last up to 10 to 15 years.
Of course, like every operation, there is a risk of infection and blood clots. Therefore, the necessary measures must be taken (preoperative antibiotics, anticoagulants, outpatient assistance for patient care).
Not every treatment is meant to give patients drugs or operate on them. Lifestyle changes are also important to relieve symptoms and avoid complications.
Physiotherapy allows the person to partially recover motor skills, self-confidence and help the person become independent, especially those with knee or hip joint problems.
Occupational therapy, together with physiotherapy, are part of the interdisciplinary team, which must ensure the health of the person.
One of its primary functions is to assess the person’s ability to perform daily activities, such as grooming and personal hygiene, functional mobility, eating, dressing, and much more.
That is where occupational therapists come in, who must observe these activities, any functional deficit, provide help and intervention if necessary, especially if the patient has undergone any treatment (for example, surgery).
Different international organizations recommend acupuncture as a valid option for certain patients, but not for others.
For example, the American College of Rheumatology recommends acupuncture to relieve moderate to severe pain in patients who are candidates for arthroplasty, but do not want to undergo it or have contraindications.
On the other hand, the American Academy of Orthopedic Surgeons strongly recommends against using acupuncture in patients with symptomatic knee osteoarthritis.
Hydrotherapy is another alternative that may seem interesting to you or to any family member with osteoarthritis problems. It consists of a resistance exercise regimen, but where the entire lower half of the body is submerged in water.
Hydrotherapy offers benefits for the joint, increasing its resistance and range of motion, allowing the person to move over greater distances.
Not only that, but it also offers cardiovascular benefits. Taken together, it reduces the risk of developing diseases resulting from the loss of quality of life, especially in very debilitating osteoarthritis, such as knee or hip osteoarthritis.
If you are overweight and have joint problems, losing weight is never a bad idea. However, reaching your ideal weight range is not as easy as it seems.
Putting aside hypercaloric food and lacking in nutrients is not the only solution to lose weight. It consists of acquiring eating habits and a healthy lifestyle, sustainable in the long term, and that reduces the risk of diseases.
Fruits, vegetables, legumes, fiber and complex carbohydrates , essential fatty acids, are some examples of foods that you should incorporate into your life gradually and consistently.
It is common for people with osteoarthritis, particularly of the knee or hip, to avoid physical exercise, due to the pain or limitation they present. But, the reality is that exercise is essential to alleviate the symptoms.
In the long term, individualized resistance training regimens and different types of exercise, such as walking, have been shown to reduce osteoarthritis symptoms, especially in elderly patients.
Another study , demonstrated that, in patients with knee osteoarthritis, stretching exercises that exercise the quadriceps avoid atrophy due to disuse. Weight-bearing workouts are not recommended .
Heat or cold therapies seem to be effective, fast and cheap therapies to treat joint pain. In the case of cold, applying cold compresses to the painful joint for twenty minutes can decrease the cold.
The cold reduces swelling (caused by inflammation) and numbs the area, which temporarily decreases pain symptoms.