Osteoarthritis: causes, risk factors, and treatment options

In osteoarthritis (OA), there is a breakdown of the smooth cartilage layer which then tries to heal itself and there is gradual progressive thinning of this cartilage layer with eventual complete loss. Osteoarthritis is characterized by pain and stiffness that is usually worse with movement and tends to be worst at the end of the day or after heavy activity.

There are two types of OA – primary and secondary. Primary OA develops in healthy joints and is the most common type, typically developing over the age of 50, with 1 in 10 people having a significant disability as a result over the age of 65. Secondary OA occurs in joints that have already been damaged through injury or deformity and so this can occur in younger people.

The most common causes of osteoarthritis include:

Degradation of cartilage

The primary hallmark of osteoarthritis is the breakdown of cartilage, the smooth, slippery tissue that covers the ends of bones within a joint. Cartilage serves as a cushion and facilitates smooth joint movement. In osteoarthritis, the cartilage gradually wears away, leading to friction between bones and resulting in pain, stiffness, and reduced mobility.

Joint inflammation

While inflammation is not the primary driver of osteoarthritis as it is in other types of arthritis, like rheumatoid arthritis, low-grade inflammation may contribute to the progression of OA. Inflammatory molecules released in response to joint injury or wear and tear can contribute to cartilage degradation and joint damage over time.

Genetic factors

Genetics may play a role in predisposing individuals to osteoarthritis. Certain genetic variations have been associated with an increased risk of developing OA, particularly in genes involved in cartilage formation, repair, and maintenance. However, genetics alone are insufficient to cause osteoarthritis, as environmental factors also play a significant role.

Joint injury or trauma

Joint injuries, such as fractures, ligament tears, or meniscal injuries, can significantly increase the risk of developing osteoarthritis, particularly in the affected joint. Damage to the cartilage or underlying bone tissue can disrupt the normal biomechanics of the joint and accelerate the degenerative process.

Metabolic factors

Metabolic disorders, such as obesity, diabetes, and metabolic syndrome, have been linked to an increased risk of osteoarthritis. Excess body weight places added stress on weight-bearing joints, such as the knees and hips, increasing the risk of cartilage degeneration and joint damage. Additionally, metabolic abnormalities associated with conditions like diabetes may contribute to inflammation and tissue damage in the joints.

Risk factors for osteoarthritis

1. Age. Ageing is one of the most significant risk factors for osteoarthritis. As individuals grow older, the cumulative effects of wear and tear on the joints, along with changes in cartilage structure and composition, increase the likelihood of developing OA. Osteoarthritis is most common in adults over the age of 50, although it can occur at younger ages, particularly in individuals with predisposing factors.

2. Obesity. Excess body weight is a major risk factor for osteoarthritis, particularly in weight-bearing joints such as the knees, hips, and spine. Obesity increases the mechanical stress placed on the joints, leading to accelerated cartilage degeneration and joint damage. Losing weight or maintaining a healthy weight can help reduce the risk of developing OA and alleviate symptoms in individuals with existing osteoarthritis.

3. Joint overuse or repetitive stress. Activities or occupations that involve repetitive movements or excessive stress on the joints can increase the risk of osteoarthritis. This includes occupations that require heavy lifting, repetitive bending, or prolonged kneeling, as well as sports or activities that place repetitive strain on specific joints, such as running, tennis, or manual labor.

4. Gender. Osteoarthritis affects both men and women, but certain joints may be more susceptible in one gender over the other. For example, knee osteoarthritis is more common in women, while hip osteoarthritis tends to affect men more frequently.

5. Previous joint injuries. Individuals with a history of joint injuries, such as fractures, dislocations, or ligament tears, are at increased risk of developing osteoarthritis in the affected joint. Even minor injuries that may not require immediate medical attention can predispose individuals to osteoarthritis later in life, highlighting the importance of proper injury management and rehabilitation.

6. Genetic predisposition. While genetics alone are not sufficient to cause osteoarthritis, certain genetic factors may increase susceptibility to the condition. A family history of osteoarthritis or related musculoskeletal conditions may indicate an increased genetic risk, particularly if multiple family members are affected. However, genetic predisposition is just one of many factors that contribute to the development of osteoarthritis, and environmental factors also play a significant role.

Understanding the causes and risk factors of osteoarthritis is essential for identifying individuals at risk and implementing preventive measures to reduce the likelihood of developing the condition. By addressing modifiable risk factors such as obesity, joint overuse, and injury prevention, individuals can take proactive steps to protect their joint health and reduce the burden of osteoarthritis. Additionally, ongoing research into the underlying mechanisms of osteoarthritis may lead to new strategies for prevention and treatment in the future.

Let's explore the symptoms of osteoarthritis (OA), which can vary depending on the affected joints and the severity of the condition:

Joint pain

One of the hallmark symptoms of osteoarthritis is joint pain, which may be mild to severe and can vary in intensity throughout the day. The pain is typically described as a deep ache or stiffness in the affected joint, which may worsen with movement or weight-bearing activities. Joint pain associated with osteoarthritis often improves with rest but may return after periods of inactivity.

Joint stiffness

Stiffness in the affected joint is another common symptom of osteoarthritis, particularly in the morning or after periods of prolonged inactivity. Individuals with OA may experience difficulty moving the affected joint through its full range of motion, and stiffness may improve with gentle movement and stretching exercises.

Joint swelling

Osteoarthritis can cause inflammation and swelling in the affected joint, leading to increased fluid accumulation and a feeling of fullness or tightness. Swelling may be more noticeable during periods of increased activity or after prolonged periods of standing or weight-bearing.

Reduced range of motion

As osteoarthritis progresses, individuals may experience a gradual loss of flexibility and range of motion in the affected joint. This can make it difficult to perform daily activities such as bending, squatting, or reaching, and may contribute to feelings of stiffness and discomfort.

Joint instability

In advanced cases of osteoarthritis, the breakdown of cartilage and changes in joint structure can lead to joint instability or a feeling of "giving way" in the affected joint. This instability may increase the risk of falls or injuries and can further impair joint function and mobility.

Severe osteoarthritis can cause joint deformities, such as bone spurs (osteophytes) or bony enlargements, which may be visible or palpable around the affected joint. Joint deformities can alter the normal alignment and mechanics of the joint, leading to further pain, stiffness, and functional impairment.

"Cracking"

Crepitus refers to a grating, cracking, or popping sensation that may occur during joint movement. In osteoarthritis, crepitus is often caused by roughened or irregular joint surfaces rubbing against each other, leading to audible or palpable sensations. While crepitus itself is not usually painful, it may be accompanied by discomfort or stiffness in the affected joint.

Functional limitations

Osteoarthritis can significantly impact an individual's ability to perform daily activities, such as walking, climbing stairs, or grasping objects. Functional limitations may vary depending on the severity and location of the affected joints and can have a significant impact on quality of life and independence.

Fatigue

Chronic pain, stiffness, and limited mobility associated with osteoarthritis can contribute to feelings of fatigue or exhaustion, particularly after engaging in physical activities or prolonged periods of joint use. Fatigue may be both physical and emotional and can further exacerbate the impact of osteoarthritis on daily functioning and well-being.

Psychological Effects

Living with chronic pain and physical limitations associated with osteoarthritis can have psychological effects, including:

• stress
• anxiety
• depression
• social isolation

It's essential for individuals with osteoarthritis to seek support from healthcare professionals, family members, and support groups to address these psychological impacts and maintain overall well-being.

It's important to note that symptoms of osteoarthritis can vary widely among individuals and may progress gradually over time. Early recognition and management of symptoms can help improve outcomes and enhance the quality of life for individuals living with osteoarthritis. If you experience persistent joint pain, stiffness, or swelling, it's essential to seek evaluation and treatment from a healthcare professional for an accurate diagnosis and appropriate management plan.

Diagnosing osteoarthritis (OA) typically involves a combination of medical history, physical examination, imaging tests, and sometimes laboratory tests. Here's a breakdown of the diagnostic process for osteoarthritis:

#1 Medical history

The healthcare provider will begin by taking a detailed medical history, including asking about the onset and duration of symptoms, the location and severity of joint pain, any factors that worsen or alleviate symptoms, and any previous injuries or medical conditions that may be relevant.

#2 Physical examination

A thorough physical examination will be performed to assess joint function, range of motion, stability, and signs of inflammation or deformity. The healthcare provider will palpate (feel) the affected joint for tenderness, swelling, or bony enlargements and observe the individual's gait and posture during movement.

#3 Imaging tests

1. X-rays are commonly used to visualize the bones and joints and can help identify characteristic signs of osteoarthritis, such as joint space narrowing, osteophyte (bone spur) formation, and subchondral sclerosis (increased bone density). X-rays are particularly useful for diagnosing osteoarthritis in weight-bearing joints such as the knees, hips, and spine.

2. MRI scans may provide detailed images of the soft tissues surrounding the joint, such as cartilage, ligaments, and tendons. MRI can provide valuable information about the extent of cartilage damage, joint inflammation, and other structural abnormalities not easily detected on X-rays.

3. CT scans may show the bones and joints in greater detail than conventional X-rays, particularly in complex joint structures or when assessing for bone abnormalities such as osteophytes or subchondral cysts.

#4 Laboratory tests

While there are no specific blood tests that can definitively diagnose osteoarthritis, certain laboratory tests may be ordered to rule out other conditions or assess for signs of inflammation or joint damage. These may include:

• Complete Blood Count (CBC: A CBC may be performed to assess for signs of infection or inflammation, such as elevated white blood cell count or erythrocyte sedimentation rate (ESR.

• C-reactive Protein (CRP: CRP levels may be measured to assess for systemic inflammation, which can be elevated in some cases of inflammatory arthritis but are typically normal in osteoarthritis.

#5 Differential diagnosis

In some cases, osteoarthritis may be confused with other types of arthritis or joint conditions, such as rheumatoid arthritis, gout, or pseudogout. Your doctor will consider the individual's symptoms, medical history, physical examination findings, and results of imaging and laboratory tests to differentiate osteoarthritis from other potential causes of joint pain and dysfunction.

While there is no cure for osteoarthritis, several treatment options are available to help manage symptoms, improve joint function, and enhance quality of life. Treatment strategies for OA may include:

1. Lifestyle modifications: Adopting healthy lifestyle habits such as maintaining a healthy weight, engaging in regular exercise, and avoiding activities that exacerbate joint pain can help manage symptoms and slow the progression of OA.

2. Medications: Over-the-counter pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) may help alleviate pain and inflammation associated with osteoarthritis. In some cases, prescription medications such as corticosteroids or hyaluronic acid injections may be recommended to provide symptomatic relief.

3. Physical therapy: Physical therapy can be beneficial for individuals with osteoarthritis by strengthening the muscles surrounding the affected joints, improving flexibility, and enhancing overall joint function. A physical therapist can develop a tailored exercise program to address specific needs and goals.

4. Joint support devices: Assistive devices such as braces, splints, or orthotic inserts may be recommended to provide support, stability, and pain relief for affected joints, particularly in cases of knee or hip osteoarthritis.

5. Surgery: In severe cases of osteoarthritis that do not respond to conservative treatments, surgical interventions such as joint replacement surgery or arthroscopic surgery may be considered to repair or replace damaged joint tissue and restore function.

Prevention

While osteoarthritis cannot always be prevented, there are steps that individuals can take to reduce their risk of developing the condition or slow its progression. These may include maintaining a healthy weight, engaging in regular exercise to strengthen muscles and improve joint flexibility, avoiding activities that place excessive stress on the joints, and protecting joints from injury or trauma.

When to see your doctor?

If you have had a painful joint or multiple painful joints that have not started to improve after a few weeks you should arrange to see your doctor who will examine you and arrange further investigations if appropriate. If your symptoms are severe you may be referred to see a specialist, and further management can include injections or surgery depending upon the joints affected.