The osteoarthritis or osteoarthritis is a chronic disorder manifested by pain persistent joints caused by abnormal wear of the cartilage and of the entire joint. It is the most common form of arthritis: 1 in 10 Canadians suffers.
The most commonly affected joints are the knee, hip and spine. However, other joints, such as the shoulder, ankle and wrist, can also be reached. Osteoarthritis of the fingers (digital osteoarthritis) is also very common, especially in women.
|Note. Osteoarthritis of the knee is also called gonarthrosis and osteoarthritis of the hip, hip osteoarthritis.|
According to Statistics Canada, osteoarthritis affects 10% of the Canadian population, both men and women. After the age of 55, however, women are more affected. The prevalence of osteoarthritis increases with age. At age 70, most people have osteoarthritis in one or more joints.
Causes of Osteoarthritis
The causes of osteoarthritis are many. Mechanical factors are in the foreground, associated with genetic factors, an inflammation process, and so on. Osteoarthritis is a disease that results in abnormalcartilage degeneration. Indeed, wear of a joint with age should not cause osteoarthritis. However, repetitive movements and repetitive strain injuries can cause abnormal wear leading to osteoarthritis. Excess weight and lack of physical activity are two other important factors.
|What happens when osteoarthritis appears?
In case of osteoarthritis, the cartilage wears out gradually and loses its original qualities, that is to say its flexibility and elasticity. However, we know today that the entire joint is affected in case of osteoarthritis: in addition to cartilage, the ligaments, bone, muscles and synovial fluid are altered. Thus, there is a loss of synovial fluid quality, a clear, thick egg-white-like fluid that normally lubricates the joint . Osteoarthritis is thought to be the result of an imbalance in the ongoing mechanisms of cartilage degradation and reconstruction. At the beginning of the disease, there is no sign of inflammation. Over time, inflammation may appear. Inflammation is seen more rarely in osteoarthritis than in other forms of arthritis.
Types of osteoarthritis
Primary osteoarthritis. When the person with osteoarthritis has no obvious predisposition, osteoarthritis is referred to as “primary”.
Secondary osteoarthritis. Diseases that affect the joints, such as inflammatory diseases (rheumatoid arthritis, gout, lupus, etc.) and metabolic diseases (diabetes, hemochromatosis ), predispose to osteoarthritis. The same is true of injuries and surgeries at a joint. When there is a predisposition for one or another of these situations, it is secondary osteoarthritis.
The symptoms of osteoarthritis (osteoarthritis)
The osteoarthritis or osteoarthritis, reaches each individual differently. The affected joints and the intensity of the pain vary from person to person:
- Of pain in the affected joint mainly when activated (e.g. knee pain down stairs);
- A sensitivity of the joint when applying a slight pressure;
- A stiffness of the joint, especially on waking or after a period of immobility. Morning stiffness lasts less than 30 minutes;
- Progressive loss of flexibility in the joint
- Feeling of discomfort in the joint as a result of changes in temperature ;
- “Crunches”, especially in cases of osteoarthritis of the knee;
- Progressive appearance of small bone growths (osteophytes) at the joint;
- More rarely, inflammation (redness, pain and swelling of the joint).
People at risk for Osteoarthritis
- People whose joints are in a wrong axis. This is the case, for example, with knees turned inwards or outwards ( genu valgum or varum );
- People with a hereditary predisposition.
- The repetitive movements caused by work or sport, which cause over time to joint damage (see the special section joints (sport and work) );
- The intensive practice of certain sports (rugby, soccer, tennis …);
- The trauma joints (sprains, fractures, dislocations);
- A lack of physical activity, which decreases muscle tone, reduces blood supply to the muscles and therefore leads to poor oxygenation of the cartilage;
- Wearing high heels (for osteoarthritis of the knee).
Prevention of osteoarthritis (osteoarthritis)
|Basic preventive measures|
Maintain a healthy weight
In case of excess weight, it is strongly recommended to lose weight and maintain a healthy weight. The causal link between obesity and osteoarthritis of the knee is well demonstrated. Excess weight exerts a very strong mechanical stress on the joint, which wears it prematurely. It has been determined that every 8 kg overweight in the 20s increases the risk of later knee osteoarthritis by 70%. Obesity also increases the risk of osteoarthritis of the fingers but the mechanisms involved are not yet well explained.
The healthy weight is determined by the body mass index (BMI), which gives the scale of ideal weight, based on the size of a person. To calculate your BMI, use our test What is your body mass index? .
Practice regular physical activity
The practice of physical activity regularly helps maintain overall good health, ensure good oxygenation of the joints and strengthen muscles. Strong muscles help to protect the joints, especially the knee, and therefore reduce the risk of osteoarthritis and symptoms.
Take care of your joints
Protect your joints when playing a sport or work that puts you at risk of injury.
If possible, avoid excessive repetitive movements or over-stressing a joint. However, the link between acute trauma and osteoarthritis is more certain than with chronic or repetitive micro trauma.
Treat joint diseases
In the event of a disease that may contribute to the onset of osteoarthritis (such as gout or rheumatoid arthritis), individuals should ensure that their condition is best controlled by appropriate medical follow-up and treatment.
Medical treatments for osteoarthritis (osteoarthritis)
There is no cure for the moment. In addition, there is no known treatment that can delay the destruction of cartilage. However, there are drug and non-drug solutions that aim to relieve the pain and stiffness of the affected joints. They vary according to the intensity of the symptoms.
The latest international recommendations emphasize the importance of non-pharmacological measures to treat osteoarthritis, especially when it affects the knee or hip.
- Regular exercise, 15 to 30 minutes, at least 3 times a week: walking, swimming, aerobics, adapted muscle building, etc. The intensity of the exercises can be adapted to the variations of the intensity of the pain;
- Weight loss in case of obesity or overweight. Losing 5% to 10% of its weight can sometimes eliminate the pain in case of osteoarthritis of the knee, reducing the burden on the joint;
- Physiotherapy if necessary;
- Adaptation of the work environment if the work causes joint trauma causing osteoarthritis.
When they are not enough, these measures can be supplemented by taking medication to relieve pain. In more serious cases, the doctor sometimes offers surgery. Consult the Arthritis chart for other ways to soothe the pain.
Acetaminophen. Acetaminophen (Tylenol, Tempra) is the first recommended pain reliever for osteoarthritis. This medicine is very effective, especially if the osteoarthritis is light. It is important to follow the recommended dosage, since high doses can damage the liver.
More powerful pain medications may be prescribed if the pain is not relieved by acetaminophen or other medications (see below). Some contain a combination of acetaminophen and codeine. However, they can cause nausea, constipation and drowsiness.
Like other pain medications, these medications do not affect the course of osteoarthritis, but its symptoms. Because of their potential adverse effects, they are only used when maximum dose acetaminophen (4 g / day) fails to relieve pain.
Classical non-steroidal anti-inflammatory drugs (NSAIDs) Nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve pain and inflammation . The NSAID family includes ibuprofen (eg, Advil and Motrin), ketoprofen (eg, Actron and Orudis) and naproxen (eg, Anaprox and Naproxen). Some are over-the-counter and others, more powerful, are issued by prescription of the doctor. As they can lead to potentially serious digestive effects, they are sometimes associated with protective drugs of the stomach wall. They are used for the shortest possible time, as needed only. Alcohol consumption is not recommended during treatment.
Common side effects: gastrointestinal discomfort, such as heartburn, ulcers, or sometimes serious digestive bleeding.
Non-steroidal anti-inflammatory drugs selective inhibitors of Cox-2 (or coxibs). This generation of anti-inflammatory, selective inhibitors of cyclooxygenase-2 (Cox-2) or coxibs, works by inhibiting an enzyme, Cox-2, involved in the inflammatory process. They are less damaging to the stomach than conventional anti-inflammatories. Celecoxib (Celebrex) is one of them. Its use is generally reserved for people whose risk of gastrointestinal complications is considered high and whose risk of cardiovascular disease is low. Meloxicam (Mobicox) also has an inhibitory effect on Cox-2, but less than that of celecoxib. For their part, rofecoxib (Vioxx), valdecoxib (Bextra) and lumiracoxib (Prexige) were in turn withdrawn by Health Canada between 2004 and 2007, due to the risk of serious side effects that they included 6,7.
These medications do not eliminate the risk of gastrointestinal symptoms and should be given the same moderation as other anti-inflammatory drugs.
Topical anti-inflammatories. This type of anti-inflammatory gel or cream is applied directly to the painful joint (for example, Pennsaid or Voltaren emulgel, diclofenac topical solution). They are a good alternative to oral anti-inflammatories because they do not cause digestive side effects. However, in cases of osteoarthritis of the hip or spine, it is not known if the drug can penetrate deep enough (to the joints) to be effective.
Injections of corticosteroids. In more severe cases, when the person has difficulty moving and the pain is not relieved by oral analgesics, the doctor will prescribe corticosteroid injections directly into the affected joint. People who take this treatment should expect relief that gradually sets in rather than immediately. Only 2 to 4 corticosteroid injections can be given each year, to limit side effects, such as a loss of bone minerals.
Injections of hyaluronic acid. In case of osteoarthritis of the hip or knee, injections of hyaluronic acid can also relieve pain, with a less rapid effect than injections of corticosteroids. This procedure is also called “viscosupplementation ” because hyaluronic acid is a kind of gel that lubricates the joint, relieves pain and provides better mobility. However, studies to date indicate that the beneficial effect of this treatment is relatively unimportant. Several studies have not shown an effect superior to placebo.
|Other medications such as glucosamine or chondroitin are effective and frequently prescribed by doctors for osteoarthritis.|
Surgery. In case of failure of the medical treatment and too much functional discomfort, surgical operations may be suggested. The arthroscopy allows removal of cartilage and bone debris into the joint. Other procedures can correct bone growths and deformities, weld joints or reconstruct part of the joint. As a last resort, replacement surgery will be performed. The affected joint (often the hip) is then replaced by an artificial joint (a metal or plastic prosthesis).
| Practical advice
Take care of your joints. After doing an activity that requires more intense articulation, give yourself a break. In case of severe pain, avoid forcing on the joint.
Moderate your physical efforts. Begin exercise or exercise safely and safely to avoid injury. Do not engage in activities that exceed your abilities.
Have a good posture. When standing, stand upright to protect the joints in your neck, spine, hips, and knees.
Lift the objects carefully. To pick up a heavy object, squat down and bend your knees. When standing up, keep your back straight while keeping the object as close to your body as possible.
Avoid staying still for too long. Change your position regularly to reduce stiffness in your muscles and joints.
Wear good shoes. If you have osteoarthritis of the knee or hip, wear comfortable shoes with good insoles that cushion shocks and allow proper weight distribution on the feet.
Use specialized devices. Supports can help you support your joints and thus facilitate movement. Visiting a doctor or occupational therapist helps to choose the right equipment: canes, walkers, trolleys, and other supports.
Adapt the house as needed. For example, a faucet that does not twist your wrist and fingers, grab bars to move or stand, lids, etc. An occupational therapist can advise you.