OSTEOARTHRITIS - AN OVERVIEW
How does the old saying go? We all can count on two things in life: death and taxes. But there is a third thing many of us can count on in life – Arthritis.
The word "arthritis" is a blend of the Greek words "arthron," for joint, and "itis," for inflammation. So arthritis literally means "joint inflammation." Although arthritis is often referred to as one disease, it is not, as Arthritis has more than 100 forms and is a common cause of pain and disability.
Osteoarthritis has been described by the WHO (World Health Organisation)as a potential epidemic and a major health care services cost driver in an aging society. OA has the largest impact on burden of disease borne in later life and has been acknowledged by its listing as the 7th health priority in Australia.
Approximately 70-80% of people in the U.S. over 50yrs of age suffer to some extent with the most common type of arthritis called Osteoarthritis, also known as 'degenerative arthritis'. The 206 bones of the body make up a framework – skeleton – that give it structure and shape. They serve to protect the soft tissue, act as a reservoir of minerals and generate cells of the blood, including some of the infection- fighting white blood cells which perform their function in the tissues. Bones are living structures and so must receive food and oxygen and eliminate metabolic waste.
Osteoarthritis is a degenerative disease that frequently leads to chronic pain and disability. This disease begins with the degeneration of the cushion of cartilage between the joints. As it degrades the synovium and the ends of the bones thicken, resulting in the pain and stiffness associated with arthritis.
You may have heard a family member or friend say he needs to have a joint replaced because he has 'bone on bone'. What he is really saying is that the cartilage (the cushion) of his joint is entirely gone. Cartilage is very similar to bone in that it is made up of many collagenous fibers. In cartilage however the fibers are embedded in a firm gel instead of the hard cement- like substance of bone.
As the joint cartilage begins to wear down, it causes increased stress to the bone. In response to this intensified stress the bone actually becomes denser. It is very common to see bone spurs (a bone spur is a growth on the bone) forming around the joint as a result. Osteoarthritis is mainly a degeneration of the cartilage in the joints, but it can also involve the synovial lining (the lining of the joint) and the underlying bone.
Knee Joint -
Since degenerative arthritis primarily involves the weight-bearing joints (hips and knees), repeated mechanical stress caused by excessive weight, trauma, or activity is a contributor to the development and progression of this disease.
If you know someone who suffers from Arthritis you are probably familiar with the symptoms they complain of, early morning stiffness, mildly swollen joints, and joint pain. Osteoarthritis is by far the most common chronic degenerative disease affecting men and women alike. It can involve every joint in the body, including the neck and lower back. As arthritis gets worse, it can cause significant discomfort, pain and even disability.
How is the joint actually damaged?
Articular (pertaining to a joint), cartilage covers the ends of our bones, while joints like the knees also have additional cartilage that acts as a cushion between the bones. Cartilage is not perfused with blood vessels like bone.
There are 3 types of cartilage –
Hyaline – Hyaline cartilage is the most abundant cartilage, covering the articular surfaces of bones and helping to cushion them from injury
Fibrous – Fibrous cartilage has the most collagenous fibers in its matrix and is therefore the strongest . Fibro cartilage is between the disks of the vertebrae and helps to cushion the spine against jolts.
Elastic – Elastic cartilage has elastic as well as collagenous fibers, so it is flexible as well as firm. The external ear and Eustachian tube are composed of elastic connective tissue. Ref. “The Clinical Nutrition Desk Reference”, Laurent Bannock DrHS MS LN, page 50.
Cartilage is primarily made up of collagen fibers, glycoproteins, and proteoglycans. The structural integrity of human cartilage is continually going through a cycle of building up and breaking down. In other words, our bodies need to be building cartilage at the same rate as it is wearing down in order to maintain healthy joints. Again, a balance is the key. When a joint begins to wear out, we know that either the breakdown of cartilage has increased or the production of cartilage has decreased.
That osteoarthritis is an inflammatory disease is a well-known fact. If you observe anyone with arthritic hands, you can actually see how inflamed and swollen the joints of the fingers and hands become. Have you ever wondered what exactly is causing the inflammation and how this leads to damage of the cartilage?
The answer is a multifaceted one, because there are actually several sources for information that occur within the joint, as you can see here below:
Causes of Inflammation in Our Joints
Cytokines are some of the leading causes of joint inflammation. These proteins carry messages between cells and regulate immunity and inflammation. Two of the most important cytokines are tumour necrosis factor alpha (TNF-a) and interleukin one beta (IL-19). These are highly concentrated in the joints of people who have osteoarthritis.
Proteases, enzymes that cause the breakdown of proteins, also have been shown to create inflammation in the joint. Proteases are under the control of the cytokines. Some have anti-inflammatory qualities, and some have pro-inflammatory (inflammation-creating) qualities. Obviously, in arthritis the pro-inflammatory proteases are winning.
Phagocytes (neutrophils) are attracted to the inflamed joint in an attempt to clear this reaction to prevent damage to the cartilage and synovial lining. But this inflammatory response is not always a good thing. Neutrophils can actually lead to more inflammation in the joint.
The ischemia-reperfusion phenomenon is a process that sounds difficult but actually is simple. As we use a weight bearing joint like a hip or knee, the pressure created by our weight when we walk, or especially when we run, blocks the blood flow to the cartilage. This is known as ischemia or lack of blood supply. When we take our weight off the joint, the pressure lessens and the blood is allowed to return to the cartilage (this is called reperfusion). This process, as well as the sources of inflammation I've just listed, causes excessive production of free radicals. In turn, the free radicals heavily tax the antioxidant defence system and cause oxidative stress.
When the antioxidant defence system is overwhelmed, oxidative stress within the joint causes damage to the cartilage and synovial lining of the joint. When the body cannot rebuild cartilage fast enough, the joint begins to deteriorate.
Signs of Osteoarthritis are:-
Early morning stiffness - However, in contrast to inflammatory joint disease, the joint stiffness in osteoarthritis is of short duration, usually lasting less than 15 minutes.
Loss or restriction of joint mobility
Pain that is worse after use. Osteoarthritis feels worse the more we exercise and as the day wears on.
Stiffness after periods of rest
Creaking/cracking of joints after movement
Tenderness and swelling in certain areas
Restricted mobility
Pain in the joint before or during changes in the weather
Examination may reveal localized tenderness and pain on passive motion, especially at the extreme of movement.
Possible causes:-
* Age. The probability of Osteoarthritis increases with age. In the Us over 80% of the population over 50 shows signs of OA. This is due to the decreased ability of the collagen matrix to repair itself, and also from general wear and tear. It generally affects the hips, knees, spine, hands and feet
* Obesity
* Poor diet and exercise regime over a long period of time.
* Genetic disposition
* Skeletal defects
* Hormonal imbalance. OA increases after menopause
* Nutritional imbalance
* Injury – increases risk of developing Osteoarthritis in the injured area
The goals of therapy for osteoarthritis are to decrease pain, maintain or improve function, and provide education about the disease and its management.
Suggested ways to cope:-
Stress reduction is essential
Proper diet is important.
Avoid caffeine, alcohol and tobacco
Avoid allergy foods
Maintain normal weight
Supplemental Omega 3 may be helpful to decrease inflammation
Hot baths and hot pads may provide some relief
Juicing is good and ginger is also beneficial as an anti- inflammatory agent. Ginger is the strong-tasting herb widely known to soothe an unsettled stomach, especially when nauseous.
Deep massage may be beneficial
It may seem counterintuitive, but a recent study confirms that people with osteoarthritis can improve mobility and enhance their quality of life with modest levels of exercise.
Although arthritis is a wear-and-tear condition, mild to moderate exercise will not damage your joints. In fact, carried out routinely and carefully, an exercise program can dramatically reduce the risk of osteoarthritis by strengthening the muscles that support weight-bearing joints. Of course, exercise will also help with weight loss, which in itself will reduce your risk of arthritis. And what if you already have osteoarthritis? A study reported in the journal Arthritis and Rheumatism (Volume 53, page 879) indicates that even modest physical activity can preserve mobility in people already diagnosed with arthritis. www.johnshopkinshealthalerts.com
Although food is often looked at solely in terms of its impact on weight gain, it is also the safest, most effective, and cheapest medicine for preserving and restoring overall health. Many foods contain micronutrients that positively impact the inflammatory cascade upstream of where medications such as Advil, Motrin, and COX-2 inhibitors act, making these drugs (and all their side effects) avoidable. Foods rich in omega–3 fatty acids are a perfect example.
27/07/2007 - Antioxidants linked to better bone health for osteoarthritis. Increased intake of fruit and the antioxidants they contain, like vitamins C and E, may improve bone health and may reduce the risk of osteoarthritis. By Stephen Daniells http://www.foodnavigator.com/news/ng.asp?n=78555&m=1FNE727&c=wnjzmbshsiegzcj
