Table of contents
What is Osteoarthritis?
Osteoarthritis is the most common form of arthritis. It is one of the leading causes of pain and disability. Osteoarthritis symptoms include stiffness, limited range of motion, swelling, and pain. This article seeks to provide a basic understanding of osteoarthritis. It will explore common treatment options as well as novel therapies.
Osteoarthritis is the most common form of arthritis. It is a degenerative joint disease and is one of the leading causes of pain and disability. It affects many joints including the knees, hips, hands, shoulders, and feet.
What are joints?
Joints occur at the junction of two or more bones. Healthy joints have thick articular cartilage which pads the bones. Joints also have synovial fluid which provides lubrication.
What causes osteoarthritis?
Low grade inflammation causes breakdown of articular cartilage. This results in the release of toxic enzymes and inflammatory proteins. These further damage the articular cartilage. More damage results in more release of toxic proteins. This cycle continues to repeat itself until you have bone on bone arthritis. The ultimate result is stiffness, limited range of motion, swelling, and pain.
Risk factors for osteoarthritis
Age, genetics, obesity, and repetitive high impact activities are risk factors for osteoarthritis. Obese patients are particularly at high risk. The extra weight results in altered biomechanics and increased loading of joints. This accelerates the wear and tear of articular cartilage. Fat tissues also release signaling molecules called adipokines. Adipokines have inflammatory properties that cause further damage to joints.
Osteoarthritis diagnosis and severity
X-rays are the best way to confirm the diagnosis of osteoarthritis. They can be used to grade its severity.
Grade 1 represents early damage to articular cartilage. Bone spurs begin to form and can be seen on x-rays.
Grade 2 results in further damage to the articular cartilage. X-rays may show signs of joint space narrowing.
Grade 3 has moderate signs of articular cartilage loss. Cracks and fissures appear along what should be a smooth cartilage surface. X-rays show signs of moderate joint space narrowing.
Grade 4 describes significant loss of articular cartilage. X-rays show severe narrowing of the joint space. Bone may be in contact with bone.
This is an excellent video visualizing the stages of knee osteoarthritis.
It’s important to point out that osteoarthritis is a progressive disease. The more osteoarthritis you have, the more you’re at risk for getting. Chondrocytes are cells that maintain the articular cartilage. These cells start to die off in osteoarthritis. As chondrocytes die, there are less and less of them to maintain the remaining articular cartilage. This leads to even more cell death. It’s a slippery slope. This is likely why we see some patients have an accelerated form of osteoarthritis. Patients can progress from mild osteoarthritis to severe bone on bone in the span of 1 to 2 years.
Treatment of osteoarthritis should focus on prevention. Studies show that physical activity and weight loss help manage osteoarthritis symptoms. Exercise helps reduce pain and improve function. Physical therapy and a home exercise program are some of the best ways to regain form and function.
Exercises to treat osteoarthritis
Shoulder osteoarthritis and pain
Knee osteoarthritis and pain
Hip osteoarthritis and pain
Ankle osteoarthritis and pain
Hand osteoarthritis and pain
What if you are in so much pain that you can’t be active?
Oral and topical anti-inflammatory medications can help reduce inflammation and swelling. Supplements with anti-inflammatory properties such as turmeric can also help. It is important to point out that these medications don’t treat the underlying disease. They don’t stop the progression of osteoarthritis. With that said, they play a valuable role. They can reduce pain and inflammation. This makes exercise and physical activity more manageable.
Some people need stronger medications. That’s where injections come into play. Physicians perform cortisone injections to treat the pain and swelling from osteoarthritis. Cortisone is a steroid and has very strong pain relieving and anti-inflammatory effects. Studies show cortisone injections can provide short term pain relief. But there are serious concerns for long term negative effects.
Novel therapies for osteoarthritis treatment
Researchers continue to look for new ways to treat osteoarthritis. Biologic and cellular based therapies appear promising. Recall that toxic enzymes and inflammatory proteins circulate in the joints of osteoarthritis. These proteins damage the joints.
Platelet rich plasma injections contain an enormous amount of bioactive molecules. These signaling molecules help improve the inflammatory environment of the joint. They aid in cell migration, cell proliferation, and cell differentiation. They help stimulate tissue healing and provide pain relief.
Literature updates in osteoarthritis
This study compared physical therapy to cortisone injections for knee osteoarthritis. They found that physical therapy resulted in less pain and disability at 1 year. There is truth to the old adages “motion is lotion,” “rest is rust,” “movement is medicine,” and “use it or lose it.”
Platelet rich plasma (PRP) for osteoarthritis
These researchers compared platelet rich plasma injections to cortisone for mild to moderate knee osteoarthritis. PRP injections outperformed cortisone in reducing pain and improving function. The effects lasted up to 1 year.
This systematic review and meta-analysis compared platelet rich plasma injections to hyaluronic acid. Hyaluronic acid is another popular injection used for the treatment of osteoarthritis. Patients who got PRP injections had significantly greater improvements in pain and function.
This study compared platelet rich plasma injections to hyaluronic acid and placebo (saline) injections. They found that PRP injections had significant improvement in symptoms at up to 1 year.
Osteoarthritis is a debilitating disease. Discuss with your doctor the best way to individualize treatment. Physical activity and weight loss are the pillars of prevention. There are many pharmacologic options to decrease pain. Platelet rich plasma injections may provide sustainable and long term pain relief.