By Luga Podesta, MD
Director of Regenerative Sports Medicine
Bluetail Me\dical Group-Naples
Since May is arthritis awareness month, I would like to present some of the common facts and myths about arthritis. Arthritis affects people in many different ways and can attack most joints in our bodies.
By the year 2030, it is estimated that 67 million Americans will be affected by knee osteoarthritis. Globally 38%-47% of the population over 60 years of age, approximately 250 million people will develop arthritis. There are several commonly diagnosed arthritic conditions such as Osteoarthritis (OA), Rheumatoid Arthritis (RA) and psoriatic arthritis (associated with psoriasis of the skin).
Osteoarthritis is by far the most common type of arthritis and can occur in numerous joints from the toes to the cervical spine. Arthritis is responsible for up to 18% of healthcare visits in U.S. at an annual cost of greater than 460 billion dollars to the economy in lost wages and medical costs. Arthritis is one of the top 5 causes of disability in U.S. and is associated with increased morbidity and mortality rates.
Osteoarthritis results from irreversible progressive damage to joint protective articular cartilage (cushion). This leads to irreversible wear and tear damages in cartilage, increasing joint friction between the rubbing bones.
Injury, infection, other inflammatory diseases or conditions such as Rheumatoid arthritis or other autoimmune diseases can cause the body to attack its own joint lining and membranes. Arthritis is believed to result in a disruption and imbalance between the numerous proinflammatory and inflammatory proteins within a joint leading to physiologic joint destruction.
Often called wear-and-tear arthritis, osteoarthritis is the most common form of arthritis. Although age is a major risk factor for the development of osteoarthritis of the knee, younger individuals are developing osteoarthritis at a greater rate due to hereditary factors, injury, infection or just being overweight.
Osteoarthritis occurs when the protective articular cartilage in the knee joint gradually wears away. As the articular cartilage begins to wear away, it becomes rough and frayed eventually effecting the bone cushening.
When this occurs, the protective space between the bones decreases eventually resulting in bone rubbing on bone, damaging the underlying bone producing pain.
Stages of osteoarthritis
Osteoarthritis also affects the thin lining of the joint called the synovial membrane. This membrane releases a fluid that lubricates the cartilage and reduces friction. In an arthritic joint, the fluid produced is either not slippery enough to lubricate the joint or is not produced causing the joint to dry out increasing the bone-to-bone friction.
People with arthritis typically will develop a number of symptoms including pain at rest (sleep), pain during activity, loss of motion, catching,
clicking, locking and swelling in the affected joint. Arthritis develops slowly over time and can take months and years for an individual to develop symptoms. Arthritis my be non-symptomatic and often undetected until there is a small injury that leads that individual to the doctor for evaluation. It is often discovered by chance making it difficult for patients to understand how damaged the joint has become. They often will raise the question “Why didn’t I have this before this new injury”?
The hallmark of treatment of osteoarthritis is lifestyle modification. Weight loss, has been shown to be extremely helpful in the self-management of osteoarthritis to decrease pain, reduce stiffness, and improve overall function. Analgesic medications such as acetaminophen have been affectively used to reduce mild to moderate pain. Non-steroidal anti-inflammatory medications have also been utilized for more severe symptoms. Corticosteroid injections into the knee have also been used but have potential secondary effects such as further articular cartilage deterioration. Hyaluronic acid injections can be extremely affective to lubricate the joint, which effectively diminishes pain and increases function. Newer orthobiologic regenerative cell-based and more physiologic therapies including Platelet-Rich Plasma and Stem Cell therapies are very promising treatments for arthritis to decrease pain, improve overall function by theoretically regenerating the damaged articular cartilage cells, increasing joint anti-inflammatory proteins, re-establishing a joints natural physiologic balance. Finally, when all else fails, Surgical Treatment with partial or total knee arthroplasty (Knee Replacement) can be performed. However, before deciding on joint replacement surgery, we must understand this too does not create a normal joint and not every treatment result in complete pain resolution or normal joint function.
Unfortunately, none of the above mentioned treatments will recreate a “normal joint”. Be sure you understand why your joint is painful and exhaust conservative treatments to preserve your natural arthritic joint before you make that decision to permanently replace it.
A word of advice regarding navigating the many media advertisements for arthritis treatments, “If it sounds too good to be true, most likely it is”!
Bluetail Medical Group
239-631-1960 | BluetailMedicalGroup.com