Osteoarthritis (OA) is the most common form of arthritis and affects approximately 28 million Americans. While it has been viewed as a “wear and tear” phenomenon, it has become quite clear that it is a disease that is multifactorial in its development.
It is not a benign disease because, in addition to the pain, OA leads to functional disability.
The joint is a dynamic structure where anabolic (building) activities are counterbalanced by catabolic (destructive) activities.
With OA, the catabolic activities gradually overtake the anabolic ones. While there are attempts at repair, these attempts are dysfunctional , leading to the formation of bony spurs, called osteophytes.
There are three major risk factors for the development of osteoarthritis. They are genetic (usually a family history is prominent), constitutional (obesity in the case of OA of the knee, and aging), and finally local components (injury and ligamentous laxity).
The development of osteoarthritis starts with an initial injury to cartilage.
The injury may trigger an inflammatory response leading to the synthesis of cartilage matrix degrading enzymes, produced by chondrocytes. Over time, the catabolic activities override anabolic activities and abnormal repair mechanisms lead to the formation of osteophytes, while cartilage continues to degrade.
The treatment for osteoarthritis is primarily symptomatic. Analgesics (pain relievers), non-steroidal-anti-inflammatory drugs (NSAIDS), weight loss, exercise, assistive devices such as wedge insoles, braces, canes, walkers, and such. Injection of glucocorticoids and viscosupplements (lubricants derived either from rooster combs or from bacteria) may also be helpful.
Eventually patients will require surgery in the form of joint replacement. Joint replacement surgery has come a long way, but there are still concerns about them. The first is the possibility of a surgical complication such as blood clot or infection. The second issue is the finite lifespan of the prosthesis. They usually last 10 to 15 years but this is a function of activity and joint replacement patients do have restrictions on their activity level. Persistent pain due to particle induced inflammation can also be a problem.
Finally, the chance of faulty prosthetic devices such as the recent Johnson & Johnson metal-on-metal hip debacle, makes the choice of total joint replacement less attractive.
Recent developments in stem cell technology may provide an alternative to joint replacement.
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