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Arthrosis

Arthrosis, or osteoarthritis, is a chronic degenerative disease that affects the joints and involves progressive deterioration of the cartilage. In the process, the cartilage wears down until the bone is exposed, causing pain and movement limitations. The joints are mostly affected because they are subjected to loads and these joints are commonly the hips, knees, and spine; more rarely, the shoulders, hands, and feet. The specific cause of osteoarthritis is unclear, which is why it is defined as a multifactor disease, i.e, multiple coexisting reasons may result in the diagnosis.

This condition is classified as primitive or idiopathic arthrosis when it happens without a known cause.

It is classified as secondary arthrosis when it has congenital or acquired deformities, the outcome of trauma, surgery, dysplasia, infectious processes, chondral lesions and cartilage pathologies (osteochondritis and osteonecrosis), metabolic pathologies (diabetes, gout and obesity), or heredity with diseases such as hemochromatosis, Ehlers-Danlos syndrome, and Marfan syndrome. In addition to the conditions mentioned above, there are arthropathies (i.e., diseases affecting the joints) of inflammatory origins such as rheumatoid arthritis, juvenile arthritis, spondylarthritis, or scleroderma.

Osteoarthritis is a disease with a progressive and disabling course because the cartilage lesions get degenerated. There are currently no treatments that can definitively reverse this chronic process.

Age group

The risk of developing this disease increases with age, with a maximum incidence between 75 and 79 years old. However, it can also affect men over 40 years old and women over 55 years old.

Anatomy of articular cartilage

All of our joints are lined with a pearly white elastic tissue called articular cartilage. This shiny and smooth tissue is made up of water, mineral salts, and chondrocytes. These cells produce a substance made up of elastic fibres and collagen that allows bone ends to glide over each other without much frictions. Thanks to this substance, the joints are protected and supported, cushioning frictions and loads. The synovial fluid flows inside the joints and acts as a lubricant which protects the joints against wear. Articular cartilages undergo a natural degenerative process linked to ageing of the body and this may cause pain, swelling, stiffness and motor difficulties.

Symptoms

The most apparent symptom of arthrosis is mechanical pain, which initially is felt only during joint movement, e.g., after many hours of immobility or upon waking up in the morning. As the disease continues to develop, the pain worsens even while resting to a point where it becomes unbearable. In the acute phase, the peripheral joints are swollen and stiff, and growths (osteophytes) may form on the edges of the two bone ends. In many cases, pain is felt upon palpation, crackling or joint jerks are also felt during movement. Joint swelling is frequent and leads to activity limitation.

When should you call a doctor?

You should call a doctor when the localized pain gradually becomes more acute and unbearable.

Diagnostic tools

The anamnestic collection is essential to understand the localization of the pain and the level of disability. Among the required examinations, there is the radiological exam which highlights the joint’s wear and possible deformity, showing the reduction of space between the joints, and detecting the presence of cystic-like lesions or the formation of osteophytes. Second level exams such as MRI or CT may also be required.

What to do in the meantime

Decrease activity and take anti-inflammatory and pain relievers as prescribed by the attending doctor. Use a brace to reduce the load to the joint. Apply ice to the joint but not directly to the skin.

How to prevent arthrosis

Regular physical activity and specific exercises will reduce the wear of the cartilage and increase endurance. High-impact activities such as aerobics, running or jumping are not recommended; low-impact activities such as walking, swimming, cycling, and stretching are encouraged. If you are overweight, a diet for weight loss is highly recommended especially since arthrosis affects the joints under load such as the knee, hip, spine or ankle.

Conservative therapies

If surgery is not necessary, it is recommended to take anti-inflammatory drugs to help reduce inflammation, including corticosteroids (cortisone) or hyaluronic acid injected directly into the joint (infiltrations) to provide temporary pain relief and reduce swelling. Drug therapy can be combined with food supplements to relieve pain and physiotherapy exercises to improve joint flexibility and to strengthen muscles. In some cases, braces, splints, elastic bandages, canes, crutches, or walkers are suggested when additional support is needed. For quick relievers, the application of ice or heat may be useful.

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