It is a Big Problem and becoming bigger, not just for the elderly but for younger people as well, not to mention the impact on society.
I’m not a Doctor and understanding Osteoarthritis is very complicated. There is no easy fix even if you have an extensive understanding of the disease, if there was, we would have a cure and a lot of people suffering would be able to enjoy life without pain, wouldn’t that be nice.
It was once thought that Osteoarthritis – OA was a disease that affected the elderly, it was also thought that inflammation did not play a role in the development of arthritis and that arthritis was mostly a degenerative disease from simple wear and tear. Now we know that OA is not just a disease that affects the elderly and inflammation does indeed play a role in its development.
OA is the fastest growing cause of disability worldwide second only to cardiovascular disease, it is one of the most devastating chronic conditions affecting an estimated 240 million people around the world and with increased life expectancy and rising levels of obesity OA is predicted to become the leading cause of disability by 2025.
Along with simply living longer lifestyle changes compounding the problem are reduced physical activity and an increase in obesity. This is leading us to a dramatic impact of the disease in the coming years, and this is one more reason to identify alternative treatment options that can provide effective relief.
As living conditions around the world improve and people are living longer, they want to make the most of this longevity – they don’t want their later-years and in some cases, younger years affected with joint conditions which can severely limit their mobility leaving them in constant pain not to mention the negative impact on their mental well-being.
OA is a disease which progresses slowly leading to active degeneration of the articular cartilage which leads to symptoms of joint pain, stiffness, and limitation of movement.
Those who are experiencing mild symptoms are encouraged to engage in moderate forms of stretching and exercise in an effort to remain active and reduce the symptoms. For those experiencing more moderate to severe symptoms walking becomes a challenge forget about exercising, this is a classic case of “it’s easier said than done”.
For many even the thought of exercising makes their joints ache. They are greeted with a sharp pain each morning when they awaken, step out of bed and cautiously tests their joints. They keep hoping that time will heal these aches and pains but it never does.
Studies have shown that approximately 50% of adults suffer from chronic joint-pain, minor injuries that we sustained when we were younger often resurface in our late 40’s and 50’s growing more painful overtime, left untreated these persistent joint aches can trap us in a cycle of inactivity.
It begins with the degradation of cartilage, the result of old injuries and normal wear and tear, the loss of this protective cushion in your joints creates bone on bone friction causing sharp pain when you exercise, even a simple walk causes discomfort.
Your immune system attempts to repair the damaged tissues by inflaming your joints, each time you experience this irritation your mind increasingly associates exercise with pain, you begin to workout less frequently to prevent further injury but this lack of physical activity only results in increased stiffness and discomfort when you attempt to return to your workouts.
Overtime this pattern of pain avoidance causes you to completely abandon the activities you once loved denying your body the exercise necessary for strength and flexibility, your joints continue to deteriorate until even the simplest movements cause pain.
The problem lies in your bodies overproduction of pro-inflammatory cytokines, young joints are often spared from harmful inflammation by a protective cushion of cartilage but for most of us this cartridge wears away with age resulting in bone on bone friction. Each time you exercise continual wear and tear causes a persistent buildup of pro-inflammatory cytokines and keeps your joints constantly inflamed which further erodes cartilage, increases stiffness and ultimately makes even simple movements painful.
The joints most affected are the hip, knee, and the joints of the hand, foot, and spine.
A healthy knee joint consists of two bones each with its own layer of articular cartilage, this is a type of connective tissue that allows the bones to glide against each other essentially without friction. With osteoarthritis we are really talking about one particular kind of joint known as a synovial joint, along with articular cartilage another important component of synovial joints, and where they get their name from, is the synovium, which along with the surface of the articular cartilage forms the inner lining of the joint space.
The synovium is composed of loose connective tissue, blood vessels and lymphatic vessels. There are Type A cells on the surface which have the responsibility of clearing cellular debris and Type B cells that produce components of the synovial fluid, which helps lubricate the two articular surfaces.
One of the main issues in osteoarthritis is the progressive loss of this articular cartilage. Which means there’s not much separating the two bones anymore, this adds a significant amount of friction between them which then generates inflammation and triggers pain through the nerve endings in the joint space.
Maintaining healthy articular cartilage is the job of the chondrocytes, this is a specialized cell that is responsible for maintaining everything cartilage related. The chondrocytes produce and are embedded within a strong gel or extracellular matrix which contains Type II collagen, a protein that provides structural support, as well as proteoglycans which are aggregates of protein and sugar molecules like hyaluronic acid, chondroitin sulphate and keratan sulfate.
All these extra cellular components give the cartilage elasticity and high tensile strength which help weight-bearing joints distribute weight so that the underlying bone absorbs the shock and the weight – these are joints like the knees the hips and the lower lumbar spine.
Chondrocytes are important for the articular cartilage, in healthy people the chondrocytes maintain a delicate balance between breaking down old cartilage – catabolic activity and producing new cartilage – anabolic activity through the use of both degradative enzymes and synthetic enzymes.
When something causes an increased expression of degradative enzymes then the balance tips towards a net loss of cartilage via loss of proteoglycans and collagen.
The biggest risk factors for osteoarthritis seems to be age and often the cartilage degrades over a long period of time which makes it very hard to pinpoint one single culprit. Inflammation also seems to be involved and there are a number of pro-inflammatory cytokines like Interleukin 1 (IL-1), Interleukin 6 (IL-6) and Tumor Necrosis Factor (TNF), among others that appear to play a role.
Some of these are more involved in breaking down the cartilage via a process called proteolysis – meaning increased catabolism, whereas others are more involved in blocking the formation of new cartilage – decreased anabolism.
Another risk factor is joint injury which brings along with it a significant amount of inflammation, this also seems to be a major risk factor for osteoarthritis, as well as mechanical stress and obesity. Other risk factors include neurological disorders and genetic factors as well as certain medications, suggesting that there are other mechanisms at play.
Whatever the initial cause of articular cartilage damage is it gets the chondrocytes to begin trying to repair the cartilage. They usually start by making less of the proteoglycans and more type II collagen but soon switch over to making type I collagen, unfortunately type I collagen doesn’t interact with the proteoglycans in the same way and there is this overall decrease in elasticity in the cartilage matrix allowing it to break down.
Eventually though over the course of years chondrocytes aren’t able to keep up and they become exhausted and can undergo apoptosis or programmed cell death, the cartilage gets softer and weaker and continues to lose elasticity, then it begins to flake off into the synovial space, these flakes are referred to as joint mice.
As type A cells and the synovium attempt to remove the debris immune cells like lymphocytes and macrophages are recruited into the synovial membrane which produces pro inflammatory cytokines, this ultimately causes inflammation of the synovium called synovitis.
The Cartlidge continues to erode away until the bone is exposed allowing it to rub with the other bone, finally on the edges bone grows outward called osteophyte or bone spurs which also causes pain.
Osteoarthritis is far too common and most of us know someone who suffers from it, people with osteoarthritis often feel stiffness in the morning which usually lasts less than an hour but tends to come back at the end of the day. The pain associated with osteoarthritis is usually a sharp pain or a burning sensation which also gets worse with prolonged activity.
For large weight-bearing joints like the hips and the knees pharmacological treatments focus on reducing pain and inflammation, if neither of these approaches are successful sometimes patients might benefit from injections such as hyaluronic acid or cortisone injections into the joint or they might need surgery to replace the affected joint.
Although there’s no cure for osteoarthritis yet, there are some self-management treatments which can involve non-pharmacological approaches like losing weight, lifestyle changes along with supplements and complementary treatments.
Thanks for taking the time to read along, after all it’s your health and your health matters.