Musculoskeletal conditions affect the loco motor system; consisting of muscles, bones, joints and connected tissues as tendons and ligaments, vary from sudden and short-lived conditions like fractures, sprains etc. Out of so many musculoskeletal conditions, the most common conditions are osteoarthritis (OA), pain in back and neck, fractures due to fragility in bones, injuries and systemic inflammatory conditions such as rheumatoid arthritis (RA).
Osteoarthritis (OA) is a degenerative chronic condition of the joints when the cartilage that cushions the joints starts breaking and wears away. It is known to affect any joint, but occurrence is more often in knees, lower back and neck, hips, small joints of the fingers and the bases of the thumb and big toe.
Though people over the age of 60 have osteoarthritis to some degree, but even people of age 20s to 50s can also get osteoarthritis, due to any underlying reason, such as too much of repetitive stress on the joints due to life style or extensive exercise without supervision or any joint injury. It has been observed that in people over age of 50, more women suffer with osteoarthritis as compared to men.
It is important to understand the structure of bone and its part if we wish to have good knowledge of OA. Joints have firm and slippery coating on the ends known as cartilage. It provides a smooth surface for joint motion and is like a cushion between the bones which helps the joints to absorb shock from movements like walking or repetitive movements and prevents the bones to rub against each other.
Bones are connected by tough cord-like tissues known as ligaments. Bones are further connected to muscles by tough, fibrous cords known as tendons. Movement of bones is initiated by contraction of muscles (bundles of specialized cells) through the stimulation by nerves which are result of signals from the brain. In people suffering from Osteoarthritis these signals do reach the muscles but further the movement of bones and joints cannot happen due to various reasons like break down of the cartilage. This causes pain and swelling with further deterioration affecting break down of bones and development of growths called spurs. In few cases bits of bone or cartilage may break off and float around the joint causing stiffness, pain and loss of mobility. This complete degeneration in the body causes an inflammatory process wherein cytokines (proteins) and enzymes develop adding further damage the cartilage.
Factors affecting Osteoarthritis are:
- Trauma and Repeated trauma
- Advanced age
- Prolonged sitting posture
- Lack of exercise
- Genetic predisposition
- Bone density
- Occupational injury
- Change in joint pressure with change in atmospheric pressure in rainy or damp season.
- Early morning stiffness for not more that 30 minutes.
- Creaking in the affected joint.
- Grinding sensation with joint motion
- Bony enlargement of the small joint at the end of the fingers
Osteoarthritis is classified into two groups:-
Primary arthritis: is a degenerative condition primarily related to aging. Joints become more susceptible to degradation due to decreased water content of the cartilages. It target hands, hip, knee, spine, small joints (peripheral), large joints (central).
Secondary arthritis: is the stage when joints are affected earlier in life due to the reasons such as injury, diabetes, obesity, frequent kneeling or squatting for long duration. It could be related to any reasons as developmental disorders, bone dysplasias, post-surgery, injury, diabetes mellitus, hypothyroidism, hyperthyroidism etc.
Management of Osteoarthritis: Despite these challenges, most people with osteoarthritis can lead active and productive lives with proper management and life style with ‘good-health attitude’.
Few self – care tips are given below:
- Proper rest
- Join support programmes
- Lear self-care
- Weight Loss
- Taking pain killers / medication as advised by the doctor.
- Eat healthy
- High intake of antioxidants specially vitamin C that reduces the progression of osteoarthritis.
- Regular and adequate intake of Calcium and vitamin D.
- Avoid joint overuse
- Avoid repetitive injury
- Regular physical exercises in which muscles are strengthened to support muscles around joints. Swimming is the best form of aeobic exercise with osteoathritis of hip or knees. Running should be avoided.
- Indulging in regular Yoga and other alternative therapies which have been scientifically documented to complement the use of drugs.
- Healing Pads
- Cold Compress
- Ice packs
There are many therapies and surgeries suggested by the medical doctors as per the condition or grade of osteoarthritis of the patient. Few are as given below:
- Hip Replacement
- Knee Replacement
- Joint Replacement
As per World Health Organization (WHO) following worldwide statistics are for Osteoarthritis 1
- 9.6% of men ageds over 60 years have symptomatic osteoarthritis
- 18.0% of women ageds over 60 years have symptomatic osteoarthritis.
- 80% of patients have limitations in movement.
- 25% are unable to perform their daily activities of life.
- In India the prevalence of this condition is 22% to 39% out of which
45% of women over the age of 65 years have symptoms
70% of those over 65 years show radiological evidence of OA.
1 Ref: https://www.nhp.gov.in/disease/musculo-skeletal-bone-joints-/osteoarthritis
As per the published details by the United Nations in the below link, by the time we reach 2050 people aged over 60 will account for more than 20% of the world’s population. Out of this 20%, an estimate of 15% will have symptomatic OA out of which one-third will be harshly disabled. It means that by 2050, 130 million people will suffer from OA worldwide, of whom 40 million will be severely disabled by the disease.
Ref: United Nations. World Population to 2300. Available at: http://www.un.org/esa/population/publications/…/WorldPop2300final.pdf
Stages of Osteoarthritis of the Knee
There are four stages or four grades of Osteoarthritis (OA) medically based on the symptoms, pain and deformity of the joints including various other factors
Stage 0 or Grade 0
Is known as normal knee health wherein the knee joint functions normally without any impairment.
Stage 1 or Grade 1
Person in this stage shows minor bone spur growth with very minor pain. Doctors may only prescribe supplements and regular exercise routine to slow the progression of the arthritis.
Stage 2 or Grade 2
In this stage, X-rays of knee joints shows greater bone spur growth, but the good part is that the cartilage is still at a healthy stage. Synovial fluid is also at good sufficient levels for normal joint motion. People start experiencing pain and stiffness after a long usage of joints, long walk or running or due to the prolonged sitting postures, while kneeling or bending.
Doctor will prescribe medicines and develops a plan to prevent the condition from further progression. If you are overweight you will be advised to lose weight through diet and exercise and maintain a healthy quality of life. Shoe inserts like gel heals or gel soles can help relieve some of the pressure on knee joints.
Stage 3 or Grade 3
This stage is classified as “moderate” OA where the cartilage starts showing degeneration. Space between the bones begins to narrow. People experience frequent pain while walking, running, bending, or kneeling, They experience joint stiffness after sitting for long periods of time or while waking up in the morning. Joint swelling may also be seen after prolonged motion of the joints.
Doctor may recommend cortisone injections or further treatment. Cortisone is a steroid which is produced naturally by our body and it has shown to relieve pain when injected near the affected joint. Research shows that long-term use of the steroid can worsen the condition.
Stage 4 or Grade 4
This is the final stage of OA known as “severe ” with great pain and discomfort experienced by people when they walk or move the joint. Space between bones is reduced, cartilage almost completely gone and this leaves the joint stiff and immobile. The synovial fluid is decreased and it no longer helps to reduce the friction among the moving parts of a joint. Options of treatment are bone realignment surgery or osteotomy. Total knee replacement or arthroplasty is a last resort for most patients with grade 4.
Bone Marrow derived Mononuclear Cells (BM-MNCs) and Knee Osteoarthritis.
Clinical trials studies and research publications world-wide have explored the effects of injecting these cells have shown that it is safe manipulation with no side effects and have reduces clinical signs of knee osteoarthritis stage II/III and in few have decreases degenerative changes in the joints building up tissues over period of time.
Please refer to the published articles and clinical trials.
Treatment of Knee Osteoarthritis with Bone Marrow–Derived Mononuclear Cell Injection: 12-Month Follow-up.