Degenerative Arthritis

Summary

Degenerative arthritis, also known as osteoarthritis, is a chronic joint condition that can affect anyone, regardless of age or activity level. In this blog post, we will delve into the definition, causes, symptoms, medical tests for diagnosis, treatments, prevention, and conclude with essential information on managing and preventing degenerative arthritis.

Definition
Causes
Symptoms
Medical Testing for Degenerative Arthritis Diagnosis
Treatment Options
Preventive Measures
Chiropractic and degenerative arthritis
Conclusion

1. Definition

Degenerative arthritis, also known as osteoarthritis, is a condition characterized by progressive damage or degenerative changes to the cartilage that protects and cushions the joints. This leads to damage in the bones and ligaments that make up the joint, resulting in inflammation and pain. It is the most common inflammatory joint condition among all inflammatory joint diseases. It is categorized into primary, or idiopathic arthritis, which occurs without a specific underlying cause and is associated with factors such as age, gender, genetic factors, obesity, and specific joint locations. Secondary, or secondary arthritis, occurs due to causes that can damage joint cartilage, such as trauma, illness, and abnormalities, without a specific genetic origin.

2. Causes

The definite cause of primary (idiopathic) degenerative arthritis is not well-established, but it is believed to be influenced by factors such as age, gender, genetic elements, obesity, and specific joint locations. Secondary (secondary) degenerative arthritis, on the other hand, is caused by factors that can damage joint cartilage, such as trauma, disease, and deformities. Examples of secondary arthritis include cases resulting from bacterial or tubercular joint infections that lead to the destruction of joint cartilage, as well as instances that occur after severe impacts or repeated minor trauma. However, even if diagnosed as secondary, the exact cause may remain unknown in some cases. It’s important to note that exposure to the same cause doesn’t necessarily result in arthritis for everyone, so the distinction between primary and secondary arthritis may not always be clear-cut.

The causes can vary by joint location. In the case of the spine, repetitive occupational tasks or lifestyle habits can be contributing factors. Hip joint arthritis is often associated with aseptic necrosis and hip joint dysplasia. For ankle joints, fractures of the ankle joint or damage to the surrounding ligaments are the most common causes of degenerative arthritis.

Degenerative arthritis primarily occurs in older individuals, and while age-related changes are associated with an increased risk, aging itself is not the sole cause, as other active factors come into play.

3. Symptoms

The most common and early-presenting symptom of arthritis is localized pain in the affected joint, and typically, there are no systemic symptoms, which distinguishes it from rheumatoid arthritis. The pain initially worsens when moving the affected joint but may become persistent as the disease progresses. Other symptoms include a reduced range of motion in the joint, swelling, tenderness around the joint, and irregularities in the joint surface due to the loss and degeneration of joint cartilage. In some cases, a grinding sensation may be felt when the joint is moved. These symptoms generally develop gradually and may occasionally follow an intermittent course with periods of improvement followed by worsening.

Specific symptoms may be observed depending on the location of the arthritis. For instance, if arthritis affects the knee joint, it can lead to changes in the joint’s shape and an altered gait. In the case of finger arthritis, the end joints of the fingers may develop bony outgrowths called Heberden’s nodes, which are small, spike-like bone growths.

4. Medical Testing for Degenerative Arthritis Diagnosis

A diagnosis of degenerative arthritis can be made by analyzing a patient’s detailed medical history and combining it with the findings from physical examinations, laboratory tests, and radiographic evidence of various joint changes. However, it’s important to note that as people age, they naturally experience some degree of degenerative changes in their joints. Therefore, a presumptive diagnosis of degenerative arthritis can be made by excluding all other conditions and diseases. Confirmation typically requires further evaluation through procedures such as arthroscopy or surgery to directly observe degenerative changes in the joints.

Simple radiographic images are the most useful for diagnosing degenerative arthritis. Initially, they may show normal findings, but over time, a gradual decrease in joint space becomes apparent, along with increased radiodensity of the bone beneath the cartilage, indicative of sclerosis. As the condition progresses further, bone spurs, resembling osteophytes, form at the edges of the joint surface, leading to irregularities in the joint surface. In the case of secondary arthritis, evidence of past trauma, disease, or deformities that serve as the underlying cause may be observed on radiographic images. However, it’s important to note that radiographic changes do not always directly reflect the severity of symptoms and functional limitations. Around 90% of individuals over the age of 40 exhibit radiographic evidence of degenerative changes, but only around 30% of them experience symptoms.

Isotope scans can reveal increased blood flow and enhanced bone formation in areas with arthritis, resulting in denser radiographic shading. A distinctive feature of isotope scans is their ability to diagnose even mild arthritis before any abnormalities appear on plain radiographic images. Magnetic Resonance Imaging (MRI) is valuable for assessing the condition of joint cartilage and detecting abnormalities in the surrounding soft tissues. Additionally, diagnostic arthroscopy can allow observation of changes in cartilage and its condition before bone lesions become evident.

5. Treatment Options

Since degenerative arthritis is primarily caused by degenerative changes in joint cartilage, there is currently no definitive method to completely halt this process. Therefore, the therapeutic goals for this condition are to help patients understand the nature of the disease, provide psychological support, alleviate pain, maintain joint function, and prevent deformities. However, in cases where deformities have already occurred, surgical correction is performed, followed by rehabilitation therapy, to prevent rapid progression of joint damage and increase the range of pain-free motion, thereby assisting patients in their daily lives.

The treatment of arthritis can be broadly categorized into conservative treatment and surgical treatment.

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Conservative Treatment

1) Lifestyle Improvement: It is advisable to change poor posture, habits, and any lifestyle or occupational activities that put excessive strain on the affected joints. Making these changes can not only alleviate pain but also prevent joint damage. Obesity is closely linked to the development of degenerative joint arthritis, particularly in the knee joints. Weight loss can be helpful in improving symptoms. Additionally, using auxiliary devices such as canes can reduce the load on the joints and may be effective.

2) Medication Therapy: There is no definitive medication available to prevent or cure degenerative joint arthritis. However, several medications with pain-relieving and anti-inflammatory properties are in use. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used, but they carry the potential for long-term use-related side effects on the digestive system and blood clotting. Therefore, their use should be approached with caution under a physician’s guidance. Recently, new-generation NSAIDs have been developed to reduce gastrointestinal side effects, but there is still concern about potential cardiovascular side effects. Opioids, a class of synthetic analgesics, are also utilized, but they can lead to side effects like constipation and confusion, particularly in older individuals, so their use should be carefully managed. Additionally, some health supplements, such as glucosamine and chondroitin, are used as adjuncts in the treatment of early degenerative joint arthritis. These supplements are believed to stimulate the production of joint cartilage components and have shown some efficacy with minimal side effects, even in long-term use, although there is still some debate about their effectiveness.

3) Local Joint Treatment: Balancing adequate rest and exercise can be beneficial in alleviating symptoms. Rest is crucial for symptom improvement, but excessive rest can lead to muscle atrophy, resulting in a reduced range of joint movement. Using braces or orthotic devices for a specified period can help provide joint rest. Since muscle atrophy is a possible symptom of arthritis, muscle strengthening and regaining the range of motion can help reduce the joint load. This can be achieved through exercise therapy, including swimming, cycling, or physical therapy, which may be used as initial treatment. For instance, in the case of knee arthritis, strengthening the muscles in the front of the thigh can help reduce pain and improve function. In some cases, intermittent traction therapy may be beneficial for neck or hip arthritis. Furthermore, physical therapies such as heat therapy, massage, and transcutaneous electrical nerve stimulation (TENS) therapy may be effective in providing symptom relief and preventing muscle atrophy.

Severe joint pain can be addressed through joint injections of steroid preparations, with relief typically occurring within hours or days. However, this relief is short-term, and repeated use can lead to dependence. Steroids can also exacerbate cartilage degeneration and have a negative impact on the overall disease progression. There is also a risk of secondary infection with steroid injections, so caution is advised, especially regarding frequent injections at intervals of less than three months or more than three to four times a year.

Hyaluronic acid, known for its lubricating and protective properties in the joints, can be used as a supplementary treatment through intra-articular injections over a few months, and it is considered effective in the early treatment of degenerative joint arthritis.

Surgical Treatment

When non-surgical treatment methods no longer provide relief, and joint changes continue to progress, causing severe disruptions in daily life, surgical treatment methods are considered. Commonly used surgical procedures include arthroscopy, synovectomy, osteophyte removal, osteotomy, joint reshaping, and joint fusion.

1) Arthroscopy: Arthroscopy is a minimally invasive surgical procedure where the interior of the joint is cleaned, and synovial tissue and joint fluid are removed to alleviate symptoms. It can be performed with minimal skin incisions, and it usually involves relatively low pain both before and after the surgery. Recovery time is relatively short, making it a common choice, especially for patients with knee arthritis. However, it may not provide a complete cure for the condition, and the duration of the surgery’s effectiveness can vary and is challenging to predict.

2) Osteotomy: Osteotomy is typically performed when degenerative joint arthritis is moderate or less and aims to change the alignment of the joint to shift the load-bearing area.

3) Subchondral Drilling, Microfracture: This method induces tiny bleeding under the bone below the cartilage, promoting the regeneration of joint cartilage. It is attempted in cases of mild to moderate arthritis.

4) Joint Reshaping, Joint Fusion: These are considered in more severe cases of arthritis. Joint replacement surgery, involving artificial joints, is a well-known and effective method. For wrist or ankle joint arthritis, joint fusion or joint reshaping using autologous tissue is considered in some cases.

Course/Complications

The natural course of degenerative arthritis varies from person to person, making it challenging to define a single trajectory. Symptoms of arthritis typically start gradually and follow an intermittent pattern of improvement and exacerbation. As individuals age and the arthritis progresses, radiological changes and joint deformities tend to worsen, but this doesn’t always correlate with the severity of symptoms.

Up to the present, there is no known treatment method that can fully restore an arthritic joint with degenerative changes to a normal joint. In cases of mild degenerative joint arthritis, conservative treatments like medication therapy and improvements in lifestyle habits, including managing factors that worsen arthritis such as excessive weight, can help alleviate symptoms and prevent further progression of arthritis. It’s possible to live pain-free by managing arthritis and preventing additional joint damage through these methods. When attempting treatments such as medication therapy or local injections, it’s essential to be cautious about the various side effects of these drugs and use them according to prescribed dosages by a medical professional for safety.

Among the surgical treatments, arthroscopic surgery is a relatively straightforward procedure that can provide symptom relief, but the duration of its effectiveness can be inconsistent. Total joint replacement surgery is a representative surgical method for degenerative joint arthritis and offers effective pain relief, as well as correction of the deformed joint. However, artificial joints have a limited lifespan, which may necessitate future replacement surgeries. It is vital to be aware of potential complications during the surgical process, such as bleeding or infection, and these surgeries should be performed selectively after thorough evaluation by a specialist.

6. Preventive Measures

Maintaining a healthy body weight is essential for the prevention of degenerative arthritis in weight-bearing joints. Additionally, one should be cautious about repetitive strenuous activities and poor posture, as these can induce degenerative changes in the joints. While excessive exercise may not be beneficial for the joints, engaging in moderate physical activity to strengthen muscles and maintain joint flexibility is crucial for the prevention of arthritis. There is currently no firmly validated method for preventing degenerative joint arthritis through dietary or medication therapy, so relying on such methods is not advisable.

7. Chiropractic and Degenerative arthritis

Chiropractic care offers relief and support for degenerative arthritis by alleviating pain, enhancing joint function and mobility, taking a preventative approach, and complementing other medical treatments, ultimately improving the overall well-being of individuals suffering from this condition.

8. Conclusion

Degenerative arthritis is a manageable condition when addressed with proper care and prevention. Consult with healthcare professionals to develop a personalized approach for the best treatment and preventive strategies to maintain joint health.

By following these recommendations and maintaining a healthy lifestyle, you can significantly improve your quality of life and reduce the impact of degenerative arthritis on your joints.