Wear-and-tear arthritis


Wear-and-tear arthritis

Description, Causes and Risk Factors:

Wear-and-tear arthritis is a disease that affects joints in the body. It can involve any joint, but usually concerns hands and weight-bearing joints such as hips, knees, feet and spine.

Joints are parts of body where one bone meets the other and movement occurs such as elbow, knee, hip and ankle. Backbone or spine also has large numbers of small joints, which allow us to move our neck, and back in all possible directions. Ends of bone which meet each other at joint are covered by cartilage. Cartilage is white, smooth, glistening material and is very specialized which functions as a cushioning material and a shock absorber so that hard bones do not rub against each other, and the cartilage also reduces friction during joint movement since its surface is very smooth. In fact no man made material can match the low friction and shock absorbing properties of healthy cartilage in the joint.

Cartilage is made up of tough fibres of a protein called collagen - Enmeshed in these fibres of collagen are the large molecules of another protein called proteoglycan. Proteoglycan molecules contain lot of water in their interior. Water keeps on moving in and out of the domain of proteoglycan molecules almost like water being sucked in and squeezed out of sponge. This property of ability to exchange water so easily gives an elastic characteristic to the cartilage. Collagen fibres give desired strength and proteoglycan molecules allow reversible compression. The combined structure thus makes up for the tough but not too rigid quality needed for this very specialized tissue.

The bone ends with cartilage covering are enclosed in a membrane called synovium. The synovium releases a slippery fluid know as synovial fluid and this fluid further reduces the friction between moving surfaces capped with cartilage and ensures that the joint moves easily and smoothly. The synovial fluid or joint fluid formed by synovial membrane is a special type of fluid that behaves like fluid when the joint is being moved and during walking when the joint is loaded its character changes to something like jelly to act as an additional shock absorber. The synovial fluid nourishes the cartilage. The cartilage has no blood vessels and relies on synovial fluid moving in and out to provide nutrients and take away the waste products.

Ends of bone, cartilage and synovium are further enclosed in a layer of tissue called capsule. Capsule is a thick and strong tissue but is capable of stretching when joint moves. The combination of bone ends with cartilage covering, synovium and capsule is the joint. The joint is further covered by muscles and tenders, which support the joint and also provide the power to move the joint.

In wear-and-tear arthritis changes occur both in the cartilage and the synovial fluid. Changes in the cartilage are easily seen even without microscope and are therefore well known, whereas changes in the synovial fluid are not discernible without the use of specialized tests and equipments. The synovial fluid changes in character and composition and it loses its characteristic capacity to behave in a jelly like manner and act as a shock absorber when the joint is loaded. The cartilage therefore has to sustain more load and impact.

At the same time the cartilage also undergoes subtle changes in chemical composition in a way that proteoglycans decrease and water content increases. As a result the collagen fibrils become disrupted and disorganized. The cartilage has now become soft due to disorganization of tight collagen fibrils, and also swollen due to increased water content. It has thus become less resistant to forces gradually develops cracks or fissures, breaks into fragments usually known as fibrillations, becomes thin and completely disappears in places.

Causes and Risk Factors:

No one knows for sure what causes Wear-and-tear arthritis, although scientists are well on their way to understanding the events that lead to the breakdown of cartilage. Researchers now think that there are several factors that may increase your risk for getting wear-and-tear arthritis.

The most common risk factors for wear-and-tear arthritis may include:

    Advanced age.

  • Obesity.

  • Family history of arthritis.

  • Injury, especially a fracture that involves the joint.

  • Rheumatoid arthritis (or other diseases that cause chronic joint inflammation).

Symptoms:

Symptoms of wear-and-tear arthritis usually come on slowly, and involve the area around the joints. If you have joint pain, stiffness, or swelling for more than two weeks.

Damage due to wear-and-tear progresses slowly over time and may result in several problems. You may have pain, especially when moving a joint. Sometimes, you may hear a grating sound when the roughened cartilage on the surface of the bones rubs together. Bumps or swelling may appear, especially on the fingers and feet. A joint may feel sore and stiff, and the joint would not move as easily or as far as it once did. All these changes can make it hard to move around and to do everyday tasks, such as opening a jar or walking up stairs.

Diagnosis:

Establishing the correct diagnosis is very important, because something can be done to manage most forms of arthritis, and most therapies work best when started early in the disease.

Your doctor may be able to diagnose wear-and-tear arthritis based on your medical history and a physical examination. Sometimes, your doctor may order certain tests to help confirm the diagnosis, to determine how much joint damage exists, or to distinguish among different types of arthritis. These tests may include x-rays, blood tests or joint fluid tests.

Imaging tests:

    X-rays: X-ray images of your affected joint may reveal a narrowing space within a joint, which indicates that the cartilage is breaking down. An X-ray may also show bone spurs around a joint.

  • Magnetic Resonance Imaging (MRI): MRI uses radio waves and a strong magnetic field to produce detailed images of bone and soft tissues, including bone cartilage. This can be helpful in determining what exactly is causing your pain.

Lab tests:

    Blood tests: Blood tests may help rule out other causes of joint pain, such as rheumatoid arthritis.

  • Joint fluid analysis: Your doctor may use a needle to draw fluid out of the affected joint. Examining and testing the fluid from your joint can determine if there's inflammation and if your pain is caused by gout or an infection.

Treatment:

Nonsurgical Treatment: Early, nonsurgical treatment can slow progression of wear-and-tear arthritis, increase motion, and improve strength. Most treatment programs combine lifestyle modifications, medication, and physical therapy.

    Lifestyle Modifications: The doctor may recommend rest or a change in activities to avoid provoking wear-and-tear arthritis pain. This may include modifications in work or sports activities. It may mean switching from high-impact activities (such as aerobics, running, jumping, or competitive sports) to low-impact exercises (such as stretching, walking, swimming, or cycling). A weight loss program may be recommended, if needed, particularly if wear-and-tear arthritis affects weight-bearing joints (such as the knee, hip, spine, or ankle)

  • Medications: Nonsteroidal antiinflammatory drugs (NSAIDs) can help reduce inflammation. Sometimes, the doctor may recommend strong anti-inflammatory agents called corticosteroids, which are injected directly into the joint. Corticosteroids provide temporary relief of pain and swelling. Dietary supplements sometimes may be useful and may help relieve pain from wear-and-tear arthritis.

  • Physical Therapy: A balanced fitness program, physical therapy, and/or occupational therapy may improve joint flexibility, increase range of motion, reduce pain, and strengthen muscle, bone, and cartilage tissues. Supportive or assistive devices (such as a brace, splint, elastic bandage, cane, crutches, or walker) may be needed. Ice or heat may need to be applied to the affected joint for short periods, several times a day.

Surgical Treatment: If early treatments do not stop the pain or if they lose their effectiveness, surgery may be considered. The decision to treat surgically depends upon the age and activity level of the patient, the condition of the affected joint, and the extent to which wear-and-tear arthritis has progressed.

Surgical options for wear-and-tear arthritis include arthroscopy, osteotomy, joint fusion, and joint replacement.

    Arthroscopy: A surgeon uses a pencil-sized, flexible, fiberoptic instrument (arthroscope) to make two or three small incisions to remove bone spurs, cysts, damaged lining, or loose fragments in the joint.

  • Osteotomy: The long bones of the arm or leg are realigned to take pressure off of the joint.

  • Joint fusion: A surgeon eliminates the joint by fastening together the ends of bone (fusion). Pins, plates, screws, or rods may hold bones in place while they heal. This procedure eliminates the joint's flexibility.

  • Joint replacement: A surgeon removes parts of the bones and creates an artificial joint with metal or plastic components (total joint replacement or arthroplasty).

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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