What Causes Osteoarthritis?

A normal joint between two bones has a layer of cartilage on top of each bone. This cartilage and the hyaluronic acid rich lubricating fluid inside the joint help the bones glide together smoothly. The joint is surrounded and tightly held together by ligaments which keep the bones tracking straight, thus preventing wear and tear on the cartilage.
If you look at a joint with osteoarthritis, the cartilage is worn thin or has disappeared, and there is a great deal of bone growth (bone spurs) around the joint. Osteoarthritis affects one out of every ten Canadians and 5% of Canadians over the age of 70 will have osteoarthritis in at least one of their joints.

What Could Have Caused Osteoarthritis?

Of course, the more stress you put on a joint (like excess weight on the hips or the knees, or overuse from constantly repeating the same movement or over straining the joint) the more wear and tear is likely. Whenever a joint stops tracking straight, there is also wear and tear on the cartilage. In young people, injury to the joint or to the bones, such as a fracture which does not heal straight, pronated feet which lead to knock knees, or poor alignment due to birth defects will cause the joint to not track straight. The commonest cause of arthritis, though, is a loosening of the ligaments which surround the joint that comes with age: As you get older, you will notice the collagen which holds up your skin thins out and your skin starts to sag. All ligaments and tendons are made up of collagen. They too thin out with age and start to get loose. When they get loose, they don’t hold the joint together enough to keep it tracking straight and this defective tracking wears down the cartilage.
As the cartilage wears down, your body reacts by trying to stabilize the joint. The best way to do this would be to tighten up the ligaments which surround the joint. If you look at ligaments around a joint, you will notice they are white. That means they have a very poor blood supply which the body needs to repair itself. This lack of blood supply prevents the repair of ligaments. Bones, on the other hand, are covered with a blood vessel rich layer called the periosteum. They need a lot of circulation because the bone marrow inside the bones produces all of your blood cells. Since they have a good blood supply, bones start to grow in an attempt to stabilize the joint. This is why you will see gnarly “bone spurs” growing on the finger and knee joints of people with arthritis. Bone spurs are found in every arthritic joint, but most of these joints are too deep inside the body for us to see them.

What can be done to help heal or prevent osteoarthritis?

The first thing you can do is to put less stress on your joints. You can lose weight and eat foods which will help keep your joints healthy. These foods will also help you repair your ligaments and tendons and regrow your cartilage. See the Caveman diet

Exercise, especially low impact exercise can help strengthen the muscles and potentially stimulate cartilage growth. To find out which exercises would be best you may want to consult a physiotherapist. Unfortunately, exercise cannot rebuild an arthritic joint.

Orthotics: these shoe inserts can help straighten out the joints of your feet, knees, hips, pelvis and back and keep them tracking straight. Dr. Bertrand can provide you with a good pair of orthotics. Splints or braces can also keep your joints tracking straight. They are, however cumbersome to wear. If you have too much pain, you may need to use a cane or a walker which will unload the painful joint.

What can you do to relieve the symptoms of osteoarthritis?

Heat: Hot soaks and warm wax may relieve pain. Chondroitin and glucosamine sulfate, are natural substances found in the joint fluid. Chondroitin is thought to promote an increase in the making of the building blocks of cartilage (collagen and proteoglycans) as well as having an anti-inflammatory effect (In the end, however, this decreased inflammation may prove counterproductive). Glucosamine may also stimulate production of the building blocks of cartilage as well as being an anti-inflammation agent. A recent study showed that glucosamine slowed progression of osteoarthritis of the knee. Glucosamine was found to increase blood sugar in animal studies, so people with diabetes should consult their doctor before taking glucosamine.

Acetaminophen, Tylenol, which is a COX3 inhibitor, has a mild anti-inflammatory effect. It, and the NSAIDs (nonsteroidal anti-inflammatory drugs) aspirin, ibuprofen, Advil, Motrin, diclofenac, Voltaren, have, until now, been the mainstay of treatment to relieve arthritic pain. They all relieve the symptoms that occur with overstretched and worn ligaments and tendons. They work by stopping inflammation which causes pain by inhibiting the enzyme cyclooxygenase (COX) which promotes the formation of inflammatory substances. Unfortunately, inflammation is the mechanism the body uses to repair itself, and using these medications interferes with the process that would help regrow the affected ligaments and tendons. All NSAIDs can cause bleeding of the stomach, high blood pressure, kidney failure, and also COX 2 inhibitors, such as Celebrex increase the risk of heart attacks. Anti-Inflammatory References

Narcotics have been given to people with severe arthritic pain who, because of liver or kidney failure could not tolerate acetaminophen or NSAIDs.

People who have suffered from intractable arthritic pain are often given cortisone shots in the joints. These even more powerful anti-inflammatory substances unfortunately interfere with healing even more than other anti-inflammatory medications and may even be associated with cartilage destruction. It is also easy for a joint that has been injected with steroids to get infected because steroids block the inflammatory response which helps your body fight infection. Infection in a joint can totally destroy the joint. Steroid References
Surgery may relieve pain and improve function but must be balanced with the risks of anesthesia and infection and the costs of hospitalization. Different kinds of operations can be done on joints: Arthroscopy is the examination of the inside of a joint using a small camera, with planing of the cartilage and the menisci and removal of loose bodies. Two “gold standard” studies have been performed on arthroscopy comparing it with a sham procedure and have shown that, after two years, it is no better than simply taking painkillers. Arthroplasty is the repair of a joint in which the joint surfaces are replaced with artificial materials, usually metal or plastic. As these materials wear out they need to be replaced with more surgery. An osteotomy is when surgeons cut out a wedge from one side of a bone then reset the bone to help the joint track straight. Chondroplasty is surgical repair of the cartilage which results in the joint having even less cartilage. Joint replacement is replacement of the joint with a man-made joint composed of metal and plastic. The average joint replacement is good for 10 to 15 years. If you are young and have a joint replacement expect to need several more. If you have suffered from intractable joint pain for many years, you might want to consider arthrodesis which will permanently fuse both sides of the joint together preventing its movement.

Osteoarthritis treatment with prolotherapy. Prolotherapy, a series of injections of growth-promoting substances in and around the joint has been shown to be effective in osteoarthritis of the fingers, elbows, knees and back. It has been shown to stimulate the growth of ligaments, including the knee’s ACL (anterior cruciate ligament), tendons and cartilage. You can make cartilage 65% thicker with prolotherapy. Even the knee’s meniscus has been shown on ultrasound to regrow with prolotherapy.

Osteoarthritis treatment with perineural injection therapy (nerve blocks ): If the pain you feel in your arthritic joint is not felt directly over the joint line (where you have the arthritis), but is felt around the joint, or even a certain distance from the joint, there is a good chance that part of your joint pain is due to damage to the nerves surrounding the joint. This damage will respond readily to treatments of nerve blocks .
Hyaluronic acid injections into arthritic joints provide lubrication to the joint and relief from the pain for about three months. They are, however, quite expensive and need to be repeated about every three months.

Because skin nerves are involved in precipitating the pain of osteoarthritis, it is possible that QR cream might help , particularly if the osteoarthritis is in your hands, your wrists, your knees, your ankles or your feet: the nerves that supply these joints are very close to the skin.

Prolotherapy References