Preventive Strategies on Osteoarthritis

 

Amongst the various arthritic diseases, osteoarthritis is the most prevalent worldwide. As global population moves toward an ageing population, the number of cases will undeniably soar. Add to this projected number of aged in the years to come, is the issue of obesity that has become a silent ‘epidemic’ of this century. However, unlike age which cannot be modified, the risk of being overweight and obese can easily be modified.

 

In this sense, YourHealthNews edition will be tackling the various strategies that can play a part in minimising the risk of having osteoarthritis.

 

 

 

Osteoarthritis: A “joint” problem

Osteoarthritis (OA) is a medical condition that affects the joints usually accorded to ‘wear and tear’. It affects mostly weight-bearing joints such as the knee, hips, feet and the spine; however, it also affects others joints such as those of the hands. The condition manifests from mild to severe pain and tenderness, which results in tremendous disability especially when it is severe. Stiffness of the joints, particularly in the morning, is common. As it gets worse, joints may be deformed with reduced range of motion resulting to loss of function.

 

The mechanism that involves in this progressive rheumatic condition is an interaction of complex biomechanical and systemic factors. Traditionally considered to be a non-inflammatory arthritis, recent researches have shown that cytokines specifically interleukin (IL)-1, tumor necrosis factor (TNF) and IL-6 induces matrix metalloproteinases to be released in the joint spaces causing inflammatory reactions.1,2 These proinflammatory agents are involved in matrix degradation leading to destruction of the cartilage. Suffice to say that inflammatory responses may not merely be involved in symptoms attributed to osteoarthritic joints but also lessen functional capacity of the joints in the long term.

 

Narrowing of the joint space is a common feature on x-rays in Osteoarthritis.

 

 

In terms of mechanical factors, it is widely known that the overload effect greatly impacts the weight-bearing joints resulting to lessened joint space. However, discovery of systemic factors associated with obesity such as leptin (a fat cell hormone implicated in appetite and metabolic regulation) may explain further the link between obesity and OA. Leptin has been studied as an important agent in the inflammatory pathway in osteoarthritis3 through plausible stimulation of other systemic factors like the cytokines discussed above.

 

 

Preventive Measures for Reducing Risks

Since osteoarthritis is associated with overweight and obesity, weight reduction is an important lifestyle modification. Losing weight eases pressure on weight-bearing joints and reduces pain as well as improves function4. The Framingham study5 noted the importance of controlling weight as it significantly decreases the likelihood of developing knee OA. In a similar investigation, the Chingford study6 showed that a gain in weight of every 5 kg increases the risk of knee OA by more than 30%.

 

In conjunction with reducing weight, exercises also improves joint stability. Muscles and joints are strengthened when non-strenuous exercise like cycling, swimming and brisk walking is regularly done. In a randomized controlled trial amongst individuals aged 59 years and older with symptomatic knee OA, which was conducted between 2004 and 2005, showed that mild to moderate activity such as hydrotherapy or Tai Chi can result to clinical improvements of affected arthritic joint7. This study states the clinical importance of regular non-strenuous exercises even with symptomatic OA. It has also been suggested that supervised physical exercises for osteoarthritic knees may delay or prevent the need for surgical intervention8 in the long term.

 

Both physical activity and weight reduction are vital components in the management of patients with osteoarthritis as well as in the prevention for high-risk patients. A trial consisting of both modalities have resulted in additive benefits9, which shows that by combining strategies that attain healthy lifestyles are important in disease prevention, not just for cardiovascular and metabolic conditions, but in degenerative conditions such as OA as well.

Risk factors associated with Osteoarthritis. Four of these risks are modifiable – physical inactivity, obesity, joint trauma and injury, and repetitive use and misalignment of joint.

 

 

Quitting tobacco smoking may also help reduce risk. A study10 in 2007, amongst men with knee OA in the USA, showed that current smokers were noted to have an increased risk for cartilage loss in two knee joints when compared to men who do not smoke. Further, it also found out that men who smoke have more severe knee pain in contrast to those who are non-smokers. This study adds that quitting smoking may also be beneficial in decreasing the likelihood of developing OA. Though, the exact mechanism is not fully understood, it further adds to growing evidences of the deleterious effect of smoking on the human body.

 

 

Latest Breakthrough

A 3-arm randomized controlled trial11 conducted by researchers from the University of Wisconsin showed that prolotherapy (an injection therapy for chronic muscular pain) led to sustained clinical improvement amongst patients with knee osteoarthritis when compared to other management modalities. In the study, the investigators compared dextrose prolotherapy to saline injections and at-home exercises.

 

Furthermore, the study showed that at 52 weeks patients injected with dextrose have reported improvement scores in pain, function and stiffness of their knee joints in comparison to those who were injected with saline and those who underwent at-home exercises. Patient satisfaction was also noted to be high amongst those who were given prolotherapy.

 

The investigators further noted that their findings on prolotheraphy may improve the standard of care for patients suffering with knee OA, as it is a relatively uncomplicated procedure that can be done in an outpatient setting.

 

 

 

References:

1.        Kapoor M, Martel-Pelletier J, Lajeunesse D, Pelletier JP, Fahmi H. Role of proinflammatory cytokines in the pathophysiology of osteoarthritis. Nat. Rev. Rheumatol. 2011; 7:33-42.

2.        Bondeson J, Wainwright SD, Lauder S Amos N, Hughes CE. The role of synovial macropahages and macrophage-produced cytokines in driving aggrecanases, matrix metalloproteinases, and other destructive and inflammatory responses in osteoarthritis. Arthritis Research & Therapy. 2006; 8:R187 DOI:10.1186/ar2099.

3.        Lajeunesse D, Pelletier JP, Martel-Pelletier J. Osteoarthritis: A metabolic disease induced by local abnormal leptin activity? Curr Rheumatol Rep. 2005; 7:79-81.

4.        Lee R, Kean WF. Obesity and knee osteoarthritis. Inflammaopharmacology. 2012; 20(2):53-58.

5.        Felson DT, Zhang Y, Anthony JM, Naimark A, Anderson JJ. Weight loss reduces the risk of symptomatic knee osteoarthritis in women. The Framingham study. Ann Intern Med. 1992; 116:535-539.

6.        Hart DJ, Spector TD. The relationship of obesity, fat distribution, and osteoarthritis in women in the general population. The Chingford study. J Rhematol. 1993; 20:331-335.

7.        Fransen M, Nairn L Winstanley J, Lam P, Edmonds J. Physical activity for osteoarthritis management: A randomized controlled clinical trial evaluating hydrotherapy or Tai chi classes. Arthritis Care & Research. 2007; 57 (3): 407-414.

8.        Deyle GD, Henderson NE, Matekel RL, Ryder MG, Garber MB, Allison SC. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee: A randomized controlled trial. Ann Intern Med. 2000; 132:173-181.

9.        Messier SP, Legault C, Mihalko S, Miller GD, Loeser RF, DeVita P, Lyles M, Eckstein F, Hunter DJ, Wlliamson JD, Nicklas BJ. The intensive diet and exercise for arthritis (IDEA) trial: Design and rationale. BMC Musculoskeletal Disorders. 2009; 10:93 DOI:10.1186/1471-247-10-93.

10.     Amin S, Niu J, Guermazi A, Grigoryan M, Hunter DJ, Clancy M, LaValley MP, Genant HK, Felson DT. Cigarette smoking and the risk for cartilage loss and knee pain in men with knee osteoarthritis. Ann Rheum Dis. 2007; 66:18-22.

11.     Rabago D, Patterson JJ, Mundt M, Kijowski R, Grettie J, Segal NA, Zgierska A. Dextrose prolotherapy for knee osteoarthritis: A randomized controlled trial. Ann Fam Med. 2013;11:229-237.