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Arthritis-osteoarthritis

Arthritis signifies every joint inflammation no matter its cause. So today we have more than 100 different types of arthritis, and as many causes of it. Almost every third citizen of Croatia suffers from some form of arthritis (including children), which shows how widespread this condition is.

Simply put, we can divide it into two groups. First we have rheumatoid arthritis, based on an auto-immune disorder which leads to inflammation, meaning that due to some inherited predisposition our immune system doesn't recognize its own tissue (usually the joint capsule) and attacks it, causing inflammatory reaction, pain, and permanent damage, possibly even deformation. There is a special branch of medicine science that deals with this called rheumatology, which speaks of their complexity. A second group is degenerative arthritis, lately called osteoarthritis, and until recently the term arthrosis was also used.  

Osteoarthritis (OA) is a most common type of arthritis and studies have shown that around 8% of Croatia's adult population suffers from it (around 360.000 people). Usually it affects knees, hips, and hands, but also ankle joints, foot, shoulder, elbow, and spine. The basis of this process is degeneration of joint cartilage, and changes in joint structures (ball and socket), sometimes with bone splinters, and inflammation of soft tissue near the joint. This is a slow process and symptoms arrive gradually, from very weak pain in certain movements (or after longer sitting or sleeping) to strong pain followed by edema or rigidity, which can result in immobility.  

What causes Osteoarthritis hasn't been answered yet. Most believe it is linked to physical stress – the more you use something, the more it deteriorates. But this theory has many exceptions. I myself have witnessed numerous cases of professional athletes who remained active well into their old age, with no significant osteoarthritic symptoms or signs. Also, many of my osteoarthritic patients lived a quite passive life with no great physical activity, and yet arthrosis advanced quickly. Probably there are many causes of Osteoarthritis , and one of the most important is genetic predisposition, which can enhance the chances for this condition. Other factors include age (with age, the chances grow), sex (up to 45 years of age OA is more common in men, and vice versa after 45), and finger OA almost always affects women. Also, traumas (joint and cartilage injuries) can lead to development of OA, as well as congenital deformities like „X“ and „O“ legs, and hip subluxation.

Setting up a diagnosis of Osteoarthritis is fairly simple, and is done by an orthopedist, based on RTG diagnostics and examination.
Patients usually see osteoarthritis as „spending the cartilage“ in the joint, and thus seek to find ways and methods to „regenerate“ it. So we must emphasize there is no drug, pill, injection, or any other kind of active chemical or biological agent that would regenerate the arthritic cartilage. Some methods like injecting cartilage cells into the joint itself, or hyaluronic acid, can help in certain cases. Sometimes taking glucosamine supplements can also help. But adequate treatment includes a vast array of other therapeutical methods - drugs, physical therapy , and surgery.  

Drugs that are used in treating arthrosis are primarily symptomatic and belong to three groups – analgesics, non-steroid anti-inflammatory medications, and corticosteroids. Their dosage, length of taking, and all other parametres should be advised by the physician. The patient should never self-medicate.

Physical therapy in broad sense should begin right after the diagnosis. The goal is to reduce or remove the symptoms as soon as possible, and preserve the joint and soft tissue functions. Depending on the degree of arthrosis we use ice therapy, electrotherapy, magnetic therapy, laser, ultrasound, warm procedures, and recently also so-called shock wave. A special part of physiotherapy is kinesiotherapy – programme of exercises and permanent physical activity for those suffering from this condition. At first it is important to keep the joints mobile, an later, when the symptoms are reduced, a steady and adequate physical activity must be maintained, which should meet the following two conditions – it cannot damage the affected cartilage any more, and must at the same time keep the strength and flexibility of muscles and joint fluid circulation, which is responsible for the nutrition of cartilage. State of the joint will help decide the type and scope of physical activity. The principle of passive lifestyle was long abandoned, because studies conducted on a large number of patients showed that physically active patients (those that „keep spending“ their cartilage) have two times less chance to need surgery, and generally have fewer symptoms compared to other group. Even though that might seem contradictory, cartilage is not a dead tissue (even though it has no regeneration ability) but is a live organ that needs physical activity. This means that the remaining cartilage in the joint must be kept active.

Methods that are applied stationary in the spas can help with osteoarthritis . A combination of mentioned physiotherapeutic procedures along with hydrotherapy and balneotherapy can help alleviate the symptoms more quickly. But after returning home one must proceed with adequate physical activity to maintain the improvement achieved.

Swimming was for a long time considered a perfect exercise for those suffering from hip and knee arthrosis, because of the reduced mobility and strength of lower extremities, which makes movement under water easier. However, some studies have shown that intense swimming can lead to worse symptoms. So if you suffer from arthrosis, especially in the knee or shoulder, and wish to indulge in recreational swimming, it's best to consult your physician or physical therapist about the technique and duration of your swim so it can help keep you mobile instead of harming you. This does not concern swimming only, but all other types of activity as well.

When osteoarthritic cartilage degeneration can no longer be helped by standard procedures (involving physical therapy and drugs), it's time for a surgical procedure in order to reduce pain and enhance total mobility and function of the joint. Type and scope of the surgery is usually determined by the orthopedist, in order to achieve maximum effect via minimal invasion. One of several techniques can be chosen.

Arthroscopy

This is a minimally invasive procedure that instead of a big cut uses a small camera to enter the joint on one side and surgical instrument on the other. In certain situations, condition of the osteoarthritic joint can be made better. Above all, grinding is performed (to sleek out the uneven cartilage). This minimizes the friction and pain. Arthroscopy can also remove bone splinters, which are a part of arthritic process. This type of surgical procedure is especially fit to be performed on the knee, ankle joint, and shoulder. Recovery is relatively quick, and full scope of abilities can be expected in a few weeks.  

Osteotomy

It is possible that arthrosis affects one of the joint cartilage parts more than the other on the knee and hip joint. More specifically, cartilage can be thicker on one part. Whenever possible, surgery should transfer the pressure to a less damaged part. This is done with osteotomy – if the hip area is problematic, one part of the thigh bone is cut, the „pin“ is inserted, and everything is re-attached again. This way the pressure is transferred to the less damaged part. Similar procedure is performed on the knee, but on the tibia. This is not a permanent solution to the problem, but can delay more complicated surgeries. Recovery is relatively long, sometimes more than six months.

Arthroplasty

Inserting an artificial joint is one of the latest methods in treating osteoarthritis. We have partial (only the ball) and complete (ball and socket) endoprosthesis (metal implant), cemented and non-cemented endoprosthesis (depending on the bone fixation). Lately a new method called resurfacing appeared, switching only a small part of the joint ball with a metal component. Choosing a best procedure will depend on the patient's specific condition, age, expected physical activity after the surgery, and many other factors. It is most commonly performed in the knee and hip joints, but can be done on the shoulder and hand as well. Post-surgery rehabilitation is long – no less than three months, and often even longer than six months

Arthrodesis

Completely frozen or blocked joints are one of the final choices, done when arthroplasty is not possible or could give unsatisfactory results. It's clear that those joints will have no movement after the surgery, but pain will be drastically reduced or completely gone. This procedure is most often done on small leg thumb joints or ankle joint, but on others as well. Rehabilitation lasts a few months. Whichever operating procedure is involved, it's important to have a long and adequate rehabilitation. It's also important to let the patient know good and bad sides of a certain procedure in detail, in order to make the best choice possible.

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