How common is osteoarthritis?

Osteoarthritis is the most common form of arthritis affecting one out of eight people between the ages of 18 and 79. According to Arthritis Foundation, approximately 16 million Americans suffer from osteoarthritis, three times as many women as men. Osteoarthritis has increased recently due to sedentary lifestyle as people walking less, are more over-weight, eat fast food, junk food etc and are not keeping the muscles toned by doing quality exercises. so they are bound to suffer from knee disorders which is simply gravity and weight leading to wearing-out of cartilages. Also more osteoarthritis is seen due to increase in awareness and life expectancy, and increase in treatment modalities.

At what age does osteoarthritis occur?

Most common age for osteoarthritis is after 60-65 years and this is a normal course of events like losing hair or getting grey hair. But when it occurs in the late 40's or early 50's, then this is due to bad lifestyle.

Osteoarthritis due in some cases may occur at a much earlier age.

How does Osteoarthritis occurs?

Cartilage contains fluid and elastic tissue, and functions to reduce friction as the joint moves. It acts as a shock absorber and as the sliding surface that covers the ends of bones. Osteoarthritis results from chemical changes in the cartilage that cause it to break down faster than it can be produced.

Knee starts degenerating with age which is more when there is extra weight, diabetes. gout, autoimmune diseases, etc. Gradually the smooth and shiny cartilage between the two bones of the thigh and leg starts wearing out and the bone strikes bone and this leads to a lot of pain and stiffness, especially early in the morning. There is stiffness in the morning and patient requires to take a few steps before he can walk properly.

Previous infection of the joint may predispose to osteoarthritis by altering the chemical makeup of cartilage. The weakened cartilage causes it to wears out due to which bone rubs against bone. ultimately leadings to osteoarthritis and increased bone density, which may result in bones that are less able to absorb impacts and to protect cartilage from trauma.

What causes Osteoarthritis?

There is no known cause of osteoarthritis. The following make one more prone to osteoarthritis:

* Age – With age parts of the body wear out including the cartilage. By 50 years age, there is 90 percent chance of having change in the cartilage. After 65 years age most show X-ray evidence of osteoarthritis. However, with modern stresses osteoarthritis is seen in all age groups.

* General wear and tear on the joints.

* Sports such as jogging, tennis and skiing

* Specific joint injury

* Joint disease like rheumatoid arthritis, Gout and congenital defects.

* Hypermobiles or highly flexible people.

* Genetics may influence cartilage makeup.

* Extra body weight affects the weight-bearing joints such as the hips, knees and spine causing osteoarthritis in them.

* Repeated minor injuries or a single injury to a joint, may change the cartilage or joint structure.

* Repeated stress on a joint like repetitive squatting, kneeling, or heavy lifting.

* Unusual metabolic or endocrine conditions, such as excess body iron (hemochromatosis) or overproduction of certain hormones, can lead to cartilage changes and osteoarthritis.

* Defects in joint development or growth can accelerate cartilage loss at a younger age.

* Post-menopause Estrogen deficiency in women.

* Vitamin D deficiency.

What are the symptoms of Osteoarthritis?

* Pain and stiffness in the joint – initially after exercise, latter constant

* Grating sound due to cartilage wearing away

* Loss of mobility may occur

* Warm and swollen joint

* Deformity of the joint

What are the tests for Osteoarthritis?

X-rays, MRI / CT, Dynamometry, Goneometry, Blood tests help diagnose osteoarthritis.

Researchers are still trying to develop test to detect the breakdown of cartilage.

What other conditions cause knee pain and can they be recognized?

What is the prognosis of Osteoarthritis?

This depends mainly on which joints are affected, how serious it is and how much care is taken of the joint. Earlier the treatment is started the more active life a person can live.

What treatments are available for O.A.?

Till now there was no known cure for osteoarthritis. The treatments available were:

·         Decrease the pain with medicines, Herbs and Heat or cold applications

·         Supportive measures like Weight loss, Rest, Nutrition / food supplements

·         Assistive devices to make life easier.

·         Exercise and Paraffin bath etc

·         Surgical treatments for severe Osteoarthritis with significant loss of cartilage. These include :

-          Arthroscopy for pain relief or to fix the joint

-          Osteotomy to correct joint deformity

-          Arthodesis to immobilize joint by fixing bones

-          Joint replacement for severe joint deterioration

Surgery for osteoarthritis is usually considered a choice surgery unless patient is unfit for surgery. However it may need several months of rehabilitation after surgery and an artificial joint may only last for 10 to 20 years when it may wears out and need repeat surgery.

What should one do to decrease the chance of degeneration of the joints?

One must exercise regularly, keep weight in check, if diabetic ensure that it is controlled and if there is any other disorder like rheumatoid arthritis it must be treated properly. Most important is to avoid postures causing repeated straining and injuring the joints.

How common are knee problems? Are these increasing with our day-to-day lifestyle?

Knee problems fall into two categories. Those due to injuries and those due to degenerative process i.e. wear and tear with age or due to causes like gout & diabetes or disorders which involve joints.

With increasing life expectancy and change in lifestyles knee problems are being seen more and more. There is also an increase in awareness, easier approach to doctor and an increase in treatment modalities. Every second person at some stage or the other of life is likely to suffer from knee problems.

What exactly happens in degenerative conditions of the knee reasons? What are the typical symptoms that person experiences like pain, and how is the degeneration triggered off?
When the knee starts degenerating with age, increased weight, diabetes or other diseases like gout and autoimmune diseases, gradually the smooth and shiny cartilage between the two bones of the thigh and leg starts wearing out and the bone strikes bone and this leads to a lot of pain and stiffness, especially early in the morning. You need to take a few steps as your muscles wake up and then you start feeling better.

Are lifestyle problems actually creating these degenerative problems?

Sedentary lifestyle is the single most important cause. People are not going for walks, they have excessive weight, eat fast food, junk food etc. They do not keep the muscles toned and are not doing good quality exercises and hence are bound to suffer from knee disorders which are simply gravity and weight leading to wearing-out of cartilages.

Is there a particular age group that suffers the degenerative kind of knee problems?
Degenerative problems are usually seen after 60-65 years and this is a normal course of events like losing hair or getting grey hair. But when degenerative problems are seen in the 40's or 50's or earlier, then this is due to bad habits like increased weight, not exercising and stress or strain of daily life.

Wills a person with an active lifestyle and controlled weight never have a knee problem?

No, he may still have it but the chance of it is much lesser. This is because the genetic factor also plays a role and that is something we can't fight. There is a genetic preponderance so that if a father and grandfather have had degenerative arthritis, the chances of the son having it is more.

 If there is genetic preponderance what can one do on a daily basis to stay away from such problems?

One must exercise regularly and keep weight in check. If one is diabetic sure that diabetes is controlled. If there is any other disorder like rheumatoid arthritis, it must be treated properly. It is important to avoid those postures where there is repetitively straining and injuring the joints.

 
What is gout?

Gout is an autoimmune disorder with production of an enzyme which is reduced so that the uric acid level increases in quantity. The uric acid crystals settle around joints, usually at the big toe causing swollen, inflamed, painful big toe. It can also deposit on cartilages around the ears. Symptoms like pain can occur in other joints also.

 
Is there a treatment for gout?

Yes. Fortunately the treatment of gout is largely medical. In the initial stages medicines alleviate the symptoms. Surgery is required only if the patient has waited so long that the joint is totally destroyed.

My mother is a diabetic patient for the last few years has pain in both the knees and can't walk. She has taken a lot of treatments but nothing has helped. She is overweight too. So I wanted to ask what is the solution for this?

By the description I suspect that by now her joints must have become arthritic and worn out, so X-rays would show a lot of degeneration. If it does, in that case Cytotron Therapy should help regenerate the cartilage again. The other alternative is surgery. Of course controlling the diabetes and reducing weight will enable better treatment results.

But if the X-rays are fine and its only local pain, then simple exercises and physiotherapy should help.

I am 43 years old and have knee pain that has just started. The knee is slightly stiff. How can I prevent further deterioration? Do I need lifestyle changes & exercise or should I wait so that the problem gets better or should I show it to an expert and let him decide?

You probably should get a little more active and learn specific knee exercises which we call the quadriceps exercises from a good physiotherapist. If it is does not get better with that, then you must see an orthopedic surgeon.

How ever if the onset was due to travel, squatting or sitting cross legged in a religious ceremony you can wait for a few of days and not worry immediately.

But if it came on after an injury or if onset was sudden and there is swelling, pain, redness or fever, it could be due to an infection and needs immediate expert opinion.

My age is 40 years and I am basically fit. I go to the gym frequently for couple of hours. When on the treadmill on a high speed, my knees pain.

If it is a hard surface and you are jogging on it, the cushion between your leg and the thigh bone in the knee may have become impacted with the force against which your foot strikes the ground. You should slow down the speed at which you are on the treadmill and, perhaps in the beginning, reduce the time that you spend on it. Gradually increase it and, in addition, before any such activity you must warm up. If pain persists try Cytotron Therapy.

What is rheumatoid arthritis and does it have a treatment?

Rheumatoid arthritis is very different from degenerative arthritis. Rheumatoid arthritis is more common in women than in men and the entire joint gets destroyed. The disease starts between the age of 20 and 40 years and affects all parts of the body including many organs. It is not limited to one joint and is a polyarthropathy mainly involving the knee, the hip, finger joints and in a few years time the patient gets completely crippled. It is a serious problem. The treatment consists of correct diagnosis as the result of the treatment depends on how quickly it is recognised. If recognized in the early stages and the patient has only stiffness, then it is easy to treat the patient even medically.

I have been advised knee surgery. I suffered a knee surgery four years back. The doctor says I need surgery if I want to go in for sports activity, please advise.

I suppose what we are referring to is either a cartilage or damage to a ligament inside the knee. The cartilage is called the meniscus and if it is torn or the ligament in the knee called cruciate ligament are torn, then these days very good surgery can be performed by a keyhole technique or so called arthroscopy. Cytotron can also give very good result non-operatively. Definitely you can go back to sports.