Osteoarthritis and its Treatment (Essay Sample)

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Arthritis
Osteoarthritis is a prevalent type of arthritis which afflicts more than thirty million patients in the United States of America ("What Is Arthritis?"). Many of the patients complain of joint pain and functional hinderances in their daily activities. The malady is the predominant cause of physical disability in senior citizens and it costs the American economy 185 billion dollars per year. We can describe it as a degenerative ailment that arises from the biochemical erosion of articular cartilage of the synovial joints ("What Is Arthritis?"). However, the accepted explanation argues that osteoarthritis also affects the whole joint structure that includes the synovium and subchondral bone in addition to the articular cartilage ("What Is Arthritis?").
Etiology
Daily stresses that an individual imposes on the weight bearing joints such as the hip, ankle and knee have a significant influence on the advancement of osteoarthritis. Most researchers hold the view that degenerative changes in osteoarthritis basically originate from the articular cartilage due to the overloading of a normal joint or ordinary loading of a joint that experienced high stresses previously. Outside forces interfere with the cartilaginous matrix and promote the catabolic consequences of the chondrocytes ("What Is Arthritis?").
Factors that increase the risk of osteoarthritis include genetics, trauma, obesity, diminishing sex hormones, neuropathic illness that causes a Charcot joint, hemoglobinopathies (thalassemia and sickle cell disease), heritable metabolic conditions (Wilson disease, hemochromatosis, alkaptonuria), initial inflammatory arthritis, acromegaly, infection, crystal deposition, repetitive performance of tasks that involve bending and hard labour and muscle frailty. Additional causes include bone disorders (avascular necrosis and Paget disease), diabetes mellitus, earlier surgical operations (meniscectomy) and internal morphological factors (congenital dislocation of the hip and slipped capital epiphysis of the femoral bone ) ("What Is Arthritis?").
Pathophysiology
Secondary and primary osteoarthritis are indistinguishable pathologically although researchers have noted bilateral symmetry in instances of primary osteoarthritis, especially when the disease afflicts the hands ("Arthritis: MedlinePlus Medical Encyclopedia"). Traditionally, medical professionals believed that osteoarthritis manifests its symptoms in the articular cartilage in synovial joints. However, investigators have observed pathophysiological developments in the synovial fluid, the surrounding joint capsule, the subchondral bone, and other tissues associated with the joint ("Arthritis: Medlineplus Medical Encyclopedia"). Previous studies have categorized osteoarthritis as a non-inflammatory type of arthritis but more recent research has established that inflammation happens when metalloproteinases and cytokines infiltrate the joint. These agents precipitate the increased matrix erosion that is a characteristic of cartilage degradation in osteoarthritis ("Arthritis: Medlineplus Medical Encyclopedia"). Thus, it is not accurate to describe osteoarthritis as a degenerative joint disorder.
Although the pharmaceutical field is yet to discover a cure for osteoarthritis, ongoing studies are considering the possibility of applying disease modifying therapy in the treatment of inflammatory arthritis. Recent research of interleukin-17 (IL-17) which is cytokine with pro inflammatory characteristics has discovered that when osteoarthritis afflicts joints, there is a presence of elevated levels of IL-17 in the synovium ("Arthritis: Medlineplus Medical Encyclopedia").
In the early stages of osteoarthritis, increased proteoglycan synthesis causes swelling of the cartilage. The chondrocytes trigger the proteoglycan synthesis to repair the cartilage tissue. This period that involves the hypertrophic healing of the cartilage lasts for a period that ranges from a few years to a decade ("Arthritis: Medlineplus Medical Encyclopedia").
The major load-bearing joints of the victims of osteoarthritis experience a decline in joint space in those regions that carry excessive burdens. This outcome is unlike the effect of inflammatory arthritis whereby the joint space narrows uniformly ("What Is Arthritis?"). An instance is an osteoarthritic knee where the joint loses space mostly in the medial femorotibial compartment although the patellofemoral compartment also experiences degradation. Failure of the lateral and the medial compartments might cause valgus and Varus disorders ("What Is Arthritis?").
Moreover, osteoarthritis also causes pathophysiological alterations in neuromuscular structures and associated ligaments. Such a change might manifest itself in the form of an abnormality of the lateral collateral ligament in cases of knee arthritis. Osteoarthritis does not spare the spine either as it causes disorders in the lumbar spine from L3 to L5("What Is Arthritis?"). Symptoms of spine degradation include stiffness, pain and periodic radical resulting from spinal stenosis.
Clinical presentation
Osteoarthritis generally progresses in a slow manner over years or decades. In this timespan, the victim adopts a more sedentary lifestyle and therefore becomes more prone to morbidities associated with physical inactivity such as weight gain("Arthritis: Medlineplus Medical Encyclopedia").
In the initial stages of the condition, the joint show no abnormalities. However, the gait of the patients becomes more antalgic if the disease compromises the load bearing joints. The initial cause of morbidity in the early stages of the malady is a pain. The patient endures an achy and deep joint discomfort that worsens with increased physical activity ("Arthritis: Medlineplus Medical Encyclopedia"). Consequently, the pain limits the range of movement of the joint and proceeds to induce crepitus. Moreover, the joints become stiff during times of rest especially in the morning hours and lasting for a duration of under thirty minutes. The condition is known as morning joint stiffness. Initially, the simple analgesics and rest can pacify the ache. However, as the condition evolves, the joints become increasingly unstable thus heightening the pain and accordingly remedies such as painkillers and rest become ineffective ("Arthritis: Medlineplus Medical Encyclopedia").
Examination of ailing joints that provides various observations. Crepitus is common and the disease also interferes with the range of motion of the joints. Malalignment of the joint with a bony enlargement is also prevalent. Many instances of osteoarthritis do not exhibit warmth in the suffering region or erythema although a bland effusion might exist. Restriction of joint mobility and muscle atrophy might occur on the very diseased joint ("Arthritis: Medlineplus Medical Encyclopedia").
Osteoarthritis manifests itself on the hand by afflicting the distal interphalangeal joints in addition to causing damage to the proximal interphalangeal joints and the joints connecting the bottom of the thumb to the hand. Moreover, it also affects the bouchard nodes and fundamental interphalangeal OA. These nodes are more common in women and they are palpable osteophytes. Inflammation is not common in the nodes ("Arthritis: Medlineplus Medical Encyclopedia").
Progression of Osteoarthritis
We can divide the etiopathogenesis of osteoarthritis into three levels. The first stage is the proteolytic decomposition of the cartilage structure (Carey, and Shea). The second stage involves erosion and fibrillation of the surface of the cartilage, with the consequent expulsion of collagen and proteoglycan fragments into the synovial fluid. The third stage involves the disintegration of cartilage products thus triggering a chronic inflammation in the synovium, which enhances the corrosion of cartilage (Carey, and Shea).
Differential Diagnoses
The original diagnostic objective is to separate osteoarthritis from other forms of arthritis including rheumatoid arthritis. To properly diagnose arthritis physical and historical examinations are necessary. The doctor will employ radiography to confirm initial results while ensuring that the laboratory figures are within a specific reference range (Carey, and Shea).
Rheumatoid arthritis commonly afflicts the wrists, proximal interphalangeal joints, and the metacarpophalangeal joints. It is not known to have an affinity for the lumbosacral spine and the distal interphalangeal joints (Carey, and Shea). Other signs of rheumatoid arthritis include swollen joints, warm joints and a morning stiffness that lasts for periods exceeding one hour. Radiographic results show marginal bone erosion instead of bone formation (Carey, and Shea). Laboratory results also distinguish rheumatoid arthritis from osteoarthritis by using the following criteria: high white blood cell level; an abundance of polymorphonuclear leukocytes in the inflammatory joint liquid; positive serologies and systemic inflammation. Individuals with secondary osteoarthritis will exhibit such as neuropathic illnesses, hypermobility syndromes, metabolic bone disease, recurring joint trauma and chondrocalcinosis (Carey, and Shea).
Other disorders that are essential for differential diagnosis to be successful are tendonitis, fibromyalgia, post infectious arthropathy, seronegative spondyloarthropathies that comprises of reactive arthritis and psoriatic arthritis, inflammatory arthritis and crystalline arthropathies including pseudogout and gout. More differential diagnoses include psoriatic arthritis, patellofemoral arthritis, Lyme dise...