A PAINFUL PUBLIC HEALTH PROBLEM :
An estimated 300 million people worldwide suffered from this condition in 2017 and every year, since then, an estimated 15 million new people have joined this dubious club. The chronic and progressive pain in the joints results in a poor quality of life and decreased life span for these millions. Despite being such a massive challenge to human health, there is no universally accepted and ideal way to treat this condition.
WHAT IS IT ?
If our joints are supple and our bodies flexible, we owe it to the unique tissues lining our joints – Hyaline Cartilage and the Synovial membrane. These especially abled tissues, when they are functioning normally, are able to provide smooth mobility to our bodies without generating any noise and heat, year after year. That is until osteoarthritis throws a spanner in the works.
Hyaline cartilage has one major weakness. It does not have its own blood supply and hence has a poor capacity to repair itself. It can be trauma/overuse/ malalignment/nutritional deficiency/genetic causes which result in cartilage injury. If the cause of injury is not removed, inflammation sets in, and, a vicious cycle of cartilage degeneration and inflammation starts. Lo and behold, we have osteoarthritis.
Management of Osteoarthritis: The Goals of osteoarthritis management are 1. Reduction of symptoms 2. Disease modification
In practice, treatment of most patients of osteoarthritis targets only the first objective because it’s a low hanging fruit. The options available are oral pain relievers, oral anti-inflammatory medication and intraarticular steroids. All these 3 options have their own adverse effects and cannot be used for long without risking grave complications.
Treatment options aimed at disease modification have a better side effect profile and should always be included in the therapeutic armamentarium. In my opinion, based on my experience, disease modification options if used effectively can eliminate the need for symptom control. The modalities available for disease modification can be divided into systemic and local.
The systemic options which I have found to be effective are supplementation with chondroprotective agents like glucosamine and chondroitin sulfate. Minerals such as Magnesium and Boron, deficiency of which have been linked to the development of osteoarthritis, can be considered for supplementation. While systemic therapy is effective, its results are seen after months of therapy.
Local treatments on the other hand can provide early and sustained relief of symptoms as well as modify the natural history of the disease. Intraarticular injections are very effective and easy to administer. Hyaluronic acid is a glycosaminoglycan that is present in the synovial fluid. As osteoarthritis progresses, there is a concomitant decrease in the production and increase in the degeneration of Hyaluronic acid.
Hyaluronic acid intraarticular injections (also called viscosupplementation) not only increase viscosity of the synovial fluid but also have anti-inflammatory, antioxidant, and chondroprotective effects. Pain relief is achieved rapidly.
Other substances which can be injected in the osteoarthritic joints include Platelet-rich plasma (extracted from the patients own blood) and autologous stem cell grafting.
In my opinion, a judicious combination of these various options along with weight loss and exercise can definitely change the natural history of osteoarthritis for the better.