OsteoArthritis

Osteoarthritis, also known as degenerative joint disease, is the most common form of arthritis. In this disorder, a joint loses cartilage, the slippery material that cushions the ends of bones, over time.

Osteoarthritis is a chronic disease of the joint cartilage and bone, often thought to result from "wear and tear" on a joint. Joints appear larger, are stiff and painful, and usually feel worse with increased use throughout the day.

As a result, the bone beneath the cartilage changes and develops bony overgrowth. The tissue that lines the joint can become inflamed, the ligaments can loosen, and the muscles around the joint can weaken. The patient feels pain and movement limitations when using the joint.

Joints

Joints provide flexibility, support, stability, and protection. Specific parts of the joint: the synovium and cartilage, provide these functions.

Synovium. The synovium is the tissue that lines a joint. Synovial fluid is a lubricating fluid that supplies nutrients and oxygen to cartilage.

Cartilage. The cartilage is a slippery tissue that coats the ends of the bones. Cartilage covers the end of bones in joints to provide shock absorption during movement.

Cartilage is composed of four components:

• Water. Cartilage is composed mostly of water, which decreases with age. About 85% of cartilage is water in young people. Cartilage in older people is about 70% water.
• Chondrocytes. Chondrocytes, the basic cartilage cells, are critical for joint health.
• Proteoglycans. These large molecules bond to water, which keeps high amounts of water in cartilage.
• Collagen. This essential protein in cartilage forms a mesh to give the joint support and flexibility. Collagen is the main protein found in all connective tissues of the body, including the muscles, ligaments, and tendons.

The combination of collagen mesh and water forms a strong and slippery pad in the joint. This pad cushions the ends of the bones in the joint during muscle movement.

Osteoarthritis commonly affects the hands, feet, spine, and large weight-bearing joints, such as the hips and knees. Osteoarthritis usually has no known cause and is referred to as primary osteoarthritis. When the cause of the osteoarthritis is known, the condition is referred to as secondary osteoarthritis.


Osteoarthritis facts

• Osteoarthritis is a joint inflammation that results from cartilage degeneration.
• Osteoarthritis can be caused by aging, heredity, and injury from trauma or disease.
• The most common symptom of osteoarthritis is pain in the affected joint(s) after repetitive use.
• There is no blood test for the diagnosis of osteoarthritis.
• The goal of treatment in osteoarthritis is to reduce joint pain and inflammation while improving and maintaining joint function.

Osteoarthritis: The Disease Process

Deterioration of Cartilage. Osteoarthritis develops when cartilage in a joint deteriorates. The process is usually slow.

• In the early stages of disease, the surface of the cartilage becomes inflamed and swollen. The joint loses proteoglycan molecules and other tissues. This joint then begins to lose water. Fissures and pits appear in the cartilage.
• As the disease progresses and more tissue is lost, the cartilage starts to get hard. As a result, it becomes increasingly prone to damage from repetitive use and injury.
• Eventually, large amounts of cartilage are destroyed, leaving the ends of the bone within the joint unprotected. 

Complicating the process are abnormalities in the bone around arthritic joints. As the body tries to repair damage to the cartilage, problems can develop:

• Clusters of damaged cells or fluid-filled cysts may form around the bony areas or near the fissures in the cartilage.
• Fluid pockets may also form within the bone marrow itself, causing swelling. The marrow, which runs up through the center of the bone, is rich in nerve fibers. As a result, these injuries may cause pain in many patients with osteoarthritis.
• Bone cells may respond to damage by multiplying, growing, and forming dense, misshapen plates around exposed areas.
• At the margins of the joint, the bone may produce outcroppings, on which new cartilage cells (chondrocytes) multiply and grow abnormally.

Herbs and Dietary Supplements

Glucosamine and Chondroitin. Glucosamine hydrochloride and chondroitin sulfate are natural substances that are part of the building blocks found in and around cartilage. For many years, researchers in the U.S. have been studying whether these dietary supplements really work for relieving osteoarthritis pain. Earlier studies indicated a potential benefit from these supplements.


Vitamin Supplements

Beta-carotene is the precursor to vitamin A, found in red, yellow, and orange fruits and vegetables and dark-green leafy vegetables. Beta-carotene supplements do not prevent osteoarthritis, but may slow the progression of the disease.

Vitamin C. Consuming vitamin C from foods seemed to reduce the risk of cartilage loss and disease progression.

Vitamin B-3. Vitamin B-3 is made up of niacin (nicotinic acid) and its amide, niacinamide, and can be found in yeast, meat, fish, milk, eggs, green vegetables, and cereal grains. A three-gram divided dosage of niacin and niacinamide seemed to improve joint flexibility and reduce inflammation of osteoarthritis when taken daily.

MSM (methylsulfonylmethane) is a naturally-occurring compound found (in small amounts) in fresh foods—fruits, vegetables, legumes, milk, eggs, fish, and grains. As foods are processed or heated, however, MSM is destroyed. In supplement form, MSM is usually derived from sulfur-rich plant or tree fibers. Some preliminary research suggests that MSM can modestly reduce some symptoms of osteoarthritis such as pain and swelling. MSM has not been shown to significantly reduce stiffness though.


Hyaluronic acid is an anti-inflammatory substance found in the connective tissue of the body that cushions and lubricates. The hyaluronic acid in supplements usually comes from bacterial fermentation—not animal sources. The FDA has approved an intraarticular (directly into the joints) injection for osteoarthritis treatment.

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