Osteoarthritis as Illness

Osteoarthritis as Illness



Osteoarthritis is a chronic disabling disease with acute exacerbations. It is one of the most disabling of all diseases worldwide. With marked disease/illness it sometimes requires expensive joint replacement surgery, which is outside the reach of common citizens of the country. Recognizing the huge problem, the Government of India declared that Osteoarthritis is the 3rd commonest cause of disability and capped the prices of implants and for the below poverty line (BPL) persons, also allows surgery to be done under Ayushman Bharat Scheme free of charge. Yet there are hundreds of thousands persons above BPL that are not able to afford the surgery.

There is no known treatment that can cure or arrest the progression of Osteoarthritis as a disease. Yet there are many treatments that can be given to alleviate the sufferings of most people and prevent them from going in for expensive Surgery. To understand what can be done we have to differentiate Osteoarthritis as an illness and Osteoarthritis as a disease. The illness of Osteoarthritis comprises of joint pain, pain in surrounding tissues or pain elsewhere. It also comprises of Stiffness in joints and loss of function. These can be improved to some extent.

One must understand the osteoarthritis pain cycle. The cause of pain in Osteoarthritis is poorly understood. It was believed that Osteoarthritis is a degenerative disease of the articular cartilage, and since the articular cartilage is devoid of nerves the origin of pain is always doubted. However, it is now recognized that Osteoarthritis is a disease of the whole joint and not just cartilage About 60 % of patients have knee joint synovial inflammation, some have bone marrow lesion, some are depressed, and some have associated fibromyalgia. There would be other factors besides the ones I have enumerated here.

Initially there is occasional mild pain that slowly becomes persistent and unbearable to the patient. Patient starts having night pain and poor sleep. Slowly this pain spreads to other areas near the joint and then may become generalized.  With pain loss of function ensues resulting in loss of muscle mass and weakness of muscles. As the disease advances there is loss of cartilage generally more on the medial or inner side of the joint. To compensate body remodels the bone to produce a bow leg deformity. Because of pain the body finds lifting the whole leg to be less painful then bending the knee leading to a waddling gait (a duck like gait). As the pain becomes persistent plasticity of the brain considers this as baseline and patient may feel pain all over body all the time akin to what happens in Fibromyalgia. This is aided by development of depression as everybody tells the patient that nothing can be done. (One of the commonest symptoms of depression is pain in the body.)

Taking care of the illness component without touching the disease component generally provides marked relief. Early treatment prevents spread of different components. A non-steroidal anti-inflammatory is useful to tackle pain. If inflammatory component is significant help of corticosteroids may be taken. Evaluation of Sleep, Depression and Fibromyalgia and its proper treatment goes a long way in treating Osteoarthritis as an illness. These should be treated earlier than later. These are also one of the causes of failure of Joint replacement surgeries. Waddling gait can also be produced by Vitamin D deficiency and it should be adequately searched for and tackled. Any loss of medial joint space should be tackled with ¼ inch lateral heel raise. It should be done early to prevent bone remodeling by the body. Physical exercises particularly quadriceps strengthening exercises go a long way in rehabilitating the patient. A close examination of the X Ray of the joint and Ultrasonography of the joint may reveal presence of calcium crystal deposition and oral colchicine may be helpful in preventing inflammation in these joints.