Osteoarthritis is a common degenerative disorder of the articular cartilage of a joint characterized by joint pain, tenderness, limitation of movement, crepitus, occasional effusion, and variable degrees of local inflammation, but without systemic effects. **** It **** is a leading cause of disability. It is the most common joint disease worldwide, affecting an estimated 10% of men and 18% of women over 60 years of age.
This condition affects almost all parts of the joint including the cartilage, the bony surfaces & the synovium of the joint spaces. There is degradation and erosion of the cartilages. Involvement of the nerve rich bony part induces pain in the joint. The joint space is also reduced in advanced condition causing friction of the articulating bones.
Commonly affected joints are hands, fingers, shoulder, spine, typically at the neck or lower back, hips & knees. It is characterized by many signs & symptoms few of which include Joint pain , s tiffness in the join t, l oss of flexibility and reduced range of motion , t enderness or discomfort when pressing on the affected areas with the fingers , i nflammation , c repitus, or grating, crackling, clicking, or popping sounds on moving the joints, b one spurs, or extra lumps of bone, which are typically painless.
Though several risk factors are associated with development of OA, obesity has the strongest association. Obesity is a risk factor for both the incidence and progression of osteoarthritis & negatively influences the outcomes. Loss of at least 10 kgs of body weight, coupled with exercise is a cornerstone in the management of obese patients with osteoarthritis, and can lead to significant improvement in symptoms, pain relief, physical function and health-related quality of life.
Obesity is known to contribute towards the onset of Early OA in several ways. With every 5 kg of weight gain there is 36 % increase in the risk of knee OA. Obesity causes release of inflammatory adipokines which cause inflammation in the joints. The weight bearing load on the joints also is very high in obese individuals causing degradation of the joint cartilage & later erosion of the bony tissue. obesity and OA collectively reduce mobility. This can initiate a vicious cycle of events: reduced activity, further weight gain and decreased muscle strength, leading to increased joint problems and disease progression. Hence, weight loss is a primary goal in obese individuals with OA.
Weight loss & osteoarthritis:
Weight loss can prevent onset of osteoarthritis, relieve symptoms, improve function and increase quality of life. This is possible as weight loss reduces joint loads. A study revealed that 5.1-kg reduction in weight over a 10-year period decreased the likelihood of women developing symptomatic knee OA by 50 %. While loss of approximately 5kgs of body weight has been shown to provide some relief in obese patients with OA, several studies have indicated that the ultimate goal should be an initial decrease in body weight of at least 10kgs,, in order to provide significant reductions in pain.
Low-impact exercise can increase the endurance and strengthen muscles around the joint, making it more stable. Heat and cold can help relieve pain and swelling in the joint. Physiotherapy can help in increasing the flexibility & range of motion of the joint while reducing the pain. Supplementation of omega-3 fatty acids might help relieve pain and improve function.
One has to be very careful while selecting the exercises for individuals with OA. Guidelines from the American College of Rheumatology and European League Against Rheumatism recommend the need for weight loss as well as exercise in the management of overweight or obese patients with OA. A combination of exercise and weight loss, together with appropriate analgesia often serves as a cornerstone for these patients. Although weight loss can be achieved through calorie restriction alone, the addition of exercise significantly improves mobility (an important determinant of disability), self-reported function and pain. Thus, one must aim for an ideal BMI by combining calorie deficit with moderate intensity workout.
References:
- Brandt, K. D., Dieppe, P. and Radin, E. L. (2008) ‘Etiopathogenesis of Osteoarthritis’, Rheumatic Disease Clinics of North America, 34(3), pp. 531–559. doi: 10.1016/j.rdc.2008.05.011.
- Hunter, D. J. and Bierma-Zeinstra, S. (2019) ‘Osteoarthritis’, The Lancet, 393(10182), pp. 1745–1759. doi: 10.1016/S0140-6736(19)30417-9.
- Messier, S. P. et al. (2017) ‘Weight-loss and exercise for communities with arthritis in North Carolina (we-can): design and rationale of a pragmatic, assessor-blinded, randomized controlled trial’, BMC Musculoskeletal Disorders, 18(1), pp. 1–14. doi: 10.1186/S12891-017-1441-4/FIGURES/3.
- Osteoarthritis: Symptoms, Causes, Treatment, and More (no date). Available at: https://www.healthline.com/health/osteoarthritis#complications (Accessed: 4 December 2021).
- Zhang, Y. and Jordan, J. M. (2010) ‘Epidemiology of osteoarthritis’, Clinics in Geriatric Medicine, 26(3), pp. 355–369. doi: 10.1016/j.cger.2010.03.001.
