Osteoarthritis


Arthritis is a painful condition that is caused by inflammation and degeneration of the joints in your body. There are multiple types of arthritis, a few of which include osteoarthritis, rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. Osteoarthritis is the most common type of arthritis, affecting an estimated 3.9 million Canadians (https://www.canada.ca/en/public-health/services/publications/diseases-conditions/osteoarthritis.html).

Joints in your body are formed where one bone meets another; the bone ends are covered by a soft, slippery tissue called cartilage, which allows the joints to move through their range of motion smoothly and without pain.  When the cartilage, connective tissue, and bone that form joints becomes damaged and the body is unable to repair the damage, movement of the damaged joint can become painful and range of motion can become restricted. This process is known as osteoarthritis – a progressive, degenerative disease that most commonly affects the spine, hands, hips, and knees. Once osteoarthritic damage to a joint is present, it cannot be reversed; however, preventative measures can be taken to protect healthy joints and slow the progression of the disease in damaged joints. Treatment options are also available to manage the painful symptoms of osteoarthritic joints.

Risk factors for developing osteoarthritis:

  • Obesity
  • Lifestyle factors, such as lack of exercise
  • Previous joint injuries
  • Repetitive and strenuous use of a joint
  • Family history/genetics
  • Sex (for unknown reasons, females are at higher risk of developing osteoarthritis)
  • Older age
  • Other diseases, such as diabetes and other types of arthritis

Symptoms

  • Joint pain – Sensation can range from a mild, achy discomfort to intense, burning pain
  • Stiffness in the joints – Affected joints may feel stiff, with limited range of motion and limited mobility
  • Noises in the joints – Cracking, creaking, or grinding sounds may be heard with movement of a joint (please note that healthy joints may also make certain noises with movement and this symptom alone is not indicative of osteoarthritis)
  • Swelling and deformation of the joint – This can be caused by inflammation of the soft tissues around the joint or formation of bone spurs

Diagnosis

A diagnosis of osteoarthritis may be reached using a number of different tests and assessments. A physician will examine the affected joint for swelling, tenderness, and range of motion; however, numerous conditions can manifest with these symptoms. Diagnostic imaging techniques such as x-ray, ultrasound,CT scan, and MRI may be used to visualize the joint, assessing for joint narrowing or tissue damage. Blood tests may be used to rule out certain conditions, such as rheumatoid arthritis. Other lab tests, such as joint fluid analysis, may also be performed to rule out other conditions related to joint pain, such as gout.

Treatment

  • Diet and exercise – A healthy diet and a gentle exercise routine designed to maintain a healthy weight, and increase strength, flexibility, and range of motion is recommended
  • Medication – For mild to moderate osteoarthritis, symptoms can often be managed with non-prescription anti-inflammatory and pain medications; for more severe cases, prescription medications may be recommended. It is important to note, however, that chronic and excessive use of these medications can have adverse effects such as ulcers, kidney damage, and liver damage
  • Physiotherapy, chiropractic treatment, and occupational therapy – Rehabilitation sessions may be recommended to assist with developing an appropriate exercise routine and adaptations in activities of daily living to minimize pain and slow the progression of joint degeneration
  • Therapeutic injections – Numerous therapeutic joint injections are available for treatment of joint pain management and inflammation reduction; these injections are an effective, non-invasive alternative to surgery in many cases
  • Surgical intervention – For severe cases of osteoarthritis, surgical intervention such as an osteotomy or even joint replacement may be recommended
  • Other treatments for osteoarthritis may include acupuncture, aqua therapy, braces and supports, TENS/MET devices, and orthotics depending on the type and severity of osteoarthritis

Possible Complications

Ongoing pain and restriction in an individual’s ability to perform day-to-day activities can take a psychological toll. Symptoms of anxiety and depression may develop as a result of chronic pain. It is important to treat these symptoms as well as the physical pain. At the Wilderman Medical Clinic, we offer psychological services, biofeedback devices and sessions, TENS devices, and lifestyle counseling, in addition to the services outlined below, to support both the physical and psychological wellbeing of patients dealing with chronic pain caused by conditions such as osteoarthritis.

At our clinic

At the Wilderman Medical Clinic, we offer numerous treatment options for management of osteoarthritis pain.

Therapeutic Injections Offered:

Areas of injection: Cervical, thoracic, and lumbar spine, TMJ, SI joints, shoulder, elbow, wrist/hand, hip, knee, ankle/foot

Types of injections: Joint injections, nerve block injections, trigger point injections

Substances used:

Cortisone for osteoarthritis – Corticosteroid injection into an affected joint can provide fast relief from osteoarthritis pain by temporarily decreasing inflammation in the joint; however, the effect of the treatment varies significantly from person to person, with some individuals experiencing little to no relief, while others are pain from for several months following an injection. While these injections may be an effective method of managing pain for some, there are significant possible side effects, including infection, a temporary flare-up of pain following the injection, and potential tissue damage and cartilage thinning at the site of the injection. Because of the possible side-effects, the frequency and number of cortisone injections is limited.

Dextrose for osteoarthritis – Dextrose prolotherapy injections involve injecting an irritant into the affected joint to help trigger the body’s natural healing process. While further studies are required in order to fully understand the mechanism by which dextrose injections work, current trials have shown that many patients report a decrease in their level of pain following a dextrose injection. Additionally, since these injections are safe and have minimal side effects, they are a viable option for managing pain. However, it is important to remember that patient responses to the treatment vary, and while some individuals may experience significant relief from the treatment, others may have little to no response to the injection.

PRP (Plasma rich protein) for osteoarthritis – Injection of autologous cells, plasma rich protein extracted from a patient’s own blood, has been found to be effective in reducing osteoarthritis pain in a joint for several months; additionally, some studies indicate that, while osteoarthritis damage cannot be reversed, PRP injections might help preventing further deterioration of the affected joint. While further study is required, these injections have been found to be both safe and effective, with minimal side effects.

nStride for osteoarthritis- Like PRP, nStride injections use an autologous cell solution, meaning they utilize cells extracted from a patient’s own body. In this case, an autologous protein solution is extracted from a patient’s blood and then injected into the affected joint. Clinical studies have found that this treatment significantly reduces pain in the injected joint and protects the joint tissues from further deterioration.

Hyaluronic acid for osteoarthritis – Hyaluronic acid is naturally part of the fluid that assists in lubricating joints to help them move smoothly and without pain. Injecting this solution into affected joint aids in lubricating the joint, which can be effective in reducing pain.

PRP Injections for osteoarthritis of the cervical, thoracic, and lumbar spine – Plasma rich protein injections to discs and facet joints of the spine have been found to substantially reduce pain in a majority of patients. While further study is required to fully understand the mechanism with which these injections work, recent studies have found them to be both safe and effective in providing long-lasting relief from pain. One study, which reviewed the existing data on PRP therapy for lower back pain, commented that “[research on PRP therapy has demonstrated remarkable improvements in pain intensity according to a variety of pain scores. The clinically-beneficial effects have enabled patients to return to normal physical activity” (Platelet-rich plasma injections: an emerging therapy for chronic discogenic low back pain, Journal of Spine Surgery, v. 4(1); 2018 Mar.).

While chronic pain caused by osteoarthritis may have become a fact of life for you, don’t let it be the deciding fact in how you live your life. Contact our clinic at 905-886-1212 for a consultation. Take steps today to prevent problems tomorrow. Be well.

Works Cited:

Dunkin, Mary Anne. Corticosteroid injections for osteoarthritis. (https://www.webmd.com/osteoarthritis/corticosteroid-injections-for-osteoarthritis)

Rabago, D et al. Dextrose prolotherapy for knee osteoarthritis: A randomized controlled trial. Annals of Family Medicine 2013 May; 11(3): 229-237. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3659139/)

NStride autologous protein solution therapy. Mayfair Diagnostics (https://www.radiology.ca/exam/nstride-autologous-protein-solution-therapy)

Mohammed, S. & Yu, J. Platelet-rich plasma injections: an emerging therapy for chronic discogenic low back pain. Journal of Spine Surgery, 2018 Mar; 4(1): 115-122. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5911760/)

Osteoarthritis in Canada: Highlights from the Canadian chronic disease surveillance system. Public Health Agency of Canada, September 2020. (https://www.canada.ca/en/public-health/services/publications/diseases-conditions/osteoarthritis.html)

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