Osteoarthritis

Osteoarthritis, better known as osteoarthritis, is a "chronic degenerative alteration of the articular cartilage, a hard but elastic material that covers the ends of long bones, reducing friction, increasing the ability to absorb impacts and improving overall functionality. of the joint.

People and joints at risk

Osteoarthritis is a fairly common disease that affects a large number of people with advancing age. This condition is also known as "attrition arthritis or burdensome arthritis", since it electively affects all those who in the course of life they have carried out particularly intense and prolonged work and sporting activities. Cartilage wear is however influenced by many other factors, first of all the body weight which, when it is high, subjects the joints to additional stress. A certain inheritance was also observed; for this reason, if parents suffer or have suffered from osteoarthritis, their children are also exposed to a greater risk of developing the disease.

Cartilage microlesions, caused by repeated small traumas in the activities in charge, represent the main risk factor for athletes. Osteoarthritis, which can also occur due to severe acute trauma, is all the more likely the greater the acute and chronic injuries suffered by the athlete during his career.

Osteoarthritis mainly affects the knee, hip, lumbar and cervical vertebrae, the joint of the big toe and the joint at the base of the thumb.

How osteoarthritis develops

When "osteoarthritis affects one" joint it progresses in stages.

Due to an acute (dislocation, fracture, sprain, contusion), chronic (repeated microtrauma, joint misalignment, etc.) or apparently non-existent injury, the cartilage loses its characteristic surface smoothness, wearing out and becoming rough. The damage seems to be caused by the cells that compose it (chondrocytes) which, when injured, release enzymes capable of undermining cartilage integrity. Small fragments of cartilage are thus detached, real debris which, movement after movement, contribute to accentuate the joint damage. On the edges of the two bony ends that participate in the joint, beak or claw-shaped protrusions appear, called osteophytes, which represent a characteristic sign of osteoarthritis. While representing a defense mechanism of the organism, through which attempts to establish a greater contact surface between the joint bodies, osteophytes are generally painful, especially when the protuberances present on the two bony heads come into contact with each other or when, protruding outside the bone, they compress nerves or blood vessels, causing pain, tingling, sensitivity changes, etc.

The last stage of osteoarthritis is represented by the complete disappearance of the cartilage, which is accompanied by joint deformity and stiffness, possibly associated with swelling.

Symptoms and Diagnosis of Osteoarthritis

In the initial phase, osteoarthritis is asymptomatic, since the articular cartilage lacks innervation: pain appears only when the lesion affects the surrounding tissues;

pain and swelling arise during and after sporting activity or at the end of a busy working day; they subside with appropriate drug treatment and a short rest period;

in the morning as soon as you get up or after a day of rest, the joint appears stiff, but is released within thirty minutes;

joint creaking is felt while performing certain movements;

when osteoarthritis affects the neck, or rather the cervical vertebrae, specific symptoms appear, such as dizziness, tingling, headaches and pain that radiates down the arm.

DIAGNOSIS: a "careful investigation of the patient's clinical history can provide valuable elements for making a diagnosis of osteoarthritis; a simple X-ray, an MRI or a bone scan can be useful to confirm it. The" arthroscopy, on the other hand, is able to directly evaluate dimensions, depth and location of cartilage degeneration.

It should be borne in mind that the pain does not always reflect the extent of the lesion highlighted by the x-rays. There may be very damaged but not very painful joints, as well as severe suffering from minor injuries.

Treatment and prevention

There is no real cure for osteoarthritis, although great progress has been made in this regard. Traditional therapy is based on pain control, in order to make it less problematic and delay removal surgery as much as possible. worn out joint and replacement with an artificial joint. Treatment with hyaluronic acid is useful, but the greatest hopes derive from advances in tissue engineering; today it is in fact possible to graft cartilage cells taken from the same patient ("autologous chondrocyte implant"), obtaining good results even in the long term. However, this is an intervention reserved for a few and for the time being decisive only in particular cases (young age, only for some joints, limited injury and good condition of the remaining bone and cartilage portions).

Prevention is essentially implemented through the reasonable use of the joints. Sedentary and overly demanding activities are therefore banned, especially for untrained subjects. Regular physical activity, on the other hand, is useful for preventing osteoarthritis. as it strengthens the ligaments and the muscles that stabilize the joint, preventing injuries and dangerous misalignments. If the patient is overweight, weight loss is essential in order to reduce the load on the painful joint.

Physical activity is also particularly useful in the case of overt osteoarthritis and it is therefore necessary to abandon the now archaic idea that physical exercise should be absolutely avoided if the disease has already affected the joint. The benefits that can be obtained are in fact numerous: greater joint mobility, muscle strengthening and joint stabilization, maintenance or reduction of body weight, better balance and prevention of falls.

Recommended practices: cycling and water activities; Running is not recommended (better walking, preferably on soft surfaces and with suitable shoes). In any case, it is recommended to be followed, at least in the initial stages, by an expert able to draw up a correct exercise program. Only in this way can gross errors be avoided, which can even worsen osteoarthritis.


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