What Is Osteoarthritis?
Ever wondered why your joints feel stiffer and more painful as the years pass by? It’s not just ageing; there is always more to it.
Osteoarthritis (OA) belongs to the arthritis family that affects millions of the global population. In 2019, more than 528 million individuals were living with OA. Among the total population, 73% of individuals were more than 55 years old, and 60% were female [1].
Osteoarthritis Causes when the protective cartilage of the joints wears off. It damages any joints in the body, including hands, hips, knees, and spine.
Osteoarthritis Causes: Why Do Joints Degenerate?
Cartilage is a protective covering that is firm and slippery, allowing frictionless joint movement. The wearing off of cartilage leads to the rubbing of bones. Various causes of osteoarthritis result in joint degeneration. This includes:
- Age-Related Cartilage Wear and Tear: Ageing leads to thinning and stiffer joints. The body’s ability to repair cartilage gets compromised. There is reduced production of collagen and joint lubrication, making cartilage vulnerable.
- Joint Overuse and Repetitive Stress: Repetitive joint movement and prolonged stress on joints accelerate cartilage damage. Activities like sports or other active professions that involve constant bending, kneeling or heavy weight lifting. Such activities increase stress on joints of the knee, hands, etc., leading to gradual degeneration.
- Obesity and Metabolic Factors: Excessive body weight creates mechanical pressure on joints (hips and knees). Obesity and systemic inflammation are related factors.
- Previous Joint Injuries: Past injuries such as sprains, ligament tears, fractures, or meniscus damage alter joint stability and alignment. Even after healing injuries increases long-term stress on cartilage, raising the risk of developing OA.
- Genetic Predisposition: Individuals with a family history are more likely to develop OA. Genetic factors affect various conditions like cartilage structure, inflammatory response, joint alignment, etc. This makes individuals susceptible to developing OA.
What are the Risk Factors for Osteoarthritis?
Major risk factors of OA include:
- Adults above 55 years
- Female (postmenopausal)
- Obesity or high body mass index (BMI)
- Metabolic disorders like diabetes (high blood sugar)
- Hyperlipidemia (high blood pressure)
- Autoimmune disease (Lupus, Rheumatoid arthritis, Sjogren’s syndrome)
How Do Your Joints Weaken Over Time?
Your joints weaken progressively. The changes occur slowly and internally. Some of the factors include:
- Cartilage Thinning and Breakdown: Cartilages are a smoother cushion between bones. With ageing or the presence of other risk factors, cartilage wears off gradually. As it becomes thinner and stiffer, the ability of cartilage to absorb shocks declines
- Loss of Joint Lubrication: The synovial fluid of healthy joints dries off with age. The lubrication and nourishment of cartilages decrease. This increases friction between joints, making movement less smoother and more painful.
- Bone-on-Bone Friction: Cartilage deterioration leads to narrowing of the protective space between joints. Direct rubbing of the bone causes significant pain, inflammation, and swelling.
- Formation of Bone Spurs (Osteophytes): the cartilage loss triggers the formation of extra bone growths (osteophytes). Bone spurs develop at joint ends, resulting in stiffness, movement restriction, and pain.
- Reduced Joint Flexibility: The progressive degeneration, inflammation, and structural changes in joints disrupt normal motion. Stiffness becomes more noticeable, especially after rest.
Osteoarthritis Symptoms You Shouldn’t Ignore
The osteoarthritis symptoms appear quite early, before the disease reaches the advanced stage. The common symptom includes:
- Joint pain during movement
- Sport injuries or falls
- Morning stiffness
- Swelling or tenderness
- Decreased range of motion
- Crepitus (grating sensation)
- Noticeable difference in the joint and its movements
What are the Osteoarthritis Stages?
OAs develop slowly and are categorized as:
- Stage 1: Wear and tear of cartilage just begun, and symptoms might not appear
- Stage 2: Mild cartilage degeneration, increased cartilage degeneration, noticeable bone spur, joint pain and stiffness might appear
- Stage 3: Moderate cartilage loss, significant cartilage erosion, chronic inflammation
- Stage 4: Severe cartilage wear off, joint become unfunctional, severe impact on daily life activities
Osteoarthritis Diagnosis: How Do Doctors Detect?
The diagnosis involves one or more diagnostic examinations. This includes:
- Physical examination of the affected joint showed tenderness, decreased flexibility, and swelling.
- Imaging tests (X-ray, MRI)
- Laboratory assessment (Blood, Urine and Joint fluid analysis)
What are Osteoarthritis Treatment Options?
Osteoarthritis Treatment cannot reverse the condition, but the aim is to reduce pain and manage other symptoms. The conventional treatment includes:
Palliative Care
- Acetaminophen (Tylenol), for mild to moderate pain
- Nonsteroidal anti-inflammatory drugs (NSAIDs) (Advil, Aleve) relieve osteoarthritis pain.
- Duloxetine (cymbalta), chronic pain
Therapy
- Physical Therapy (muscle strengthening, swimming, walking) strengthens muscles.
- Occupational Therapy (helps with daily life activities)
- Transcutaneous electrical nerve stimulation (low electric current relieves pain in the hips or knees)
Surgical Interventions
- Cortisone injection
- Lubrication injection
- Osteotomy for reeling bones
- Joint replacement, removal of damaged joints and replaced with plastic or metal sheets
All the above treatment modalities focus on managing disease symptoms. However, none of the above treatments is curative. Joint replacement involves high risks like infection or blood clots, that brings other complications.
Modern Osteoarthritis Treatment: Regenerative Approaches
Stem Cells for OA
Stem cells have emerged as a regenerative approach that potentially can regenerate damaged cartilage. Mesenchymal stem cells (MSCs) have emerged as promising therapeutics for OA. MSCs are derived from:
- Umbilical cord tissue/blood
- Adipose Tissue
- Bone-marrow
What Do Stem Cells Do in OA Patients?
Stem cells target the causes of osteoarthritis in a multifold manner. This includes:
- Regeneration: Stem cells enable regeneration and repair of degenerated cartilage, replacing the damaged one
- Anti-Inflammation: MSCs release bioactive molecules, including anti-inflammatory markers. This suppresses pain and releases joint stiffness.
- Cartilage Modulation: stem cells differentiate into cartilage cells (chondrocytes), which promotes the repair of damaged tissue
- Joint Lubrication and Pain Relief: Promotes restoration of synovial fluids, promotes lubrication and reduces friction between bones
What Preclinical and Clinical Trials Reveal About Stem Cell Therapy?
Stem cell therapy for OA is subjected to multiple preclinical and early clinical trials. The use of MSCs showed significant positive outcomes, such as:
- Significant pain improvement
- Anti-inflammatory effects and relief of stiffness
- Potential halt in osteoarthritis progression, supportive environment for existing cartilages
- Double the quality of life of patients receiving stem cell treatment [2]
- Created a supportive environment for knee replacement and recovery [3]
What are the Possible Challenges?
MSCs for OA patients are generally safe. There are some challenges reported as follows:
- Currently, stem cell treatment is supportive
- Determining the standard dosage of stem cells
- Cell heterogeneity, high variability in cell source, preparation, patient selection, etc.
- Possible placebo effect, contextual effect (injection itself might affect symptom improvement)
There is an immense need for designing larger-clinical trials for determining the long-term safety of the stem cell therapy for OA treatment.
*NOTE: Stem cells used for treatment must be of premium quality. Advancells, India, is among the leading research laboratories that conducts advanced research with stem cells. The laboratory is GMP certified and maintains clinical-grade stem cells for use.
Final Thoughts: Managing Osteoarthritis at Every Stage
- OA is a progressive disease; early recognition of symptoms and diagnosis is key to adequate management.
- The treatment plans vary depending on the individual’s specific needs
- Stem cell therapy for OA treatment involves a regenerative approach that brings changes from within
- MSCs can potentially regenerate cartilage, create a supportive environment, reduce inflammation and reliefs pains
- The key to OA management is understanding causes and taking preventive measures at the early life stage
References
- World Health Organisation. Osteoarthritis [Internet]. Geneva: WHO; 2023 Jul 14. Available from: https://www.who.int/news-room/fact-sheets/detail/osteoarthritis
- Wang G, Xing D, Liu W, Zhu Y, Liu H, Yan L, Fan K, Liu P, Yu B, Li JJ, Wang B. Preclinical studies and clinical trials on mesenchymal stem cell therapy for knee osteoarthritis: A systematic review on models and cell doses. International Journal of Rheumatic Diseases. 2022 May;25(5):532-62.
- Carneiro DD, Araújo LT, Santos GC, Damasceno PK, Vieira JL, Santos RR, Barbosa JD, Soares MB. Clinical trials with mesenchymal stem cell therapies for osteoarthritis: challenges in the regeneration of articular cartilage. International journal of molecular sciences. 2023 Jun 9;24(12):9939.
FAQ’s
Q- What are the Primary Causes of Osteoarthritis?
Osteoarthritis is primarily associated with age-associated wear and tear of cartilage. Other causes include joint overuse, injuries, obesity, genetic disposition, trauma, or accidents.
Q- What are Early Osteoarthritis Symptoms?
Early symptoms include joint pain, stiffness, tenderness, swelling or inflammation around the joints.
Q- Can Osteoarthritis Be Cured?
Currently, there is no complete cure for osteoarthritis. The current treatment regimen involves the management of its symptoms. Stem cell therapy is promising in restricting cartilage degradation and creating a supportive environment.
Q- Is Stem Cell Therapy for Osteoarthritis Safe?
Preclinical and clinical trials have suggested the safety of stem cell therapy for osteoarthritis patients. In the future, large-scale clinical trials are desirable for determining long-term safety. The research must reflect on process optimisation and standardisation.
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