Arthritis

Arthritis is a general term which implies inflammation of a joint. There are many forms of arthritis.

Osteoarthritis is the most common of many forms of arthritis which can affect people. In general when people say they have arthritis they usually imply osteoarthritis.  It is estimated that 50% of people over 50 years of age have arthritis (osteo).  Although common and a potential source of reduced function there is a lot one can do about arthritis to relieve its symptoms and maintain or increase function.

Arthritis left on its own generally progresses over time and is responsible for a significant cause of treatable disability as a person ages. It decreases function through pain and stiffness, which results in reduced movement mobility and function. Let our Toronto sports medicine specialists help you!

Although we do not know the exact mechanisms in the onset and progression of arthritis, the process in part involves the breakdown of the molecular scaffold which makes up the cartilage lining of the joint structures. This allows the water normally trapped within the scaffold to be released changing the properties of the cartilage and resulting in significantly increased friction during normal joint movement and decreased resilience to compression. This in turn leads to further breakdown of the cartilage and a vicious cycle of degradation in osteoarthritis. Once the cartilage is degraded, excessive pressure is transmitted to the bone surfaces which are usually protected by the cartilage. This leads to characteristic changes in the bone which lead to joint deformation and dysfunction including pain, swelling and restricted range of motion. This is the classic definition of osteoarthritis. The pain and stiffness leads to decreased use of the joint resulting in a weakening of the surrounding muscles. Muscles which act on a joint not only move the joint but provide it with appropriate support and shock absorption. With decreased use of the joint, the affected muscles lose this ability resulting in a loss of joint protection and further joint breakdown.

Causes of arthritis include congenital or developmental defects in a joint or alignment of a limb, previous acute or repetitive trauma or infection of the joint, heredity and other unknown factors.

Arthritis is diagnosed on clinical grounds through a medical history and physical examination. The diagnosis is supported or confirmed by investigations including x-rays, bone scans, CT and MRI. The most common joints of the peripheral skeleton include the knees and hips and hands. Most of these cases will not require surgery. Osteoarthritis of the neck and back are extremely common. Osteoarthritis of the spine rarely requires surgery and is very amenable to rehabilitation and other conservative measures.

Currently there is no known way of reversing arthritis once it starts. The treatment of arthritis involves providing biomechanical and chemical support to the joints involved and treating the pain stiffness and swelling as necessary. The goal is to maintain function and slow down the further breakdown of the arthritic joint. This may delay or completely eliminate the need for surgery including joint replacement.

The most important factor in treating arthritis is trying to maintain adequate biomechanical support and stability for the joint while providing relative rest of the joint. The team at our Toronto sports medicine clinic achieves this through a comprehensive program of flexibility and strengthening provided through physical rehabilitation. Specialized rehabilitation techniques such as aquatic therapy, available at The Toronto Centre for Sports Medicine provide a unique and unmatched method of rehabilitation of osteoarthritic joints.

Chemical support of the joint can be achieved through the oral intake of glucosamine and chondroitin (two of the molecular building blocks of the cartilage scaffold) which are available as over the counter supplements in pharmacies and health food stores. While there is a lot of controversy as to whether they are effective, many studies backed by clinical experience seem to indicate that they can help relieve inflammation and pain and may help to slow the progression of osteoarthritis. It is too early to say whether these products can reverse the arthritic process to any degree. The good news is that they have very few side effects and are fairly inexpensive. There is not much to lose in trying them, so we offer help from our sports clinic in Toronto. These supplements are generally contraindicated in diabetics or people on anticoagulants.

Viscosupplementation is the injection of hyaluronic acid (another molecular building block of the cartilage scaffold) into a joint. It functions similar to glucosamine and chondroitin and has been found to relieve inflammation and pain and preserve joint function. There are many products available on the market, often covered by extended health plans. These products are injected during a short office procedure which is no more painful than receiving an immunization. The effect of these injections may last up to six months at which time they can be repeated. Patients with moderate arthritis have obtained significant relief and attained increased function of the injected joints. The most common joint injected is the knee.

One of the products we have injected extensively at our sports clinic in Toronto is Durolane. We are very excited about such products because the ease of administration, the low rate of side effects and the excellent functional results patients have obtained. Viscosupplementation should be considered in anyone with mild to moderate osteoarthritis especially of the knee.

Further treatment of arthritis involves further support of the joint through biomechanical interventions beyond physiotherapy. This may include soft over the counter braces, splints, orthotics and custom osteoarthritis unloader braces etc. These braces provide further support of the joints over and above optimal muscle functioning. The effects can be dramatic. 

With regards to all the interventions listed above, the earlier the interventions are instituted in arthritis the more effective they will be in providing joint preservation and joint function.

In summary arthritis is very common in our population. Effective treatment of arthritis is available from our Toronto sports medicine clinic

To learn more about how we can reduce your pain and increase your functioning despite your arthritis please contact us.