Arthritis is a simple mechanical failure of our bodies. The cartilage wears out in certain
joints, mainly
the hip, knee, lower back, neck and hands which leads to stiffness, pain and ultimately lead to
almost total immobility.
But these mechanical explanations are not entirely convincing, as logically the more one uses the
muscles the stronger they should become; rather than wearing out. Moreover, we don’t see that
two people leading the same active life develop bad hips or knees at the same time or to equal
severity. In fact, it is the disuse that should lead to muscle weakness.
So what factors besides wear and tear can explain arthritis?
The most common arthritis affecting is degenerative arthritis know as osteoarthritis (OA). There are
many other forms, but the majorly recognized is rheumatoid arthritis, which is not caused by wear
and tear or aging but is rather an autoimmune disease. As the cartilages health deteriorates, due to
any cause, the underlying bone also starts degenerating. Other parts of the joint like ligaments,
meniscus (a fibrous band covering part of the knee) and muscles, become altered as well.
Inflammation causes a burning pain and even bone spurs could form. With time the joint starts
getting stiff and even small movements can get really painful and difficult.
Joints are remarkable pieces of nature’s engineering, which move with frictionless ease. The knee is
the largest joint in the body, as it connects the femur (thigh bone), tibia (shin bone), fibula (outer
shin bone), and patella (kneecap). It is a hinge joint, with a limited range of motion. It is held
together by an extensive network of muscles, ligaments, and tendons, which provides added
stability to the joint and permits it to move at the same time. However it is also one of the reason for
the knee joint being so prone to injury.
The hip is a ball-and-socket joint which is located near in the area where the femur meets the pelvic
cone. This construction allows the hip joint to have a large range of motion. This joint however
needs sturdiness to support the body’s weight for standing, walking or running. Since the ball-
shaped head of the femur is the only moving part of the hip joint, hence both the femoral ball and
the socket it fits into (the acetabulum) are covered with hyaline cartilage. The rest of the femur is
attached with the femoral ball by a thin neck region. This is also the part of the hip joint that most
often get fractured during old age.
Now coming to the question that, how the joints deteriorate?
The breakdown of joint cartilage starts long before any symptoms surface. It is considered that in the
early stages the inflammation occurs as cytokines (which is a substance released by the immune
system) and other chemicals get into the joint. Due to which, the normal healthy cartilage matrix
starts to degrade. And as the cartilage cells attempts to repair this damage it causes the cartilage to
swell.
With time, the cartilage softens and loses its elasticity. It is observed that microscopic flakes and
clefts appear on the surface of the cartilage ant the joint space narrows as cartilage is lost. And this
process keeps happening repeatedly, the underlying bone gets exposed, which causes the bone to
rubs against the bone of joint. Eventually, the bone becomes increasingly vascularized (filled with
blood vessels), thicker, and denser. This can cause cysts in the bone, and as the bone cells attempt to
compensate for lost material bone spurs can develop. These changes and the stress they bring on
lead to the damage of the connective tissue, muscles, ligaments, nerves and also the synovial fluid
that lubricates the joints.
As we have understood the process of joint deterioration, let’s look into some of the prominent
causes of Osteoarthritis.
Endocrine: People with diabetes are more prone to osteoarthritis. Other endocrine
problems like hyperparathyroidism, acromegaly, hypothyroidism and also obesity, can
promote osteoarthritis development.
Posttraumatic: There exist two major kinds of traumatic causes: macrotrauma or
microtrauma. Macrotrauma is an injury to the joint for example a bone break which causes
the bones to line up inadequately (malalignment), lose of stability, or damaged cartilage.
Microtrauma however occur over time (chronically) for example repetitive movements or
the overuse experienced in several occupations.
Inflammatory joint diseases, which include infected joints, chronic gout, and rheumatoid
disease.
Metabolic: Diseases causing problems of metabolism may also lead osteoarthritis, for
example Paget’s disease and Wilson disease.
Developmental or Congenital i.e. Abnormal anatomy like unequal leg length can also lead to
osteoarthritis.
Genetic: A genetic defect can lead to breakdown of the protective architecture of the
cartilage. For Example collagen disturbances such as Ehlers-Danlos syndrome.
Neuropathic: Diseases like diabetes, etc can cause nerve problems. As the body loses the
sensation it can affect how the body knows the position and condition of the joints or limbs.
In simple words, the body cannot tell when it is injured.
Since I have taken you through the facts about arthritis, let’s look into the Prevention and relief
aspect. In total honestly I would like to mention that there is no cure for osteoarthritis till now,
however there are steps that one can take to reduce the chances of developing this disease and also
to manage the symptoms if you already have it.
1. Weight Control: Maintaining a normal weight can greatly reduce the chances of
2. Exercising: Consistent low-impact exercises can help lose weight, prevent knee OA and
3. Protect the Joints. An injury to the knee can change the alignment in the joint which
4. Diet: Consuming certain foods and drinking plenty of fluids can help to relieve
5. Heat and cold: An easy way to ease inflammation, swelling and discomfort is Heating
6. Topical medications: There are several topical nonsteroidal anti-inflammatory drugs like
7. Supplements: Some studies have found Glucosamine and chondroitin sulfate to be
8. Injections: People with acute OA can opt for Injections which are interred into the
In my experience though, the treatment that has proven beat is Physical therapy, Yoga and
Acupuncture. Arthritis creates a vicious circle: painful joint causes restricted movements, and then
the lack of movement makes the muscles weak and tight. In this scenario physical therapy (PT) yoga
and Acupuncture can be extremely helpful in getting healing to a point where you can do everyday
activities without difficulty. Let me take you through how each of these healing techniques prove
beneficial in treating arthritis.
Physical therapy helps the muscle stretch and strengthens itself, which in turn helps to stabilize it,
increase range of motion and lessen the pain. An experience physical therapist can teach the pain-
relief techniques, suggest helpful devices like a shower stools and long-handled shoehorns, etc and
also provide with a diet plan for weight loss. In my practice I have seen that combining Manual
therapy (in which variety of hands-on techniques are employed) with exercise therapy has proved
fruitful to the patients.
Yoga takes a whole-body approach to joint problems by emphasizing on realigning bones and on
overall posture, which helps in relieving stress on the joint and avert further damage. With
consistent yoga one can gain muscle flexibility and even lessen their pain.
Acupuncture has proven to be the most successful technique at relieving pain, but it can also have a
positive effect on other symptoms that appear in the three primary forms of arthritis.
Acupuncture relieves pain in three ways. First, it helps the body produce chemicals called
endorphins (similar to morphine), which curb the perception of pain. Second, it works via the
nervous system by blocking the transmission of pain signals to the brain. Third, it deactivates trigger
points which are tender and extremely reactive areas that develop in the muscles of the body. They
are the ones responsible for chronic pain and can be found around the arthritic joints.
Not only this acupuncture has the an anti-inflammatory effect as it stimulates the adrenals which
can produce natural steroids. This can help in healing rheumatoid arthritis, which is characterized by
inflammation (swelling, heat, redness and pain) in and around joints. Also, acupuncture helps in
producing the hormone that draws calcium out of bones by stimulating the parathyroid glands. This
hormone works on the arthritic deposits which can heal the second and most common form is
osteoarthritis.
Having being treating this disease from a long time now I would like to advice all those suffering
from arthritis to become an educated patient. Resolve to have healthy diet, exercise properly and
use healing techniques and try to keep a positive mindset. This will help you in living a better and
you will be able to remain active even with arthritis.
Now, to become a more informed patient I have mentioned couple of aspects that you should ask
your doctors about . It’s important to get all the information you need to make an informed decision
about the right treatment for you.
Ask about the local resources with which you can educate yourself.
Which therapist to refer : physiotherapist , rheumatologist, , occupational therapist or orthopedic surgeon?
Ask about the possible side effects of the medications given to you.
Things you can do minimize the chances of side effects.
What will be the signs that can help you know if drug is working.
What medications should you stop taking before the treatment?
In the end I would like to point out that though there is no cure for arthritis, but be more vigilant
about your body so that you can be diagnosed early and start the right treatment in time. This can
help you in taking control of your disease and may delay or even avoid severe damage to your joints.
Most people with arthritis can make themselves capable of leading an active and productive life with
the help of the right medication, surgery (if required) exercising, rest and joint protection
techniques.
