What Can I do to Prevent Osteoarthritis?

Osteoarthritis (OA) is an age-related condition that is increasing in prevalence and one that can result in significant pain and disability. This chronic disease is becoming one of the most important healthcare challenges for physicians and researchers. OA is a complex disease with an etiology that connects biochemistry to biomechanics, and it incurs serious social, psychological, and economic costs.

The symptoms of clinical OA include stiffness, crepitus, joint pain, limited mobility, and decreased joint function. If OA arises spontaneously and with an unknown course, it is considered ‘idiopathic’. Amongst adults 30 years of age or older, symptomatic OA disease in the knee occurs in approximately 6% of individuals, and symptomatic hip osteoarthritis occurs in roughly 3%. This condition is the most common reason for total knee and hip replacements. Before the age of 50, OA is more prevalent among men than women. After the age of 50 years, however, women are more affected with knee, hand, and foot OA than their male counterparts (Felson et al., 2000).

Pathology

The entire joint is involved in a disease process. This includes cartilage loss with notable changes in the bone lying beneath the cartilage. Other changes include increased thickness of the bony envelope (sclerosis) and osteophyte (bone spur) formation. The soft tissue structures that are inside and around the joint are affected with OA. When OA is present, the synovium (membrane) has inflammatory infiltrates, ligaments are frequently lax, and the bridging muscle weakens (Felson, et al., 2000).

Risk Factors

OA occurs as the result of other conditions, or from a combination of factors. The preventable and modifiable risk factors for OA are obesity, sports participation and activity level, nutritional status, occupation, muscle weakness, bone density, and hormonal influence. It is possible to manage these factors to reduce OA pain and disability (Bijilsma & Knahr, 2007).

Genetics and ethnicity are non-modifiable risk factors. OA has a strong genetic determination, with genetic factors accounting for around 50% of hand and hip OA. Regarding ethnicity, African-American men are 35% more likely than Caucasian men to have hip OA. African-Americans with knee or hip OA have more severe radiographic features of the condition and more bilateral involvement and mobility impairment than Caucasian individuals.

It is unclear if the contributions of biology, lifestyle, and socioeconomic factors to the ethnic differences in OA contribute to pain and disability. Researchers believe that biological and genetic factors such as body mass index (BMI) and genetic biomarker variances do result in ethnic differences occurring in OA cases. In addition, obesity is more prevalent in certain ethnic populations, particularly Hispanic, Native American, and African-American women (Felson et al., 2000).

Primary Prevention

According to Dieppe (1993), risk-factor analyses suggest that many cases of OA can be prevented by reducing obesity, changing certain high-risk occupations, and reducing the incidence of joint trauma. Other preventive measures focus on avoidance of high impact exercise, eating a well-balanced diet, keeping muscles strong, getting the right kind of exercise, and maintaining adequate estrogen and bone density levels.

  • Lose Weight
    The main thing you can do to prevent OA in your weight-bearing joints is to lose weight. Obesity is a major risk factor for OA of these joints. Recent research findings proved that excess weight and obesity precedes or is a consequence of OA, excessive weight antedates disease development and being overweight increases radiographic progression. Knee OA is particularly related to weight because overloading these joints leads to cartilage breakdown and structural support failure. Unilateral hip OA is not associated with being overweight but bilateral disease (of both hips) is (Felson et al., 2000).
  • Avoid Strenuous Sports Participation and High Impact Exercise
    There has been concern among researchers that too much physical activity leads to OA development. Saxon, Finch, & Bass (1999) report that the continuous stress certain exercises and sporting activities place on the joints causes microtrauma and degeneration of the articular cartilage. OA onset is directly associated with the frequency, intensity, and duration of certain high impact sports and other aggressive physical activity. Furthermore, participants are at risk for abnormal joint alignment, instability, imbalance, and weakness. Severe joint trauma and injury causes OA, but researchers believe the disease is a product of both systemic and local factors. For example, a person may have a genetic disposition to develop OA and a biomechanical insult (such as an injury) increases the risk. Furthermore, epidemiological studies found that certain sports activities, such as soccer, running, and aerobics increase OA risk. (Felson et al., 2000).
  • Eat a Well-Balanced Diet
    The musculoskeletal system requires adequate vitamins and minerals, particularly calcium, vitamin D, vitamin C, and iron. To maintain good joint health and optimum overall physical performance, eat a well-balanced diet. Avoid crash diets, fasting, and empty calorie foods.
    Because evidence indicates that chondrocytes (cells in cartilage) may damage cartilage collagen and synovial fluid, you should eat micronutrient antioxidant containing foods. These items provide tissue injury defense and protect against OA. Vitamin C is an important nutrient to reduce progression of radiographic OA. Vitamin D is necessary for normal bone metabolism and adequate levels protect against development of OA and disease progression (Felson, et al., 2000).
  • Do Muscle Strengthening Exercises
    People who have joint injuries and/or macrotrauma are at risk for accelerated OA development. This is why muscle-strengthening exercises are important in the prevention of OA. Athletes and individuals who have knee surgery should do passive motion rehabilitative exercises to promote healing of the articular cartilage, tendons, and ligaments (Saxon, Finch, & Bass, 1999). Quadriceps muscle weakness is common in people with knee OA, and this leads to limb atrophy and pain. Knee extensor weakness is also associated with knee OA. These muscles need strengthened to prevent structural damage of the joints (Felson, et al., 2000).
  • Participate in Aerobic and Resistance Exercise
    In 2001, Penninx and associates researched how the prevention of disability in activities of daily living could prolong older people’s autonomy. They also examined whether an exercise program could prevent this type of disability. The trial was conducted at two health centers, and the participants were assigned to an aerobic exercise program, a resistance exercise program, or a control group. The 250 participants were aged 60 years or older with OA of the knee and free of disability in the area of activities of daily living. The results showed that for the exercise groups, there was a lower incidence of disability than in the control group. The scientists concluded that aerobic and resistance exercises reduce disability for older people with knee OA, and that exercise is an effective prevention strategy.
  • Change Jobs
    If you currently have a job or occupation that causes stress on one or more of your joints, consider a job change. Jobs where a worker does repetitive tasks tend to overwork the joints and lead to muscle fatigue. These factors put you at risk for OA. Mill workers, farmers, and labor workers who kneel, squat, and lift frequently all are at risk for OA development. Other occupations linked to OA are those with excessive stair climbing, prolonged sitting or standing, and walking on uneven ground (Felson, et al., 2000).
  • Maintain Adequate Oestrogen Levels
    The high incidence of OA in women just after menopause has suggested that estrogen deficiency plays a role in disease emergence. Research studies found that women taking estrogen had less prevalence and incident of radiographic OA. Estrogen exposure slows the subchondral bone changes and bone turnover, and current evidence suggests that estrogen may help to prevent OA (Felson et al., 2000).
  • Maintain Adequate Bone Density
    When you are at your primary care provider’s office, ask for a DEXA scan to evaluate your bone mineral density (BMD). Researchers found that women with knee OA had lower levels of osteocalcin (a marker of bone turnover) than those without the condition. Higher bone density protects against OA progression if the disease is already present.

Secondary Prevention of Osteoarthritis

According to Felson and associates (2000), there are many treatments to reduce OA pain and disability. These include chondrocyte transplantation and other surgical interventions, new anti-inflammatory medications, and health education. Also, Dieppe (1993) found that OA can be controlled and further prevented through drugs that either stimulate cell repair and/or inhibit connective tissue breakdown.

  • Medications
    According to experts, the use of anti-inflammatory medications prevents further progression of OA and slows its development. Certain drug therapies were found to reduce joint damage along with pain. These medications include ibuprofen and naproxen. Hyaluronic acid injections are also able to prevent disease advancement.
  • Surgical Interventions
    For significantly damaged joints, a partial or total joint replacement may help prevent further progression of OA. However, there are some surgeries that appear to be associated with increased risk of OA development, particularly knee procedures. Athletes who have surgery should avoid returning to sporting activities as long as possible to allow for optimum healing. Because fractures of the articular surfaces, joint dysplasias, and meniscus tears all lead to joint instability, these injuries need repaired to prevent OA or delay disease advancement. Risk factors for post-traumatic OA include high level of activity, high body mass, residual joint instability, and persistent articular surface incongruity (Bijilsma & Knahr, 2007; Saxon, Finch, & Bass, 1999).
  • Health Education
    Because OA is associated with limited function, health education is needed regarding rehabilitative interventions, physical fitness, physical modalities, and joint exercises. This self-management also helps to prevent overuse of the joints and promote joint wellness (Bijilsma & Knahr, 2007).

References

  • Bijilsma, J.W.J., & Knahr, K. (2007). Strategies for the prevention and management of osteoarthritis of the hip and knee. Best Practice & Research Clinical Rheumatology, 21(1): 59 – 76.
  • Dieppe, P. (1993). Strategies for the prevention of osteoarthritis. Internal Joint and Tissue Reactions, 15(3): 93 – 97.
  • Felson, D.T., Lawrence, R.C., Dieppe, P.A., Hirsch, R., & Helmick, C.G. (2000). Osteoarthritis: new insights. Annuals of Internal Medicine, 133(8): 635 – 646
  • Hochberg, M.C. (1991). Epidemiology and genetics of osteoarthritis. Current Opinions in Rheumatology, 3(4): 662 – 668.
  • Penninx, B. W, Messier, S.P., Rejeski, W.J., Williamson, J.D., DiBari, M., Cavazzini, C., Applegate, W.B., & Pahor, M. (2001). Physical exercise and the prevention of disability in activities of daily living in older persons with osteoarthritis. Archives of Internal Medicine, 161(19(: 2309 – 2316.
  • Saxon, L., Finch, C., & Bass, S. (1999). Sports participation, sports injuries, and osteoarthritis: implications for prevention. Sports Medicine, 28(2): 123 – 135.

Last reviewed 26/Feb/2014

 

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Dr Merlin Thomas

Professor Merlin Thomas is Professor of Medicine at Melbourne’s Monash University, based in the Department of Diabetes. He is both a physician and a scientist. Merlin has a broader interest in all aspects of preventive medicine and ageing. He has published over 270 articles in many of the worlds’ leading medical journals
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