No medication or intervention has been shown to stop or reverse the disease process in OA.

Osteoarthritis, the most common form of arthritis, can affect any joint. It’s characterised by the progressive breakdown of joint cartilage and bone at the margins of the joint

“Osteoarthritis is an important topic to discuss,” says Steve Biko Academic Hospital rheumatologist, Dr Raksha Kalpee. “Unfortunately there haven’t been a lot of new developments in terms of the pathogenesis or reversing the disease process, but there are some new things on the horizon.

What is osteoarthritis?

Osteoarthritis (OA) is a slowly progressive non inflammatory musculoskeletal disorder typically affecting joints of the hands, spine, and weight bearing (hips, knees, and first metatarsophalangeal joint). “Interestingly, the articulation of the ankle joint is such that it is spared from OA, says Dr Kalpee. OA is caused by excessive load on a normal joint or normal load on an abnormal joint.

Classification

  • Primary idiopathic OA: localised or generalised
  • Secondary OA

Pathophysiology

“OA is no longer confined to be a ‘degenerative’ or ‘wear and tear’ disease. Rather, OA has evolved from a chondrocentric to whole joint organ, focal lesions of the articular cartilage, subchondral bone sclerosis and new bone formation (osteophytes) at the joint margin, periarticular muscle weakness, lax ligaments, low-grade synovitis, meniscal degeneration, and neurosensory system alteration. Unfortunately none of the disease modifying antirheumatic drugs have been proven to actually reverse this low grade synovitis.”

THE BONE-CARTILAGE UNIT IN OSTEOARTHRITIS

Risk factors

Age (the risk of osteoarthritis above the age of 70 is almost 80%), gender (women higher risk than men), genetics, obesity, occupation, physical activity, biomechanics, laxity, neuromuscular, inflammation, and bony changes.

Obesity and osteoarthritis

According to the The European League Against Rheumatism (EULAR), the risk of knee OA increases by 36% for every 5kg weight gain, but decreases by 50% for every 5kg loss (if BMI > 25). “Interestingly they’ve found that OA in obese patients doesn’t only affect weight bearing joints, this is due to adipose tissue that is a source of pro-inflammatory cytokines (leptin, adiponectin, resistin, interleukin 1, IL6, etc.). Other than weight loss, we don’t know how to target this yet.”

Clinical features

“While topical NSAIDs should be considered as the first line drug option, absolutely no medication or intervention has been shown to stop or reverse the disease process in OA. But there are three interventions that can improve the outcome in your patient with regard to pain and functions: Intra articular steroids, joint replacement surgery, and exercise,” Dr Kalpee concludes.