Osteoarthritis in older people

Osteoarthritis is a chronic disease characterized by progressive deterioration of the joint, mainly in the hands, knees, hips or in some joints of the spine. This aging begins in the articular cartilage, which gradually deteriorates and loses its integrity. Articular cartilage performs two important functions:

• It helps the bones slide between them with little friction.
• It distributes the mechanical stresses preventing the bones from breaking when loading the joints.

As the cartilage breaks down, it is altered and there is a reactive formation of the bone underlying cartilage and at the margins of the joints to withstand mechanical forces, forming bony prominences called osteophytes. These changes, among others, end up producing a failure of said joint that implies limitation of movement, pain and deformity.

Types of osteoarthritis

• Idiopathic or primary osteoarthritis: it is the most common and there is no previous alteration that predisposes its appearance, so the cause of the progressive deterioration of the cartilage and the joint is unknown.
• Secondary osteoarthritis: in these cases the joint usually has a previous alteration. One of the many causes are previous trauma, for example, knee meniscus injury, repeated trauma in some professions or previous congenital diseases of the joint.

Although in most cases there is no known cause, there are a number of risk factor's known for the development of osteoarthritis as: age and obesity. This association of the disease with age has led to the suggestion that osteoarthritis is related to aging in itself. However, this not exactly like that, since the changes in cartilage and other tissues of the joint that occur with aging are different from those seen in osteoarthritis. While these biochemical changes in aging cartilage can facilitate its appearance and development.

Frequent symptoms

• The pain of the joint is the main symptom of the disease. It is usually a pain that appears with use of the joint and improves with rest, although in advanced stages of the disease it can be continuous.
• In some cases there are morning stiffness short-lived after inactivity.
• Sometimes periods of inflammation and small effusions in the joint, this being another source of pain.
• When examining the joints, they are usually deformed and crackle when moved, as if the bones were rubbing against each other.
• In advanced stages you can observe loss of mobility and joint fixation (ankylosis).

Diagnosis in the elderly

He is established based on the Clinical examination and in about radiological results Characteristic where the narrowing of the joint space can be observed when the cartilage is lost, the reactive sclerosis of the bone located below the cartilage and the proliferation of bone in the form of osteophytes. The absence of manifestations of the disease outside the joints, at other levels of the body, makes the analyzes and other laboratory studies normal.

Treatment

Regarding treatment, the main objectives that must be taken into account when facing this pathology are the control pain and minimize disability and the functional limitation that it produces. This should be attempted by avoiding as much as possible adverse effects of medication and the possible complications that may appear with medical interventions. In the treatment of osteoarthritis, measures are available pharmacological Y non-pharmacological.

Non-pharmacological treatment

• Health education programs focused on techniques of joint protection or techniques of relaxation.
• Weightloss in cases of obesity.
• depending on the individual clinical situation they are also useful.
• Programs that improve strength of the quadriceps in knee osteoarthritis can reduce pain and improve its function.
• Hydrotherapy or hot or cold techniques can improve pain and mobility.

Pharmacotherapy

• Analgesics simple, such as acetaminophen
• Anti-inflammatories non-steroidal
• Other pain relievers such as tramadol
• Therapeutic treatment with intra-articular injections of corticosteroids in more difficult cases.
• Glucosamine sulfate and chondroitin sulfate, with limited effect in the early stages of the problem. It is a specific treatment designed to try to stop the progression of the disease.
• In the event that the above measures are ineffective, in some cases, and age itself is not a contraindication, surgery may be necessary of the joint or its replacement by a prosthesis.