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Posted on 02-21-2012

Morning everyone!

Osteoarthritis otherwise known as "OA" is the most prevalent form of arthritis and a major cause of disability in people aged 65 and older. OA affects the majority of adults over age 55.  

58% of those older than 70 years have symptomatic OA. 10-30% of those with OA have significant pain and disability.

OA is the clinical and pathologic outcome of a range of disorders that results in structural and functional failure of [synovial] joints. OA occurs when the dynamic equilibrium between the breakdown and repair of joint tissues is overwhelmed.

The risk of OA has 2 major categories: systemic factors and local factors:

1) Systemic Factors:

  1. A))  Ethnicity

  2. B))  Age: "The presence of x-ray OA rises with age at all joint sites."

  3. C))  Gender

  4. D))  Hormonal Status

  5. E))  Genetic Factors

    OA has a major genetic component

  6. F))  Bone Density

  7. G))  Nutritional Factors
    There is evidence that OA is linked to free radicals, and that high dietary antioxidants (especially vitamins C and D) are protective against the development of OA. "Chondrocyte senescence is thought to be the result of chronic oxidative stress."

2) Local Factors:
Local factors "result in abnormal biomechanical loading of affected joints."

  1. A))  Obesity

  2. B))  "Altered joint biomechanics"

    • ••  ligamentous laxity

    • ••  malalignment (think Chiropractic)

             ••  impaired joint position sense

  • With aging, there is a decline in joint position sense, causing decreased neurologic responses, impairing neurological joint-protective mechanisms. Consequently, reduced joint position sense advances OA.

  •       ••  muscle weakness

C)) Prior joint injuries

  1. D))  Occupational Factors

  2. E))  Effects of sports and physical activities

  3. F))  Developmental abnormalities

    "If systemic factors are in place, the joint may be thought of as vulnerable, and thus local joint motion factors will have more of an impact on joint degeneration."

"Injuries that alter mechanical or joint alignment may also predispose individuals to OA at other sites."

"Other risk factors for posttraumatic arthritis include high body mass, high level of activity, and residual joint instability or malalignment."

Obesity increases the risk of OA. Importantly, the increased risk includes joints that are not weight bearing, like hand OA. This suggests that "obesity may predispose to OA, perhaps via an inflammatory or metabolic intermediary." [I suggest prostaglandin E2 (PGE2) which can be beat with Fish Oil]. "This means that obesity plays a role not only as a local process but systemically as well."

Repetitive occupational stresses increase OA.

In the absence of systemic factors, moderate exercise, such as running, does not cause joint degeneration. However, there is increased OA in male runners who exceed more then 20 miles per week.

High-intensity direct joint impact or torsional loading can increase the risk of OA in the affected joint.

Loss of normal joint biomechanics result in increased joint vulnerability to OA.

Joint malalignment, or joint position sense deficits predispose the joint to the development of OA.

"Impaired joint nerves (proprioception) has been seen in patients with OA compared with age-matched controls, which may also indicate that proprioceptive loss preceded disease development."

"Joint immobilization has been shown to be detrimental, reducing cartilage thickness and proteoglycan content." (Thus Chiropractic adjustments are CRITICAL)

Intense exercise, especially in the elderly, can accelerate cartilage breakdown and OA.

Muscle weakness predisposes individuals to the development of OA because greater stress loads are borne by the joints, accelerating joint damage.

"Adequate muscle strength and bulk are protective to the joint."

"Cartilage has no blood supply (avascular), and therefore chondrocytes receive nutrients and eliminate waste by diffusion through the synovial fluid and by facilitated imbibition."

Osteoarthritis of a joint typically involves all of these tissues of the synovial joint, including:

  1. 1)  Articular cartilage

  2. 2)  Subchondral bone

  3. 3)  Synovial tissue

  4. 4)  Ligaments

  5. 5)  Joint capsules

  6. 6)  Muscles that cross the joint

    A decreased range of joint motion leads to muscle atrophy and loss of joint protection, increasing the risk of OA.

Although OA is considered to be a non-inflammatory arthritis, as cartilage destruction proceeds, mild to moderate inflammatory reactions are found in the synovial membranes.

As the OA catabolic process progresses, the synoviocytes begin to make and release the pro-inflammatory eicosanoid hormone prostaglandin E2 (PGE2). [Recall that PGE2 is derived from the omega-6 fatty acid arachidonic acid which accumulates from lots of vegetable and other oils in our food]

KEY POINTS I WANT YOU TO KNOW:

1) "Osteoarthritis (OA) is the most prevalent form of arthritis and a major cause of disability in people aged 65 and older." OA affects the majority of adults over age 55.

2) OA is "the clinical and pathologic outcome of a range of disorders that results in structural and functional failure of synovial joints. OA occurs when the dynamic equilibrium between the breakdown and repair of joint tissues is overwhelmed."

3)  Both systemic factors and local factors will increase the risk of osteoarthritis.

4)  Systemic Factors:

  1. A))  Ethnicity

  2. B))  Age: "The presence of radiographic OA rises with age at all joint sites."

  3. C))  Gender

       D))  Hormonal Status

  1. E))  Genetic Factors

    OA has a major genetic component

  2. F))  Bone Density

  3. G))  Nutritional Factors
    There is evidence that OA is linked to free radicals, and that high dietary antioxidants (especially vitamins C and D) are protective against the development of OA. "Chondrocyte (cartilage forming cells) in escence is thought to be the result of chronic oxidative stress (free radicals)."

5) Local Factors:
Local factors "result in abnormal biomechanical loading of affected joints."

  1. A))  Obesity

  2. B))  "Altered joint biomechanics"

    •• ligamentous laxity
    •• malalignment
    •• impaired proprioception

    With aging, there is a decline in proprioception, causing decreased neurologic responses, impairing proprioceptive joint-protective mechanisms. Consequently, reduced proprioception advances OA.

    •• muscle weakness

  3. C))  Prior joint injuries

  4. D))  Occupational Factors

  5. E))  Effects of sports and physical activities

  6. F))  Developmental abnormalities

5) "If systemic factors are in place, the joint may be thought of as vulnerable, and thus local biomechanical factors will have more of an impact on joint degeneration."

6) "Injuries that alter mechanical or joint alignment may also predispose individuals to OA at other sites."
[Altered alignment or mechanics predispose joints to osteoarthritis]

7) "Other risk factors for posttraumatic arthritis include high body mass, high level of activity, and residual joint instability or malalignment."
[Important: joint instability and malalignment increase risk of OA - Stop popping your knuckles]

8) Obesity increases the risk of OA in both weight-bearing and non weight- bearing joints. This suggests that "obesity may predispose to OA, perhaps via an inflammatory or metabolic intermediary." [I suggest prostaglandin E2 (PGE2)]. "This means that obesity plays a role not only as a local process but systemically as well."

9) Repetitive occupational stresses increase osteoarthritis.

10) High-intensity direct joint impact or torsional loading can increase the risk of OA in the affected joint.

11) Loss of normal joint biomechanics result in increased joint vulnerability to osteoarthritis. [Important]

12) Proprioceptive deficits predispose the joint to the development of osteoarthritis.
[This is important because the spinal misalignments is not only a mechanical alignment lesion, but also has associated aberrant proprioception (joint nerve communicating joint position sense)]

13) "Impaired proprioception has been seen in patients with osteoarthritis compared with age-matched controls, which may also indicate that proprioceptive loss preceded disease development."

14) Muscle weakness predisposes individuals to the development of OA because greater stress loads are borne by the joints, accelerating joint damage. "Adequate muscle strength and bulk are protective to the joint."

15) "Cartilage is avascular, and therefore chondrocytes receive nutrients and eliminate waste by diffusion through the synovial fluid and by facilitated imbibition." [Important: reduced motion impairs joint nutrition, accelerating OA]

16) Both immobilization and decreased range of joint motion leads to muscle atrophy and loss of joint protection, increasing the risk of osteoarthritis.

17) Although OA is considered to be a non-inflammatory arthritis, as cartilage destruction proceeds, mild to moderate inflammatory reactions are found in the synovial membranes.

18) As the OA catabolic process progresses, the synoviocytes begin to make and release the pro-inflammatory eicosanoid hormone prostaglandin E2 (PGE2). [Recall that PGE2 is derived from the omega-6 fatty acid arachidonic acid]

COMMENT:

For decades, chiropractors have maintained that the spinal subluxation accelerated spinal joint degeneration and osteoarthritis. Components of the subluxation include altered alignment, altered movement, muscle atrophy, reduced range of joint motion and aberrant proprioception. These components of the subluxation are the same factors that this article associates with an increased risk of osteoarthritis. This supports the teachings of Chiropractors since the 1970s, and the phases of subluxation degeneration. It supports the contention that uncorrected subluxations predispose those joints to osteoarthritis.

If you or someone you know is worried about OA or common arthritis, please know it is NOT an old person's disease but a lack of full motion disease.  Make an appointment today with our office to assess your families risks associated with OA and lets work on preventing it! Our friendly office staff can be reached at 243-9464.

Have a blessed day!

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