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Let’s talk about osteoarthritis



Dr. Sylvester Ikhisemojie

This condition is one that affects joints around the body, causing both inflammation and stiffness in the affected joints. At some point, there is associated pain and an inability to move that same joint freely as a result of such pain. Many people who suffer from joint pains are quick to call it rheumatism, a blanket term for any joint disease that is associated with pain. However, osteoarthritis is only a part of what is a spectrum of joint disease conditions with particular characteristics that have to do with the gradual wear of the cartilage lining of the joint spaces so that the bone’s ends rub against each other and cause pain. That situation makes it painful to move the joint, and motion from one point to another becomes difficult.

In extreme cases, the joint is so damaged that it could become deformed. Today, as far as modern medical care is concerned, there is no cure for this condition, but a combination of medications, physiotherapy and weight management strategies often help to control the symptoms. In both rural areas and cities, this condition is increasingly common, even though the causes are different among the people who live in either community. In rural areas, hard manual and farm labour are responsible for the immense wear and tear that causes the condition. In urban centres, obesity and a sedentary lifestyle are major causes.

This is a progressive disease condition, and the first symptoms will typically appear for the first time in people over the age of 50 years. When these changes are seen, they usually result in some attendant loss of the muscle bulk around such a joint; there is also swelling and pain in the area, and there is associated difficulty with moving the affected joint. The pain that results and stiffness which is often observed over time are two conditions that develop later primarily as a result of long periods of immobility. Occasionally, the joint is found to be warm and swollen. All these result from the fact that the smooth cartilage which allows for frictionless and easy movement of the joint surfaces becomes rough and uneven such that they shear away leaving exposed bone surfaces without their protective cushion. Over time, these forces cause bony lumps to form around the joint and cause prominences called bone spurs, or to use a medical term, osteophytes.

These osteophytes are responsible for the changes in the shape of the bone which are seen on x-rays. Beyond this point, the joints become less mobile and stiffer. Pain becomes another additional feature and fluid may gather within the joint resulting in swelling.

The joints that are most commonly affected by these changes are the knees, hips, ankles, hands, neck and lower back. Over the last several months, we have discussed on this page low back pain, and previously upper back pain, during which we examined some of the mechanisms responsible for bringing these changes about. In the knees, this condition is more often associated with one knee which is in most cases, due to injury or infection. When both knees are involved, it usually has more to do with the wear and tear circumstances discussed above. Sufferers may observe that they have pain when walking or running which will be more pronounced as they climb a hill or a flight of stairs. When they bend their knees, they may hear a clicking sound similar to broken glass. When an examining doctor elicits this sound, it is called crepitus. In the hips, osteoarthritis can cause associated pain in the buttocks, groin and the inside of the knee or thigh. Some of the people who have this disease affecting their hips may occasionally find that their hips are locked in an abnormal position. Such intermittent locking can also affect the knees and there have been instances in the past of motorists who drove to certain places only to become unable to step out of their vehicles as a result of locked knee joints. But this event is not nearly as bad as when arthritis destroys a joint so much that its shape changes and the person’s posture becomes altered.

In the lower back region, the first thing a person may notice is stiffness followed by pain. The pain is typically worse in the morning or after lying down for some time. When the back is moved, there may be crunching sounds heard. These experiences also occur in the neck where degeneration of the vertebrae, joints and spinal discs are also implicated in the development of this problem. As a result, doctors will refer to such pain in the lower back as being due to osteoarthritis or spondylosis. There is cervical spondylosis as we discussed several months ago due to such problems in the neck and lumbar spondylosis if they occur in the lower back. The exact causes of osteoarthritis are not known but there are certain factors in various individuals that would make it more likely to develop. Osteoarthritis is more common in women generally than it is in men and as we stated above in an earlier paragraph, the features are likely to appear after the age of 50 years. Injury to certain joints from trauma, infections or overuse, as in athletes, can also make people more predisposed to developing arthritis. In addition, certain characteristics common to families may make family members have a particularly heightened likelihood of developing osteoarthritis. Lastly, obesity and just being overweight are conditions that often make people more prone to developing these conditions.

Other features in an individual’s physical characteristics that may contribute to the development of osteoarthritis include such things as a person’s level of physical activity and the strength of their related muscles. The diet they predominantly take also plays a role such that people who take lots of carbohydrates and little protein will neither have the muscle strength nor bulk to protect their joints. The effects are on the opposite end of the scale when people take a diet rich in milk and dairy which both contribute to the strength and density of their bones and the elaboration of their sex hormones.

The peculiar problem of osteoarthritis can also affect the hands. The most commonly affected parts of the hands are the base of the thumb, the farthest joints in the fingers closest to the nails and the middle joints of the fingers. Any person who has these features will have recurrent pain, stiffness in the joints, and inability to properly open their hands or close the fingers completely. The joints will also swell and they may develop nodules on the joints described above – the middle finger joints and the farthest ones. As time progresses, the joints gradually bend and become deformed. Occasionally, this development leads to the deformity of the fingers described as gnarled hands.

Questions and answers

Dear doctor, we woke up to see the swelling on the upper lid of my son’s right eye. He is a year old and the swelling does not seem to be painful or itchy. What can I do? 081xxxxxxxx

Thank you for your question. Your son looks well and that swelling appears to be due to some kind of bite. It has no features of inflammation and is, therefore, not likely to be due to an infection. The best thing for you to do in this circumstance is to administer one teaspoonful of paracetamol or ibuprofen three times a day for two or three days to see if the swelling will contract. If it does not go down, you should take him to see a doctor.

Dear doctor, I have never missed Sunday LENTORLITENEWS for seven years now because of your write-ups. I pray that God favours you with long life to continue your services to the masses. A lot has been written on cancer. Concerning prostate cancer, a doctor said he was cured of the last stage of prostate cancer; if cancer has no cure, was his cure due to luck or expertise? For early diagnosis, which one is safer between MRI and CT scan, in terms of effectiveness and less side effects? I am 74 years old; my PSA were 7.5 and 8.0 nanogram per millilitre as of December 8, 2021 and May 23, 2022 respectively. My doctor prescribed Finasteride 5mg and Tamsulosin XL 0.4mg once daily. I experience chest and waist pains off and on. Please, what is your view? 0802xxxxxxx

Thank you very much for keeping the Sunday appointment with us over the seven-year period and for your prayers in particular. As for your results, it is difficult to see why you have been placed on the above medications especially since the PSA values that you recorded are not at variance with your age. Perhaps, you complained about certain problems with urination and your doctor felt obliged to place you on Tamsulosin but according to your results, there is no need to use such drugs. MRI is much safer to deploy than CT scan because it does not use radiation like the CT scan does. It also delineates the tissues into much bolder relief than the CT scan so that its images are superior to those of the latter. Radiation from CT scan is massive actually and is often said to be similar to taking 28 different X-rays (you can imagine the level of exposure to radiation).However, the MRI is a more expensive investigation to perform than the CT scan and is therefore less commonly available. With regard to the good doctor’s submission that he was cured of the last stage of prostate cancer, it will be safer to say he has cheated most of the effects of that stage of cancer for now. Cancer is curable when diagnosed early and followed with appropriate treatment in a timely manner. This has been evident from direct observation and research. Cure in late-stage disease belongs in faith lore.

Dear doctor, I have a 62-year-old uncle in the house, who was diagnosed with cancer about three years ago and has been on treatment since then. He has been operated on twice and had chemotherapy. Now he gets blood transfusion every two to three weeks, and he is always in pain. He doesn’t eat well too. What do we do about the pain? Please help us. 0813xxxxxxx

The best person to give you advice on what pain relief medications he can safely use will be the doctors treating your uncle. It is possible that he doesn’t complain much when he visits the hospital, otherwise he almost certainly would have been given what medicine is considered appropriate. Perhaps, you could accompany him during his next appointment and lodge this complaint on his behalf.

Dear doctor, I work at Apapa in Lagos and live at Mowe in Ogun State. Every day, I spend an average of four hours in traffic going to Apapa and four hours on the return journey. I didn’t want to look for another accommodation around Apapa like some of my colleagues have done because I live in my house at Mowe. Recently, I developed a mild form of hypertension and I am on medication now. What is your advice? 0810xxxxxxx

It is something to sympathise with you about. That road is causing huge health problems for hundreds of thousands of people who live in that corridor. Your attachment to your own home is understandable but you do need to counterbalance the level of stress you are undergoing with your inner peace. If you work for the government, an agency or a private firm, you will be under a lot of pressure to resume early as opposed to if you are self-employed and can get to work when convenient. In the end, the choices you are faced with can only be sorted out by you, and your doctors will determine if their medications are working or not.

Dear doctor, please can I whiten my teeth? I am curious. O.A.

Whether to whiten the teeth or not is usually a cosmetic decision, not a medical one. It also depends on what the colour was prior to this inquiry and whether this is part of a broader attempt to change your appearance. On the whole, if your teeth were always off-white, it is better to keep them so but if they were formerly white and somehow lost their sheen at some point, you would be justified in trying to get them back to their normal colour.

Dear doctor, what is the cure for diabetes? My late mother was on insulin for 10 years before she passed on while on intermittent dialysis. Does it mean insulin is not the cure? Thank you. 0701xxxxxxx

Diabetes has no cure at this time, but with the current volume of research work going on, a cure could be available within the next few years. Insulin is one modality for controlling the symptoms of the disease. However, it has its problems and can be deadly without strict supervision. Lastly, it is not usual for an adult to be on insulin for such a long time unless she had stopped responding well to oral medications and had no other recourse. In that case, it is likely that she sustained some kidney damage which would have directly led to her death rather than from diabetes itself or as you seemed to imply, from dialysis.

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