Introduction:
Osteoarthritis (OA) is a persistent degenerative condition that impacts the joint tissues within the body. Affecting many individuals worldwide, osteoarthritis (OA) is one of the prevailing global diseases. There are various joints in the body with surrounding soft tissue structures like cartilage (flexible connective tissue protecting the joint), synovial membrane (a specialized connective tissue that lines the joint cavity), ligaments (a firmly attached band of tissue that connects two bones), fat pad, and meniscus (a pad of cartilage that acts as a shock absorber).
This condition can affect these soft-tissue structures. Progressive osteoarthritis can result in structural deterioration, severe joint pain, loss of flexibility, joint stiffness, and reduced quality of life. Hence, early diagnosis of this condition with early intervention is essential. This article will discuss the mechanism of osteoarthritis (EO), early diagnosis, and early management options in detail.
What Is the Pathophysiological Mechanism of Pre-osteoarthritis?
Osteoarthritis is believed to be an inflammatory disease affecting the soft tissue structures surrounding a joint, including the underlying subchondral bone. A subchondral bone is a bone tissue that lies underneath the cartilage structure.
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In general, cartilage is composed of a gel-like matrix that contains various proteins like collagen, non-collagenous proteins, and proteoglycans.
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Cartilage has no separate blood supply, and its close association with the vascular subchondral bone keeps them vascularized. Any changes or alterations in the compositions of the cartilage matrix resulting in articular cartilage degeneration are associated with pre-osteoarthritis.
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Articular cartilage degeneration results in the active acceleration of destruction of the subchondral bone. Osteoarthritis is a multifactorial disease caused by a cascade of events leading to disease onset.
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Factors like aging, obesity, injury-causing ligament or meniscus injury, general wear and tear, or genetics may increase the risk of developing osteoarthritis.
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Pre-osteoarthritis is when cellular changes have started in the cartilage; however, the patient is still free of symptoms.
How Is Pre-osteoarthritis Diagnosed?
The early diagnosis of the osteoarthritic joint is essential in planning the proper treatment strategies for pre-osteoarthritis. Various modes of assessment carry out the diagnosis of osteoarthritis.
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History Taking: The doctor will perform a detailed history taking, especially regarding the history of trauma or indulgence in excessive physical activities like soccer games.
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Physical Examination: A thorough physical examination is performed.
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Radiographic Examination: The doctor will perform radiographic investigations like an X-ray, but not like a regular X-ray in a supine position. The X-ray will be performed with the patient in a standing weight-bearing position.
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Biomarkers: Biomarkers are molecules present in the blood and an indicator of the pathologic process of the body. Hence they are used in diagnosing pre-osteoarthritic conditions indicating the presence of biological markers that indicate the progression of osteoarthritis.
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Computed Tomography: Contrast-enhanced computed tomography scans were used to evaluate ion distribution in cartilage tissues.
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Magnetic Resonance Imaging (MRI): MRI is used extensively in diagnosing pre-osteoarthritis to evaluate the changes in soft tissue structures and subchondral bone.
What Are the Current Strategies in the Early Interventions of Pre-osteoarthritis?
The currently developed interventions in the treatment of pre-osteoarthritis are mentioned below.
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Synergic therapy combines both lubrication and drug therapy.
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Maintaining the balance between bone formation and resorption.
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Exercise therapy.
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Articular cartilage repair.
These treatment options are focused on reducing joint pain and restoring the functions of the joint.
1. Synergetic Therapy Combining Both Lubrication and Drug Therapy:
This novel, innovative treatment strategy involves cooperative therapy by enhancing the joint's lubrication and the sustained release of local drugs. This therapy was researched to eliminate the limitations of normal clinical interventions like oral administration of inflammatory drugs and intra-articular corticosteroid injections. Synergetic treatment was believed to produce long-term effects without causing systemic toxicity and shear thinning nature of intraarticular injections. This therapy involves the infusion of lubricating drug-loaded nanoparticles. These are formed by altering the nano-drug carriers with potent lubricating materials like phosphocholine lipids or polymer brushes.
2. Maintaining the Balance Between Bone Formation and Resorption:
Subchondral bone defects are believed to cause the progression of OA. This treatment strategy is focused on treating subchondral bone diseases by regulating the balance between osteoblastic (bone-forming cell) and osteoclastic (bone-resorbing cell) activity. Various treatment options are available for subchondral bone by inhibiting the actions of osteoclast activity and stimulating osteoblastic activity. This therapy uses a coupling mechanism of both bone resorption and formation. Studies have shown that transforming growth factor β family (a molecule essential for cell proliferation and differentiation) and insulin growth factors in the bone matrix have coupling mechanisms of bone resorption and formation.
Hence alterations in the activities of these two growth factors have been shown to decrease the progress of OA.
3. Exercise Therapy:
This therapy involves a well-planned regimen of physical exercises to prevent pre-osteoarthritis progression. This exercise program primarily involves neuromuscular treatment, strength training, and aerobic conditioning. Neuromuscular exercise therapy is indicated especially for patients with sensorimotor deficiencies (defects in motor functioning and sequencing of movements) and functional instability associated with joint injuries. Weakness along the surrounding muscles are one of the common risk factor leading to osteoarthritis of the joint. Hence, strength training exercises are essential in improving muscle strength and muscle mass. Recent studies have shown evidence that people with osteoarthritis benefit from performing strength training exercises. It has also been shown to reduce pain and improve functional abilities in these patients. Aerobic exercise therapy is one of the effective interventions for pre-osteoarthritis.
4. Articular Cartilage Repair:
Defects of the articular cartilage have been shown to increase the progression of osteoarthritis. This treatment option involves the repair of articular cartilage in pre-osteoarthritic conditions, potentially delaying the progression of OA. This procedure usually uses an arthroscope (a small thin instrument inserted into the body for diagnostic and therapeutic purposes).
Conclusion
Osteoarthritis is a condition causing degenerative changes in the soft-tissue structures of the joints resulting in pain and functional disability. The cellular changes preceding the OA begins in the pre-osteoarthritic state. The patients are generally free of symptoms during this stage. However, early diagnosis of this stage and early interventions can prevent the progression of osteoarthritis. The above-mentioned treatment options are novel interventions to delay the progression of OA.
