What is Arthritis and How is it Treated?

osteoarthritis in the knee

What is Arthritis and How is it Treated?

The word “arthritis” literally means “joint inflammation” and originates from the Greek prefix arthro- (joint) and the Greek suffix -itis (inflammation). Rather than thinking of arthritis as a single entity, realizing this condition is a process is helpful. In generic terms, a joint is the contact point where two bones come together to allow motion. Each joint in the body has a unique design to serve its designated function. 

There are several anatomic components common to all joints. 

  1. Cartilage
  2. Ligaments (connect bone to bone)
  3. Tendons (connect muscles to bone)
  4. Joint Capsule (seals the joint)
  5. Joint Fluid (lubricates cartilage)

The cartilage that covers the end of each bone is referred to as articular cartilage. The shiny white tissue on the end of a chicken drumstick bone represents a helpful visual reference to what cartilage looks like. Articular cartilage has a firm, rubbery texture. Ligaments (which connect bone to bone) span across the joint to keep the bones properly aligned. Tendons (which connect bone to muscle) also span the joint. Contracting muscles allow the joint to move by pulling on the tendon. A flexible joint capsule (seal) maintains liquid (synovial fluid) within the joint to keep the cartilage surfaces slippery as they glide smoothly upon one another. Think about how extra slippery ice becomes when there’s water on it.

Types of Arthritis

Arthritis can occur when a person’s immune system “attacks” (autoimmune) their own joints. The two most common examples of autoimmune arthritis diseases include rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Treatment strategies for these types of arthritis target the immune system. The emphasis of this article, however, is to explain the most common type of arthritis, osteoarthritis (OA). A not-so-glamorous way to think about osteoarthritis is as “human rust.” 

It represents the process of a mechanical breakdown of the joint, which can happen gradually over time with degeneration or progress more rapidly following a major joint injury. Treatment strategies for osteoarthritis focus on interrupting the degeneration of the individual parts of the joint.

 The Process of Osteoarthritis

The process of osteoarthritis begins when there is a breakdown of the articular cartilage, which damages the smooth gliding function. The joint creates extra synovial fluid to aid in lubrication. This process contributes to the joint swelling that accompanies osteoarthritis. Additionally, the injury to cartilage cells provokes an inflammatory reaction, contributing to the swelling. Because our cartilage tissue lacks an adequate blood supply, articular cartilage can never be restored to its original smooth surface. As cartilage continues to break down, it becomes thinner. With a thinner layer of cartilage between them, the joint’s bones move closer together. Supporting joint ligament attachments are now also slightly closer together, which results in slack (laxity) of the supporting joint ligaments—adding instability to a joint from ligament laxity results in more advanced cartilage breakdown. The cartilage breakdown accelerates the process of osteoarthritis. To offset joint instability, the body deposits calcium into ligament tissue to increase stability. Calcium deposits (bone spurs) called osteophytes also form around the joint and can eventually bridge the joint from one side to the other. These osteophytes alter the normal joint range of motion and are responsible for the stiffness and loss of motion common to osteoarthritis. If the joint breaks down asymmetrically, then the alignment of the joint can change, which in turn contributes to a further acceleration of joint degeneration. 

Traditional Osteoarthritis Treatments

For most joints, there is the option to surgically replace them when the degeneration has reached an advanced stage. Many people have a growing interest in intervening in some way before a joint reaches the stage where surgical replacement becomes the best option. As with every other medical condition, early intervention for osteoarthritis will result in the best outcome. Understanding the sequence of events representing osteoarthritis’s process clarifies why specific non-surgical interventions are helpful. Activity modification helps minimize mechanical factors that may exceed what a given joint can tolerate. Weight loss can help decrease the burden on weight-bearing joints – especially hips and knees. Physical therapy and independent exercise programs help to maintain a good range of motion and muscular strength to support the ideal joint motion. Non-steroidal anti-inflammatory drugs (NSAIDs) are available to swallow, apply topically, or inject to address the inflammatory component of osteoarthritis. These medications help with the symptoms of pain, swelling, and stiffness, but they don’t change the degenerative process. NSAIDs can also cause organ damage with prolonged use. 

Steroid medications can be injected into arthritic joints and provide the same anti-inflammatory benefits of relieving pain, swelling, and stiffness. Steroids are more potent than NSAIDs, so the symptom relief is more prominent and lasts longer. Steroids, however, can cause or worsen many other health conditions and may eventually lead to the acceleration of articular cartilage degeneration with repeated injections. These factors limit the use of steroids for osteoarthritis.

Regenerative Treatments for Osteoarthritis 

Regenerative Medicine is driven by an ever-increasing number of people who want to avoid joint replacement surgery for their osteoarthritis. Two specific treatments that are becoming progressively more popular are Bone Marrow Regenerative Cell Therapy and Platelet Rich Plasma (PRP) Therapy. 

Bone Marrow Regenerative Cell Therapy

Your bone marrow is a rich source of regenerative cells that have the potential to accelerate healing. Your bone marrow occupies the hollow center cavities of your bones and is a “factory” for replacing cells that circulate in your bloodstream. Bone marrow regenerative cells recruit cell signaling recovery molecules (cytokines) and other healing cells to migrate into the injured area to assist with recovery. Bone marrow regenerative cells can be beneficial in restarting and accelerating the healing process of articular cartilage within a degenerative joint. Although the articular cartilage can never be restored to its original status, improvement in the “smoothness” of the articular cartilage can help slow the progression of osteoarthritis and help lessen pain. Regenerative cells can also stimulate improved integrity of the joint’s stabilizing ligaments. Addressing this laxity can also help slow the progression of osteoarthritis. Using your own bone marrow regenerative cells ensures that no one else’s genetic material is injected into you (compared to purchasing “frozen regenerative cells in a vial”) and avoids the possibility of germ or other contamination introduced during processing. Using your cells also guarantees that they have never been exposed to preservatives or subjected to a freeze/thaw cycle, potentially impacting their viability.

PRP (Platelet Rich Plasma) Therapy

Your “whole blood” is primarily liquid (plasma) containing solid particles like red cells, white cells, and smaller platelets. During a PRP procedure, a syringe of your whole blood is obtained from your vein and then placed in a centrifuge to separate the plasma layer containing a high concentration of platelets. The desirable growth factors and other cytokines (cell signaling molecules) useful in healing are associated with platelets. After this platelet-rich layer of your plasma has been isolated, it can be injected back into your body to target an area of tissue damage in muscles, tendons, ligaments, or joints.

The Regenerative Spine & Joint Center specializes in non-surgical treatment for osteoarthritis. Learn more at RegenerativeSpineAndJoint.com or call us today at (614) 999-9899 to find out if Bone Marrow Regenerative Cell Therapy or PRP therapy is the right option for your joints.

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I’m Boris Terebuh MD, Ohio’s first and most experienced Discseel® provider. I am also the Founder & Medical Director of the Regenerative Spine & Joint Center