Osteoarthritis (OA) is a joint disease that is characterised by damage to the joints which affects synovial fluid, cartilage, bones, muscles, blood supply and nerves. It happens when the protective cartilage that covers the tips of our bones is gradually worn down and this causes multiple bones to rub against each other. This ultimately leads to pain and eventual loss of function.
Osteoarthritis also affects other connective tissues and muscles related to the affected joint. For example, knee osteoarthritis may affect the connective tissues and muscles in the thighs, calf, buttock and even other joints like the hip and ankle. Having said that, OA does not only affect the knee joint, it also affects the joints in the hands, hips, and spine.
Proper use of the joints will keep it lubricated and this stimulates the repair and rebuilding process. On the other hand, lack of joint use causes the cartilage to become dryer, more brittle and more prone to damage over time. This tends to happen in the parts of the joint surface that is related to ranges of motion that are not being used sufficiently. As time passes, the damage and pain become so severe that it leads to deformities that cannot be corrected and this would leave surgery as the only option.
The 5 Stages of Knee OA
OA of the knee progresses in stages and takes many years to develop. This condition can be hard to treat because symptoms may not appear until OA reaches an advanced stage. OA is divided into five stages (5) with stage 0 representing a healthy & stable knee. As the stages progress, pain and stiffness increase. Here we will focus on the 4 Stages of OA, from Minor to Severe.
Unlikely pain or discomfort due to minor wear and tear only
Stage 2 - Mild
Greater bone spurs
Synovial fluid starts to decrease
Cartilage still intact
Start to feel pain after prolonged walking, and more stiffness when the joint is not being used with mild tenderness when kneeling
Stage 3 - Moderate
Cartilage damage and joint space starts to narrow
Joint stiffness after prolonged inactivity
Joint swelling
Frequent pain while walking
Stage 4 - Severe
Cartilage almost completely gone and joint space is extremely narrow
Severe pain and discomfort during rest and simple activities like walking
Primary Osteoarthritis vs Secondary Osteoarthritis
Osteoarthritis can be classified into 2 categories:
Primary (or idiopathic): Most common type of OA, the exact cause being unknown (in the large majority of cases) but it is not a result from any injury or disease, rather it is said to be associated to certain risk factors, such as, age, sex, obesity, genetic, job hassle and etc.
Secondary: Occurs with another disease or condition, such as an infection, a joint abnormality that appeared at birth, an injury, or metabolic disorders that cause excessive iron in the body or excess copper in the liver.
Who Tends to get OA?
Symptomatic knee OA is currently the fourth leading cause of disability worldwide, [4] with an estimated prevalence of 70–80% in the population aged 55 years and older [5]. An ageing Asia with longer lifespan suggests ever-greater numbers of knee OA, among other chronic conditions [6]. The point prevalence of knee OA in Malaysia today is estimated to be 10–20% of the total adult population [7].
Older people. Cartilage deteriorates naturally with age. It is affecting more than half of the population that is over the age of 65. Although it is more prominent in the later stages of life, some younger people may be affected by it too. According to The Star (6th August 2019), one in three Malaysians over the age of 55 suffers osteoarthritic pain.
Crude prevalence of knee pain and knee osteoarthritis by age Source: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0225075
Gender. Women are more likely to develop osteoarthritis, though it is not clear why. It is believed that the hormone oestrogen protects the cartilage from inflammation and women tend to lose that protection after menopause when oestrogen level drops. Besides that, wider hips in women compared to men may cause extra stress on the insides of the knee, making women have a higher risk of getting OA when compared to men.
Crude prevalence of knee pain and knee osteoarthritis by ethnicity according to age group Source: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0225075
Obesity. Based on 2019 WHO global estimates of obesity and overweight data, Malaysia has the highest rate in Asian countries; therefore, weight related joint disease such as OA is indeed one of the main knee problems in Malaysia. Also, fat tissue produces proteins that can cause harmful inflammation in and around the joints which increase the chances of getting OA.
Joint injuries. Weak joints are more susceptible to OA. OA may develop as a secondary consequence of joint damage from rheumatoid arthritis, gout or other arthritic conditions.
Repeated stress on the joint. Physically demanding jobs or a sport that places repetitive stress on a joint can increase the chance of developing OA.
Genetics. The only clear genetic link is called nodal osteoarthritis, which affects the small hand joints in older women and runs in families.
Bone deformities. Some people are born with malformed joints or defective cartilage such as knock knee and bow knee which may lead to OA in the later stages of life.
Certain metabolic diseases. Diseases like diabetes may slow down the healing process within the joint.
Surgery or Trauma. Repair of the cartilage, ligaments and menisci (the small spacers in the knee) can restore normal function to a joint, but around 50-60% of patients develop osteoarthritis to some degree from five to fifteen years later.
Chronic lower back pain. People tends to adjust themselves to a more comfortable position to avoid the pain and this causes muscle imbalance in our lower extremities which may develop into OA as time passes.
Which Joints Get Osteoarthritis?
While osteoarthritis can occur in any joint due to injury or abnormality it is much more common in certain joints, particularly weight bearing ones. It is often symmetrical, occurring to some degree in joints on both sides.
Knees. Common in older people, especially women. If severe may lead to total knee replacement.
Hips. Again common in older people and may require total hip replacement.
Spinal. The small joints in the back and neck (not the major disc joints) can become arthritic and give stiffness, pain and limited movement.
Hands. The small hand joints may develop bony swelling, become stiff and go off at angles to straight. The most common and troublesome is the joint at the base of the thumb.
Big Toe. This joint is susceptible to changes in the same way as the base of the thumb.
We shall look into the signs and symptoms of OA and how Oxidative Stress can lead to OA in our next Blog.
“The epidemiology of osteoarthritis in Asia,” International Journal of Rheumatic Diseases, vol. 14, no. 2, pp. 113–121, 2011.
“Pain in osteoarthritis,” African Journal Biomedical Research, vol. 11, no. 2, pp. 119–128, 2008
“Tibiofemoral osteoarthritis affects quality of life and function in elderly Koreans, with women more adversely affected than men,” BMC Musculoskeletal Disorders, vol. 11, article 129, 2010.
Clinical Practice Guidelines on the Management of Osteoarthritis, Ministry of Health Malaysia, 2010
OA is diagnosed by a triad of typical symptoms, physical findings, and radiographic changes. The American College of Rheumatology has set forth classification criteria to aid in the identification of patients with symptomatic OA that include, but do not rely solely on, radiographic findings. Diagnosis of Osteoarthritis is done by noting the signs and symptoms:
Pain on movement
Chronic pain that gets worse over time
Joint stiffness
Tenderness around the joint
A clicking or grinding sensation
Crunching and creaking on movement
Hard swelling around the joint
Fluid swelling in the joint
Limited range of movement
Abnormal movement and joint laxity
Loss of muscle size and strength
Impact of OA on Quality of Life
There are several ways in which OA can impact the quality of life such as increasing stress and sleep disruption due to pain that has intensified. Osteoarthritis also reduces the ability to perform normal activities in our daily life and reduces productivity. It can also lead to problems with anxiety and depression.
Pain and stiffness can decrease your desire to be active. Not only does a lack of activity limit your enjoyment of life — it can also reduce muscle mass which leads to muscle tightness and a risk of falling and suffering from other injuries. Muscles are more prone to injury when it is tight or weak, and micro-tears lead to scarring of the muscles that can disrupt normal muscle function, therefore affecting the surrounding connective tissues.
Lack of activity can also lead to weight gain. Extra weight may exacerbate OA symptoms, and this may lead to an increased risk of getting other complications such as:
Diabetes
Hypertension
Heart disease
Other complications that can arise from OA are:
Bone spurs
Gait disturbance
Loss of flexibility and stability
Stress fractures
Bleeding or infection in the joint
Bone death (osteonecrosis)
Prevention of Osteoarthritis
A number of factors may put a person at risk of developing OA. Making changes may not prevent the condition, but a person may be able to reduce their risk or keep OA from advancing.
The Arthritis Foundation suggest the following:
Maintain a healthy weight: Excess weight puts extra pressure on the knees. Over time, this contributes to wearing down the cartilage. Extra fat can also cause the body to produce cytokines, a type of protein. This can lead to widespread inflammation, and it can change the way that cartilage cells work.
Controlling blood sugar: High glucose levels can affect the structure and function of cartilage, and diabetes increases the risk of inflammation and cartilage loss.
Exercising regularly: Moderate exercise can help the joints stay flexible, strengthen the muscles that support the knees, and reduce the risk of many health conditions. It may help to garden, walk, or swim for 30 minutes at a time, five times a week.
Reduce the risk of injury: Cartilage that sustains damage from an injury is more likely to develop arthritis later. Reduce the risk of tripping in the home, wear shoes that fit well, and use protective gear while playing sports to prevent injury.
Avoiding overuse: Some sports or professions involve repetitive motions of the knee joint, such as kneeling or squatting. People who regularly lift more than 55 pounds may have an increased risk of OA. Jobs that put people at risk may include laying carpets and unloading trucks or ships. Repetitive exercise can increase the risk of developing OA of the knee.
Physical therapy:Strengthening of the muscles around the knee joint may help decrease the burden on the knee. Preventing atrophy of the muscles is an important part of maintaining functional use of the knee.
Undergoing posture and bone alignment tests: Some sources suggest that these can affect a person’s risk of developing OA.
Eating a healthful diet, getting enough sleep, managing stress, and staying active all contribute to better overall well-being and a decreased risk of health issues, including OA.
How Oxidative Stress can lead to Osteoarthritis?
Oxidative stress happens when there is an imbalance between the number of free radicals and antioxidants in our body. This is particularly harmful as it can lead to cell and tissue damage. Oxidative stress is considered a main causative factor in the pathogenesis of OA. Many pro-inflammatory mediators or free radicals are elevated in OA, including Reactive Oxygen Species (ROS), and Reactive Nitrogen Species (RNS).
The excessive production of free radicals can harm cell functionality as it damages cellular lipids, proteins and DNA. Free radicals can give rise to cartilage apoptosis/ cell death, thus accelerating articular cartilage dysfunction and degeneration.
Oxidative stress is known to be detrimental to many cells and to occur during disease and with ageing. It has also been implicated in the development of OA. Although osteoarthritis has been traditionally classified as a non-inflammatory arthritis, however evidence has increasingly shown that inflammation occurs as cytokines and metalloproteinases are released into the joint. Inflammation get worse when more of these agents are released, especially when triggered by excessive free radicals. Inflammation in the cartilage and synovial leads to loss of joint structure and progressive damage to the cartilage, causing OA to become worse. Inflamed articular cartilage still remains a huge hurdle to treat due to the limited self-healing capacity of the cartilage which lacks nerves and blood supply.
How Hydrogen Therapy Can Help?
Hydrogen therapy is one of the newest and most effective treatments to manage arthritis due to its role as a therapeutic antioxidant. It is able to selectively neutralize free radicals in the affected area which reduces inflammation and prevents further damage to the joint, thereby slowing down the progression of OA. As hydrogen is the smallest molecule on earth, it is able to diffuse itself into the targeted cells without affecting the functions of other cells and organs.
Based on a research by Ding Li and Wan Chun Wang in the year of 2012, hydrogen is considered to be a selective antioxidant and can be used as a kind of therapeutic medical gas. This further reinforces the idea that hydrogen treatment can help to decrease the damage of cartilage caused by oxidative stress.
In Hi-Bliss Hydrogen therapy centre, we combine the therapeutic benefits of hydrogen therapy with osteopathic manual practices. Our certified physiotherapist will perform the Osteopathic Structural and Functional Examination on the lower limb area to find out the root cause of the pain by measuring the Range of Motion (ROM), Muscle Strength, Gait Analysis, Posture Alignment, Quality of Movement, Pain during Movement, Muscle Bulk and Tone. The hydrogen treatment aims to suppress inflammatory factors such as free radicals and slow down the progression of osteoarthritis.
By combining the Hydrogen with Osteopathic practices, we help our clients reduce pain in the joint, slow down the progression of OA and ultimately help them return to normal daily life. Hydrogen therapy is efficient in treating the inflamed joints caused by OA by repairing the internal cells in our body while our physiotherapy/osteopathic techniques helps to improve the external muscles caused by muscle imbalance. We will also educate clients about suitable stretching and strengthening exercise that aims to manage symptoms and improve joint function, flexibility and balance.
By reducing the number of OA symptoms, it will improve your ability to get around and increase your quality of life.
EN 
ZH 
BM 
