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Monday, 25 November 2013

Osteoarthritis - The Causes of Risk Factors

Osteoarthritis (OA), a form of arthritis, is defined as a condition of
as a result of aging causes of wear and tear on a joint, affecting over 25 million people in the United States in alone.
Causes of Risk Factors
A. Causes
1. Process of wear and repair
Osteoarthritis (OA) is a widespread degenerative disease of skeletal joints and is often associated with senescence in vertebrates. OA commonly results from excessive or abnormal mechanical loading of weight-bearing joints (‘wear-and-tear’), arising from heavy long-term use or specific injuries; yet, in the absence of injury, the aetiology of OA remains obscure(6)
Improper repair process of injure of joints can result of symptoms of Osteoarthritis (OA) in old age, according to TCM.
2. Nutrient deficiency
Poor nutritional conditions experienced by moose (Alces alces) early in life are linked to greater prevalence of OA during senescence as well as reduced life expectancy(7).
3. Cartilage
Cartilage is a flexible connective tissue which cushions the ends of bones in your joints and allows the joints to move smoothly. If the cartilage becomes rough  or wears down due to aging or damage, it can causes pain as a result of  bone in the joint rubbing against another bone.
The above causes of Osteoarthritis (OA) are the result of injure, overuse, Rheumatoid Arthritis, etc.
4. Etc.
B. Risk factors
Aging changes in the musculoskeletal system contribute to the development of OA by making the joint more susceptible to the effects of other OA risk factors that include  abnormal biomechanics, joint injury, genetics, and obesity. Age-related sarcopenia and  increased bone turnover may also contribute to the development of OA(8). Other suggested that Osteoarthritis development in the injured joints is caused by intra-articular pathogenic processes initiated at the time of injury, combined with long-term changes in dynamic joint loading. Variation in outcome is reinforced by additional variables associated with the individual such as age, sex, genetics, obesity, muscle strength, activity, and reinjury(8a).
1. Age and age related sarcopenis
Older adult are at increased risk of developing osteoarthritis as a result of muscular atrophy that occurs due aging. Normal aging in humans is associated with declines in skeletal muscle mass and strength and increased muscle fatigability (sarcopenia). These changes, together with the age-associated decline in whole-body exercise tolerance (VO2max), can substantially reduce the amount and intensity of physical activities performed by elderly (>60 y) men and women (Evans 1995)(9). 
2. Gender and race
Women and Male Asian are at higher risk to develop osteoarthritis than men and male Caucasians, accordingly. The total prevalence of knee ROA was 24.3 % (CI 23.4-25.2 %). The whole prevalence in male patients was 24.3 % (CI 23.4-25.2 %); I2 = 59.4 (p = 0.002) and in female patients 32.6 % (CI 31.8-33.4 %); I2 = 49,1 (p < 0.001). Younger male patients (age 50-) had a prevalence of 5.6 (CI 4.5-6.8). In older patients (80+) the male prevalence was 44.5 % (CI 39.6-49.5 %). In this age group female patients had a prevalence of 71.6 % (CI 67.6-75.3 %). The higher prevalence of knee ROA in female patients was significant (OR = 1.8 [1.7-1.9]; I2 = 46.0 [p < 0.001]). The prevalence of knee ROA was higher in male Asians compared with male Asians compared with male Caucasians(OR = 1.1, CI 0.9-1.2; p = 0.080) in tendency. This difference was significant in female patients (OR = 2.2; CI 2.0-2.4; p < 0.001). Furthermore another trend was evaluated. Female patients (70-79 years) from the birth-year cohort 1920- had a prevalence of 37.8 % (CI 35.9-39.7)%. In contrast female patients from the birth-year cohort 1920 had a prevalence of 62.8 % (CI 60.8-64.8 %) at 70-79 years. This difference was significant (OR = 2.8; CI 2.5-3.1; p < 0.001), according to research of Praxisklinik für Unfallchirurgie und Orthopädie(10) 
3. Deformation of bone
 People who were born with defective joints or cartilage are at increased risk of developing osteoarthritis.
4. Activity
People who involve in activity such as sport are at higher risk to develop osteoarthritis.
5. Obesity
Researchers at the McMaster University in the study of Obesity and knee osteoarthritis showed that the potential mechanisms to link obesity and knee osteoarthritis, as both a biomechanical and metabolic condition are strongly linked. It has been established that weight loss for obese patients with knee osteoarthritis is clinically beneficial, for pain reduction, and for improved function. The exact mechanism linking obesity and osteoarthritis is complex; however, it is our opinion that further evidence supporting the link between the two diseases will be useful in providing clinicians and researchers with targets for physical therapy and pharmacological management of obese patients with knee osteoarthritis(11).
6. Occupations 
Certain occupation are associated to the increased risk of osteoarthritis, especially to workers involving repetitive movements that stress on a particular joint. OA is potentially aetiologically linked to occupation in a sizeable segment of the population and that OA can no longer be considered an inevitable disease of ageing(12).
7. Genetics
Genetic studies have identified polymorphisms associated with osteoarthritis and related end-points. These include genes in signaling cascades involved in joint and bone biology, as well as genes in inflammatory pathways and a cluster of five genes in perfect linkage disequilibrium in the 7q22 region(13).
8. Deficiency in DNA repair
In the study of Analysis of osteoarthritis in a mouse model of the progeroid human DNA repair syndrome trichothiodystrophy, suggested that in premature aging TTD mice age-related changes in cartilage were not more severe compared to WT mice, in striking contrast with bone and many other tissues. This segmental aging character may be explained by a difference in vasculature and thereby oxygen load in cartilage and bone(14).
9. Other diseases and conditions may have a higher risk of developing the condition.
a. Gout
Gout is defined as a type of arthritis as a result of uric acid builds up in blood that leads to joint inflammation.  Acute attacks of gout at individual joint sites are associated with the presence of clinically assessed OA. In a study of A total of 4249 completed questionnaires were returned (32%). From 359 attendees, 164 cases of gout were clinically confirmed. A highly significant association existed between the site of acute attacks of gout and the presence of OA (aOR 7.94; 95% CI 6.27, 10.05). Analysis at individual joint sites revealed a significant association at the first metatarsophalangeal joint (aOR 2.06; 95% CI 1.28, 3.30), mid-foot (aOR 2.85; 95% CI 1.34, 6.03), knee (aOR 3.07; 95% CI 1.05, 8.96) and distal interphalangeal joints (aOR 12.67; 95% CI 1.46, 109.91)(15)
b. Rheumatoid arthritis
Rheumatoid arthritis (RA) is defined as a chronic, systemic inflammatory disease that leads to the attack of flexible (synovial) joints, inflammation of the surrounding tissues and many tissues and organs. Rheumatoid arthritis (RA) cam cause progression of osteoarthritis in aging population.
c. Paget’s disease of the bone
Paget’s disease of bone is defined as a condition a chronic disorder that can lead to enlarged and misshapen bones resulting in excessive breakdown and formation of bone tissue causing pain, misshapen bones, fractures, and arthritis in the joints near the affected bones(16). Paget’s disease of bone (PDB) is a condition of unknown etiology characterized by excessive and abnormal bone remodeling. It may be localized to one or several skeletal segments. The disease seldom appears before the age of 40 years, but its prevalence tends to double each decade from the age of 50 onwards, reaching about 10% after ninth decade. PDB may virtually affect every bone in the skeleton. Affected bones are involved right away with no new involvement during the evolution. The basic symptom of the disease is bone pain, while complications depend on skeletal sites involved and range from secondary osteoarthritis to malignant degeneration(17).
d. Septic arthritis
Septic arthritis is a condition of  inflammation of a joint as a result of bacterial or fungal infection of that it can lead to osteoarthritis. Others researchers suggest that joint sepsis should be considered if a patient with osteoarthritis develops new symptoms from a single joint with associated systemic features(18).
e. Etc.
9. Etc.

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