నైరూప్య

Osteoarthritis: From complications to cure

Maria Khalid, Shafia Tufail, Zunaira Aslam, Ayesha Butt*

Background: Osteoarthritis (OA) is a degenerative disorder that affects the cartilage of bones and characterized by severe pain in joint, joint lock and instability. Factors associated with its risks are obesity, past trauma, advancing age, female sex and genetics. Women and older people are more susceptible to the risk of OA. There are different types of OA on basis of joint affects as hip, knee, hand etc. Innate immunity plays an important role in pathogenesis of OA. Activation of innate immunity as a result of small fragments e.g., of protein results in secretion of cytokines (IL1-β and TNF-α, IL-8, IL-17 etc.) and enzymes (MMP and ADAMTS) which cause degradation of bone and imparts inflammatory effect. Aging also plays an important role in OA as chondrocytes show reduced autophagy with aging, so risks of OA increases. Different drugs have been in use for the treatment of OA which provide anti-inflammatory, analgesic effects and help in improving bone integrity. Acetaminophen is usually prescribed as first line drug. Oral NASIDs and opioids provide an alternative when it does not prove effective. But these are associated with the high risks of gastrointestinal (GI) tract, cardiovascular (CV) and renal system, and liver toxicity. Topical NASIDs can also be used as alternative to oral NASIDs for their safety. Another option is topical capsaicin which can be used as an adjunctive treatment with only local adverse effects such burning, itching etc. Intra-articular injections of hyaluronic acid and corticosteroids are also used. Both are considered almost safe with local adverse effects. Non-pharmacological treatments for OA includes education, exercise, therapies, surgery and regenerative therapies. In this study, we have briefly enlightened the pathogenesis of osteoarthritis. Moreover, pharmacological as well as nonpharmacological treatment for OA is also explained.