Post-Traumatic Arthritis

The term arthritis stems from the Greek word “arthro” meaning joint and “itis” referring to inflammation. The plural, arthritides, is a form of joint disorder that involves inflammation of one or more joints. There are over 100 different kinds of arthritis. The most common type is osteoarthritis, a degenerative joint condition, which is a result of trauma to the joint, infection or age. Other forms are rheumatoid arthritis, psoriatic arthritis and related autoimmune diseases. Septic arthritis is caused by joint infection. One of the major symptoms is joint pain. Pain is often a constant and may be localized in the affected joint. The pain from arthritis is due to the inflammation that occurs around the joint, damage to the joint from disease, daily wear and tear of joint, muscle strains caused by forceful movements against stiff painful joints and fatigue. Arthritis is the most common cause of disability within the United States. An average of 20 million individuals with arthritis have severe limitations in function on a daily basis. The degenerative nature of the condition physically limits individuals and a certain amount become entirely home bound. It is presumed that the total sum of arthritis cases is more than $100 billion. Each year, arthritis results in over 1 million hospitalizations and close to 45 million outpatient visits are related to arthritis. This contributes to an increased risk of obesity, diabetes, high cholesterol and heart disease. Individuals with arthritis are also at increased risk of depression, which often worsens the condition. Rheumatoid arthritis of joints involves the inflammation of the synovial membrane. Joints become swollen and stiffness limits the overall movement. Within time, multiple joints can be affected. The synovial membrane, also referred to as synovium or stratum synoviale, is the soft tissue between the articular capsule, the joint capsule, and the joint cavity of synovial joints. The term synovium is related to the word synovia, relating to the synovial fluid, which is a clear, viscid, lubricating fluid secreted by synovial membranes. The word synvovia was coined by Paracelsus. The term may have been derived from the Greek word syn, meaning with and the Latin word ovum, meaning egg, as the synovial fluid in joints, that have a cavity between the bearing surfaces, is similar to the consistency of egg white. The synovium often has two layers. The outer layer, subintima, can be of almost any type, fibrous, fatty or areolar. The inner layer, intima, consists of an incredibly thin sheet of cells. Where the underlying subintima is loose, the intima sits on a pliable membrane, giving rise to the term synovial membrane. This membrane, together with the cells of the intima, provides an inner tube, sealing the synovial fluid from the surrounding tissue, effectively preventing the joints from running dry when subjected to movement. The intimal cells are of two types, fibroblasts and macrophages, both of which are different in certain respects from similar cells in other tissues. The fibroblasts produce a polymer known as hyaluronan, which colours the synovial fluid in egg-white, together with a molecule called lubricin, which lubricates the joint surfaces. The water of synovial fluid is not secreted but is effectively trapped in the joint space by the hyaluronan. The macrophages are responsible for the removal of undesirable substances from the synovial fluid. The surface of synovium may be flat or may be covered with projections or villi, which is presumed to allow the soft tissue to change shape as the joint surfaces move one on another. Just beneath the intima, the synovium has a dense net of small blood vessels that provide nutrients not only for synovium yet also for the avascular cartilage. The cartilage therefore in most cases receives nutrition direct from synovium. Certain areas of cartilage have to obtain nutrients indirectly and may do so either from diffusion through cartilage or possibly by triggering the movement of the synovial fluid.
In essence, the bearing surfaces of human joints interlock. This is rare for biological joints, although the badger’s jaw interlocks. More often than not the surfaces are formed together by cord-shaped ligaments. All cavities between muscles, ligaments, bones, and cartilage is filled with pliable solid tissue. The fluid-filled gap is at most only a twentieth of a millimetre thick. The synovium provides a plane of separation between the dense tissues that movement can occur with minimum bending of solid components. If this separation is lost, the joint cannot move. However, it also allows the bearing surfaces to move without friction. Although the membrane also controls the amount of fluid within the cavity to permit the solid components to move freely. This volume is normally so small that the joint is under slight suction. Synovium can become irritated and thickened in conditions such as synovitis or rheumatoid arthritis. The synovium can become a danger to the bearing surface structure in a variety of ways. Excess synovial fluid can weep from the inflamed synovium, creating a barrier to diffusion of nutrients to cartilage. The synovial cells may also use up nutrients, reducing the glucose level within the tissue almost completely. These factors may lead to starvation and necrosis of cartilage cells. Synovial cells may also produce enzymes that can digest the cartilage surface, although it is unclear thus far whether this is to digest healthy cells.
Osteoarthritis, also known as degenerative arthritis or degenerative joint disease, is a group of mechanical abnormalities involving the degradation of joints, including articular cartilage and subchondral bone. Symptoms may include joint pain, tenderness, stiffness, locking, and effusion. A variety of causes hereditary, developmental, metabolic, and mechanical deficits may initiate processes leading to the loss of cartilage. Once bone surfaces become less protected by cartilage, the bone may be exposed and damaged over time. This may result in, decreased movement , pain and regional muscle atrophy. “Treatment generally involves a combination of exercise, lifestyle modification, and analgesics.” However, recent studies have discovered that THC is also effective. If the pain becomes debilitating, joint replacement surgery may be used to improve the quality of the individuals life. Osteoarthritis is the most common type of arthritis and the leading cause of chronic disability in the United States. It affects about 1.9 million individuals in Australia, 8 million individuals in the United Kingdom and nearly 27 million individuals in the United States. , g ability and often stiffness. “Pain” is generally described as a sharp ache or a burning sensation in the associated muscles and tendons. Osteoarthritis can cause a crackling noise, known as crepitus when the affected joint is moved or touched. Individuals may experience muscle spasms and contractions in the tendons. In certain cases, the joints may occasionally also be filled with fluid. Numerous reports of increased pain associated with cold temperatures, high humidity and barometric pressure drops, although studies displayed varied results. Osteoarthritis generally affects the hands, feet, spine, hips and knees, although in theory, any joint in the body can be affected. As the condition progresses, the affected joints appear larger, are stiff and painful and usually feel better with gentle use and worse with excessive or prolonged usage, thus distinguishing it from rheumatoid arthritis. In smaller joints, such as at the fingers, hard bony enlargements, called Heberden’s nodes, commonly on the distal interphalangeal joints or Bouchard’s nodes on the proximal interphalangeal joints may form. Although they are not necessarily painful, they can limit the movement of the fingers significantly. Osteoarthritis within the toes can result in the formation of bunions, causing redness or swelling. Certain individuals notice these physical changes before they experience any pain. It should be noted that osteoarthritis is the most common cause of joint effusion of the knee. A joint effusion is the presence of increased intra-articular fluid. It may affect any joint. It is also commons in gout, trauma and septic arthritis. Septic arthritis is the purulent invasion of a joint by an infectious agent with a resultant large effusion due to inflammation. Gout is usually present with recurrent attacks of acute inflammatory arthritic, caused by elevated levels of uric acid in the blood that crystallizes and deposits in joints, tendons, and surrounding tissues. Gout affects 1% of individuals in Western populations at a point in their lives. Trauma from ligamentous, osseous or meniscal injuries can result in an effusion. These are often hemarthrosis or bloody effusions.

Contributing Factors

Damage from mechanical stress with insufficient self-repair by joints, it is believed to be the primary cause of osteoarthritis. Sources of stress may involve misalignments of bones due to congenital, pathogenic causes, mechanical injury, excess body weight, loss of strength in the muscles supporting a joint and impairment of peripheral nerves, leading to sudden or uncoordinated movements. However, physical exercise, including running in the absence of injury, has not been found to increase the risk, nor has cracking one’s knuckles. Numerous studies have shown that there is a greater prevalence of the disease among siblings, especially in identical twins, indicating a hereditary origin. Although a single factor is not generally sufficient to trigger the disease, about half of the variation in susceptibility has been assigned to genetic factors. As early human ancestors evolved into bipeds, changes occurred in the pelvis, hip joint and spine, which increased the risk of osteoarthritis. In addition, genetic variations increasing the risk were likely not selected against as commonly problems only occur after reproductive success, since the body struggles to recover from the overall calcium depletion.
The development of osteoarthritis is often correlated with a previous history of joint injury and with obesity. Since the correlation with obesity has been observed, not only for knees and for non-weight bearing joints, the loss of body fat is more closely related to symptom relief than the loss of body weight, it has been suggested that there may be a metabolic link to body fat as opposed to mechanical loading. Conversely, changes in sex hormone levels may also play a role in the development, as it is more prevalent among post-menopausal females than among males of the same age. A study of mice discovered natural female hormones to be protective while injections of the male hormone, dihydrotestosterone, reduced protection. Primary Osteoarthritis is a chronic degenerative disorder related to, yet not caused by aging, as there are countless individuals in their nineties that have no clinical or functional signs of the disease. As the individual ages, the fluid content of the cartilage decreases, resulting in a reduced proteoglycan content, thus causing the cartilage to be less resilient. The fluid content of healthy cartilage is finely balanced by compressive force driving fluid out as well as swelling pressure drawing fluid in. Collagen fibres exert the compressive force, whereas the Gibbs-Donnan effect and cartilage proteoglycans create osmotic pressure, which draws fluid in. However, during the onset, there is an increase in cartilage fluid content. This increase occurs whilst there is an overall loss of proteoglycans, which is outweighed by a loss of collagen. Without the protective effects of the proteoglycans, the collagen fibers of the cartilage can become susceptible to degradation and thus exacerbate the degeneration. Inflammation of the surrounding joint capsule can also occur, though often mild, compared to rheumatoid arthritis. For instance, as breakdown products from the cartilage are released into the synovial space and the cells lining the joint attempt to remove them. Bone outgrowths, referred to as osteophytes can form on the margins of the joints in an attempt to improve the congruence of the articular cartilage surfaces. These bone changes in combination with the inflammation result in additional pain and movement restrictions.

Treatment Conclusion

Apart from cloning the tissue and replacing it synthetically, the publicly accessible options are limited. Analgesics, weight loss and muscle growth to support the joint are often a temporary solution. Almost all studies produce inconclusive evidence. Medical marijuana has merely become a herbal analgesic, as it was used throughout history. After that, pure cocaine and heroine was routinely handed out to aid pain relief. Out of the above options, the effect of the THC can support the oxidisation of the bones, dependent upon the amount consumed. Above all, a intravenous drip, containing a cannabis oil or hemp seed oil solution, has yielded greater medical results in the subject in the actual treatment of whilst reducing the overall pain threshold. In fact, 18 states within America, including Washington, D.C., have legalized limited use of medical marijuana for certain conditions. California permits its use for arthritis. New Jersey and New York, do not.) Two states, Washington and Colorado, have decriminalized even its recreational use. A 2011 Journal of Pain survey revealed that almost 10 percent of Americans with chronic pain use marijuana. Large-scale surveys from the United Kingdom and Australia indicate that roughly one-third of individuals that use medical marijuana for arthritis report considerable pain relief. Additionally, a Canadian study in Arthritis Care & Research found that among 457 patients with fibromyalgia, 13 percent used cannabis to manage their condition. Although Canadian research has also proven its healing effects through injection.

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