National Bone and Joint Day | Bone and joint problems in obese

Dr G K Sudhakar Reddy
August 4, 2020

Resizer_15964697448200.jpg

Being overweight or obese is now recognised as a serious cause of ill health and disability. There is a significant positive association between orthopaedic disorders and the level of obesity causing pain, deformity and difficulty in walking.

Excess body weight accumulation increases pressure on joints, particularly the hips, knees and ankles.

Here are a few type of  arthritis:

Osteoarthritis

It is a condition of damage/ wear and tear of the joint lining or cartilage. Obesity triggers this by loading excessive weight on the weight bearing joints like the knee and the hip. 

Knee Osteoarthritis

This is the most common arthritis especially in the Indian subcontinent.

While walking, an individual exerts 3 to 6 times pressure that of the body weight on the weight-bearing knee joint, which means in an obese with excess body weight, larger forces are exerted, which lead to higher risk of deterioration of cartilage.

In addition, there are excessive fat tissues that produce hormones and other factors that affect the joint cartilage metabolism and cause inflammation of the joints giving rise to joint pathology.  Leptin is one of the hormones causing knee osteoarthritis. 

Hip osteoarthritis

The force exerted across the hip is 3 times that of body weight. Hip osteoarthritis is caused by factors such as joint injury, increasing age and being overweight.    

Hand osteoarthritis

The observation that obese individual has a higher risk in having hand osteoarthritis has led to a hypothesis that the metabolic effect produced by fat tissue is the underlying factor. 

Osteoporosis

It is a progressive bone condition of decrease in bone mass and density (Bone Mineral Density or BMD) which can lead to an increased risk of fracture. Recent research suggests that obesity may accelerate bone loss. It is the amount of muscle mass which is seen in an active person, which accounts for bone strengthening effects and not due to the fat seen in a heavy person.

Low back pain

Low back pain from degenerative disc disease of the lumbar spine is one of the most disabling conditions in the community and overweight and obesity have the strongest association with seeking care for low back pain.

Managing Hip and Knee Osteoarthritis

Life style changes

If one is overweight, try to lose weight by doing more physical activity and eating a healthier diet. Regular exercise keeps you active and mobile and builds up muscle, thereby strengthening the joints and can improve symptoms. 

Pain Killers

Painkillers help with pain and stiffness for short term. They don’t affect the arthritis itself and won’t repair the damage to your joint. Creams and gels can be applied directly onto painful joints.

Nutritional Supplements

Glucosamine and chondroitin are nutritional supplements. Animal studies have found that glucosamine can both delay the breakdown of and repair damaged cartilage. However, there is insufficient evidence to support the use of glucosamine in humans and one can expect only a mild-to-moderate reduction in pain

Joint injections

If pain from osteoarthritis is severe joint steroid injections are injected into the joints that can reduces swelling and pain. The injections can start working within a day or so and may improve pain for several weeks or months. 

Hyaluronic acid injections, which help to lubricate your knee joint also give short term relief. In early stages. Stem cell treatment or cartilage regeneration procedures are being tried in young people with small defects, however it is still experimental and lacks long term evidence.

Surgery

May be recommended if you have severe pain or mobility problems.

Arthroscopy

If one has frequent painful locking/stiffening episodes especially in the knee joint, an operation to wash out loose fragments of bone and other tissue as joint can be performed by a minimally invasive key hole procedure called Arthroscopy.

Arthrodesis

If hip or knee replacement is not suitable, especially in young people who do heavy manual work, one can consider an operation known as an arthrodesis, which fuses your joint in a permanent position. This means that your joint will be stronger and much less painful, although you will no longer be able to move it.

Osteotomy

In young, active people in whom a knee joint replacement would fail due to excessive use one can consider an operation called an osteotomy. This involves adding or removing a small section of bone either above or below your knee joint.  This helps realign your knee so your weight is no longer focused on the damaged part of your knee. An osteotomy can relieve your symptoms of osteoarthritis, although you may still need knee replacement surgery eventually as you grow old

Joint replacement surgery

Joint replacement therapy is most commonly carried out to replace hip and knee joints. It involves replacing a damaged, worn or diseased joint with an artificial joint made of special plastics and metal.

For most people, a replacement hip or knee will last for at least 20 years, especially if it is cared for properly and not put under too much strain.

Dr G K Sudhakar Reddy is a Sr Consultant Orthopaedic Surgeon at Citizens Speciality Hospitals, Hyderabad

Comments

Add new comment

  • Coastaldigest.com reserves the right to delete or block any comments.
  • Coastaldigset.com is not responsible for its readers’ comments.
  • Comments that are abusive, incendiary or irrelevant are strictly prohibited.
  • Please use a genuine email ID and provide your name to avoid reject.
Agencies
September 15,2020

covid.jpg

Beirut, Sept 15: Once herd immunity is attained, the novel coronavirus may follow suit and become a seasonal virus in countries with temperate climates, but until that time, COVID-19 will continue to spread across the seasons, a new study says.

According to the review research, published in the journal Frontiers in Public Health, when a significant section of the population becomes immune to the novel coronavirus and achieves herd immunity, the effective transmission of the virus may drop substantially making it more prone to seasonal fluctuations.

"COVID-19 is here to stay and it will continue to cause outbreaks year-round until herd immunity is achieved," warned study senior author Hassan Zaraket from the American University of Beirut in Lebanon.

"Therefore, the public will need to learn to live with it, and continue practising the best prevention measures, including wearing of masks, physical distancing, hand hygiene, and avoidance of gatherings," Zaraket added.

According to the scientists, there could be multiple waves of COVID-19 before herd immunity is achieved.

Citing earlier research, they said other respiratory viruses similar to the novel coronavirus -- SARS-CoV-2 -- follow seasonal patterns, especially in temperate regions.

They said influenza and several types of coronaviruses that cause common cold are known to peak in winter in temperate regions but circulate year-round in tropical regions.

In the research, the scientists reviewed these seasonal viruses, examining the viral and host factors that control their seasonality as well as the latest knowledge on the stability and transmission of SARS-CoV-2.

They explained that virus survival in the air and on surfaces, people's susceptibility to infections, and human behaviours, such as indoor crowding, differ across the seasons due to changes in temperature and humidity.

These factors influence transmission of respiratory viruses at different times of the year, the study noted.

However, in comparison to other respiratory viruses such as the flu, the scientists said COVID-19 has a higher rate of transmission -- at least partly due to circulation in a largely immunologically naive population.

So unlike the flu and other respiratory viruses, they said the factors governing seasonality of viruses cannot yet halt the spread of COVID-19 in the summer months.

However, once herd immunity is attained through natural infections and vaccinations, they believe the transmission rate of COVID-19 should drop substantially, making the virus more susceptible to seasonal factors.

The researchers said such seasonality has been reported for other coronaviruses, including those that emerged more recently such as NL63 and HKU1, which follow the same circulation pattern like influenza.

"This remains a novel virus and despite the fast-growing body of science about it there are still things that are unknown," Zaraket said.

"Whether our predictions hold true or not remains to be seen in the future. But we think it's highly likely, given what we know so far, COVID-19 will eventually become seasonal, like other coronaviruses," he added.

The scientists noted that the highest global COVID-19 infection rate per capita was recorded in the Gulf states, regardless of the hot summer season.

"Although this is majorly attributed to the rapid virus spread in closed communities, it affirms the need for rigorous control measures to limit virus spread, until herd immunity is achieved," Yassine said.

Comments

Add new comment

  • Coastaldigest.com reserves the right to delete or block any comments.
  • Coastaldigset.com is not responsible for its readers’ comments.
  • Comments that are abusive, incendiary or irrelevant are strictly prohibited.
  • Please use a genuine email ID and provide your name to avoid reject.
Agencies
September 26,2020

WHO.jpg

The World Health Organisation (WHO) warned that the global coronavirus death toll could hit two million before an effective vaccine is widely used.

WHO emergencies head Mike Ryan on Friday said the figure could be even higher without concerted international action, the BBC reported.

The number of Covid-19 deaths is fast approaching one million - nine months after the outbreak started in China.

Ryan also urged Europeans to ask themselves whether they had done enough to avoid the need for lockdowns.

He questioned whether all the alternatives had been implemented, like testing and tracing, quarantine, isolation, social distancing, wearing masks and hand-washing.

Earlier, Spain's capital Madrid brought another eight districts under tougher coronavirus restrictions, which now affect a million people in the city.

In France, staff from bars and restaurants in the southern city Marseille protested against the closure of their workplaces which was brought in on Saturday.

And in the UK, tougher restrictions were announced in several regions as new daily infections rise.

Comments

Add new comment

  • Coastaldigest.com reserves the right to delete or block any comments.
  • Coastaldigset.com is not responsible for its readers’ comments.
  • Comments that are abusive, incendiary or irrelevant are strictly prohibited.
  • Please use a genuine email ID and provide your name to avoid reject.
Agencies
September 17,2020

Vaccine candidates for COVID-19 should elicit a broad immune response that includes antibodies, and the body's helper and killer T cells, according to a study which says weak or uncoordinated immunity may lead to a poor disease outcome.

The research, published in the journal Cell, confirms that a multi-layered, virus-specific immune response is important for controlling the novel coronavirus during the acute phase of the infection and reducing COVID-19 disease severity.

"Our observations could also explain why older COVID-19 patients are much more vulnerable to the disease," said study senior author Shane Crotty from the La Jolla Institute for Immunology in the US.

"With increasing age, the reservoir of T cells that can be activated against a specific virus declines and the body's immune response becomes less coordinated, which looks to be one factor making older people drastically more susceptible to severe or fatal COVID-19," Crotty said.

In the research, the scientists collected blood samples from 50 COVID-19 patients, and analysed multiple branches of their immune system -- novel coronavirus specific antibodies, helper and killer T cells.

"It was particularly important to us to capture the whole range of disease manifestation from mild to critically ill so we could identify differentiating immunological factors," said study co-author and infectious disease specialist Sydney Ramirez.

The researchers found that all fully recovered individuals had measurable antibody, helper and killer T cell responses against the novel coronavirus SARS-CoV-2.

However, they said the response varied widely in acute COVID-19 patients, with some lacking neutralising antibodies, others helper or killer T cells or any combination thereof.

"When we looked at a combination of all of our data across all 111 measured parameters we found that in general, people who mounted a broader and well-coordinated adaptive response tended to do better," said Carolyn Moderbacher, another co-author of the study from La Jolla Institute for Immunology.

"A strong SARS-CoV-2 specific T cell response, in particular, was predictive of milder disease. Individuals whose immune response was less coordinated tended to have poorer outcomes," Moderbacher said.

The scientists found that the effect was magnified when they broke down the dataset by age.

"People over the age of 65 were much more likely to have poor T cell responses, and a poorly coordinated immune response, and thus have much more severe or fatal COVID-19," Crotty said.

The scientists explained that as people age, the immune system's supply of deployable immature T cells dwindles, with fewer cells available to be activated to respond to a new virus.

"This could either lead to a delayed adaptive immune response that is unable to control a virus until it is too late to limit disease severity or the magnitude of the response is insufficient," Moderbacher said.

The scientists believe T cells, and helper T cells in particular, are associated with better protective immune responses.

"This was perplexing to many people, but controlling a primary infection is not the same as vaccine-induced immunity, where the adaptive immune system is ready to pounce at time zero," Crotty said.

"Thus, these findings indicate it is plausible T cells are more important in natural SARS-CoV-2 infection, and antibodies more important in a COVID-19 vaccine," he said.

Comments

Add new comment

  • Coastaldigest.com reserves the right to delete or block any comments.
  • Coastaldigset.com is not responsible for its readers’ comments.
  • Comments that are abusive, incendiary or irrelevant are strictly prohibited.
  • Please use a genuine email ID and provide your name to avoid reject.