Samantha OlewnikBiology of Aging Research PaperProfessor KobreApril 30, 2013

Osteoarthritis of the Spine

There are many types of arthritis, the most common being osteoarthritis. Osteoarthritis refers to arthritis of the joints, and a common place to develop this condition is the spine. Sometimes called spinal arthritis, osteoarthritis of the spine can turn into a painful, debilitating condition that leaves its victim immobilized and sometimes causes a humped back.The spine consists of a series of twenty four vertebrae which extend from the skull down to the small of the back, enclosing a key part of the central nervous system, the spinal cord. The spine, also referred to as the backbone, provides support for the thorax and abdomen as well. The vertebrae in the spinal column are cushioned and supported by disks of fibrocartilage. This type of cartilage is a connective tissue that is stronger than the hyaline cartilage found on the ends of long bones and the nose, but less flexible than the elastic cartilage that can be found in the ear flaps and epiglottis. Unfortunately, as we age, this cartilage between the disks in the vertebral column can start to deteriorate, causing the spine to become misshapen. Coupled with an increasing loss of calcium from bones with aging, including those in the spinal column, an older persons back can curve into an abnormal hump shape. This deterioration, also known as osteoarthritis, can cause the vertebrae to collapse in or slip forward on one another, adding to the deformity (Gyoderpa).Not only does osteoarthritis affect the cartilage in the spine, but it attacks the joints as well. The joints in the spine are commonly called facet joints because of their hinge-like dexterity in linking vertebrae together. These joints are synovial, meaning that they are surrounded by a capsule of connective tissue and produce fluid to nourish and lubricate the joint (Bridwell). The fibrocartilage in the spine also serves to help the joints glide smoothly, or articulate, against each other, allowing our backs to bend and move in various directions. Osteoarthritis results in chronic inflammation that can cause the articular cartilage of these joints to deteriorate. Symptoms associated with this type of inflammation include stiffness, locking of the joints, overall joint pain, and sometimes effusions. The pain associated with osteoarthritis can make it hard for someone to move their back at all, forcing them into a hunched position, adding to the humped disfiguration. As osteoarthritis progresses, the affected joints may appear larger, also making the afflicted persons back seem larger than normal (Dorland). This disease generally happens as people age, but younger people can also contract it after an injury or because of a genetic defect involving the cartilage (Zelman). Currently there is no single test to confirm a diagnosis of osteoarthritis, but doctors may order a number of tests to aid in its diagnosis. X-rays can be done to detect bone damage, loss of cartilage, or the misplacement of vertebral disks. Blood tests may be run to exclude the possibility of other diseases, and a magnetic resonance imaging scan (or MRI,) may be prescribed to show possible narrowing of areas where spinal nerves exit due to the eroded cartilage or damage to vertebral disks (Zelman).For the most part, the treatment of osteoarthritis focuses on helping the joint regain some functional ability and alleviating the symptoms of pain, working towards an overall healthy lifestyle. It is recommended that everyone with osteoarthritis maintain a healthy weight, and weight loss will be encouraged if initially needed. Exercise is also likely to be prescribed as a form of treatment. Besides helping with weight management, staying physically active can help osteoarthritis sufferers increase flexibility, strengthen the heart, improve blood flow, improve attitude and mood, and make daily tasks more accomplishable. Exercises associated with the treatment of osteoarthritis are often broken up into three categories: strengthening exercises, aerobic exercises, and range-of-motion exercises. Strengthening exercises work to make the muscles that support the afflicted joints stronger through the use of resistance with weights or rubber bands. Aerobic exercises aim to make the heart and circulatory system stronger, while range-of-motion exercises work to increase the bodys flexibility.Non-drug treatments for osteoarthritis include massage, acupuncture, applying heated or cold compresses to the afflicted site based on a doctors recommendations, nutritional supplements, and transcutaneous electrical nerve stimulation (TENS,) which is the use of a small device to emit electrical impulses onto the affected joint. Over-the-counter drugs that may be used to treat the disease include acetaminophen, certain non-steroidal anti-inflammatory drugs (NSAIDs,) like aspirin and ibuprofen, and topical ointments and creams that are applied directly to the skin of the area that hurts. NSAIDs can have serious side effects, however, including stomach irritation and bleeding and kidney damage, so it is advisable to consult a physician before starting any NSAID regimen. Prescription drugs may also be recommended to help treat osteoarthritis, including prescription painkillers, narcotics, or injections of corticosteroids, which are hormones sometimes used to treat inflammation. Most cases of spinal osteoporosis can be treated without surgery, but in the instances when the spinal canal has become so narrowed that it impairs bladder and bowel function, walking, or the nervous system in general has become damaged, joint replacement surgery will likely be recommended (Zelman).Because there isnt a cure for osteoarthritis currently, most research that has been done focuses on the topic of rebuilding/ repairing the damaged joints or cartilage or trying to mask the symptoms of the disease. One study suggests that gelatin can actually rebuild the cartilage in the joints (Gez). According to the study, because gelatin occurs naturally in the body and aids in the lubrication of joints and the formation of cartilage, drinking 1 teaspoon melted in a half cup of water or juice daily can help rebuild cartilage in the joints, lubricate the damaged joints, and prevent further damage, allowing the cartilage to heal naturally. The study also suggests that this regimen can aid in recovery after surgery.Although these studies are useful in determining the best ways to attempt to repair cartilage and joints damaged by osteoarthritis, as well as the most current methods available to help alleviate the painful symptoms associated with the disease, I feel that it would be much more conducive to the health of the patient to research a way to prevent this degeneration from happening in the first place. Discovering new ways to mask the pain is not helpful in actually fixing the problem; it can in fact simply lead to bigger problems when the disease becomes worse after numbing its warning signs. If I had the ability to do so, I would conduct a study involving an injection of chondroblasts directly to the cartilage in-between and surrounding the vertebral disks. Because cartilage contains no blood supply, attempting to conduct a study with a drug that must be ingested and travel through the bloodstream to reach its destination would probably produce little results. Chondroblasts are specialized cells that produce large amounts of extracellular matrix composed of collagen fibers, proteoglycan, and elastin fibers, the three essential building blocks for any type of cartilage (Pratt). Because cartilage is directly made up of these cells, I think placing extra chondroblasts exactly where they are needed most would be most helpful in preventing the damage associated with osteoarthritis from occurring to the joints of the spine. If we placed a concentration of chondroblasts in an area that we knew to be at risk for developing osteoarthritis in the future, maybe the injected and natural chondroblasts could work together to strengthen the preexisting cartilage, preventing it from wearing down and the joint from becoming irritated.I think the best way to test this sort of hypothesis would be to conduct a longitudinal clinical study on the effects of injecting the cartilage around the vertebrae with extra chondroblasts. I would gather volunteers between the ages of 30 and 40 to participate, as that is the age at which the early signs of osteoarthritis may start to develop. The study participants would be split into two groups; one would receive a yearly injection of chondroblasts into the fibrocartilage in their spines, the other would simply be a control group that would receive no treatment and be left to age naturally. Every year, tests would be run on the participants (outside of the injection dates) to see whether or not they seemed to be losing any cartilage, experiencing any deterioration, and how limber their backs felt in general, including a test to see how wide of a range of motion they possessed in their backs. This would go on for about twenty years, as by that time most participants would be in their sixties, an age where it would be highly likely for the symptoms of osteoarthritis to start becoming apparent in the control group or if the treatments turned out to be useless. Hopefully this study would uncover that strengthening the cartilage of the spinal column before any deterioration took place, instead of trying to treat and cope with the loss of mobility that results from osteoarthritis after the fact, is a better alternative to using drugs to hide the symptoms of the disease. If we prevent deterioration and inflammation from having a chance to occur by giving back-up to our fibrocartilage, hopefully the woe of osteoarthritis could be solved. We wouldnt have to worry about coming up with safer ways to treat the side effects of the disease because we would be able to prevent it from ever happening in the first place.Osteoarthritis of the spine is a severe condition that attacks the cartilage and joints of the spinal column, leading to severe pain, stiffness, lack of mobility, and the possibility of developing a hunchback due to the misplacement of vertebrae following cartilage deterioration. There arent any cures for the disease yet, but much research has been done trying to find ways to alleviate the associated symptoms. This only masks the problem of the affliction, however, which can result in it growing and the eventual destruction of the spines facet joints. I think that a longitudinal clinical study involving the injection of additional chondroblasts to a middle-aged persons spinal fibrocartilage could over time result in a strengthening of the preexisting cartilage, preventing age-related erosion and deterioration and eliminating the resulting possibility of joint inflammation and eventual drastic joint replacement surgery. Even though osteoarthritis is not life-threatening, it can be life-altering, as it dramatically alters a persons ability to function normally due to its resulting lack of mobility. Any time someone has to change their lifestyle to accommodate the symptoms of a disease that may be able to be prevented, action must be taken to examine how we can fix it. I hope that we will someday see research that focuses on preventing this crippling disease from happening in the first place, not just on how we can comfort the patient; at that point its too late.

Bibliography

Zelman, David, MD. "Spinal Osteoarthritis Symptoms, Causes, Treatments, Pain Relief, and More." WebMD. WebMD, 03 Jan. 0000. Web. 28 Apr. 2013.

Gyoderpa. "What Causes a Hump in the Back and What Can Be Done about It?" WikiAnswers. Answers, n.d. Web. 28 Apr. 2013.

Dorland. "Osteoarthritis." Wikipedia. Wikimedia Foundation, 29 Apr. 2008. Web. 28 Apr. 2013.

Bridwell, Keith, MD. "Facet Joints of the Spine Anatomy." SpineUniverse. Spineuniverse, 04 June 2012. Web. 28 Apr. 2013.

Mooney, Vert, MD. "Osteoarthritis Complete Treatment Guide." Spine-health. Spine health, 25 May 2005. Web. 28 Apr. 2013.

Gez, Deborah. "The Causes of and Cures for Cartilage Damage in Joints." Ezinearticles. Moriahherbs, 13 Apr. 2010. Web. 28 Apr. 2013.

Pratt, Rebecca. "Cartilage." Wikipedia. Wikimedia Foundation, 26 Oct. 2012. Web. 28 Apr. 2013.