Osteoarthritis does not evolve in a consistent way; it is unpredictable.
It can remain silent and no longer manifest itself even when the joint seems very damaged on the X-rays. But it can also worsen quickly over several weeks to several months, to a point where the X-rays are almost normal.
It is this imbalance between pain and radiological signs of osteoarthritis that makes it so difficult to understand and assess.
- Why this imbalance?
- How do the radiological signs evolve?
Osteoarthritic flare-ups reflect structural changes and destruction of the cartilage surface, with the production of debris.
At first, the thickness of the cartilage is preserved and X-rays are normal. The debris and degradative enzymes released are very irritating to the joints. As a result the latter manufacture a larger amount of synovial fluid (which normally exists in small quantities) to enable diluting irritant substances and lubricate the damaged joint.
During an osteoarthritic flare-up these lesions persist and worsen if the joint is left untreated and/or not rested either completely or partially, by using a cane, for example for weight bearing joints. In this case, the cartilage no longer having its normal resistance, irritant substances continue their action of cartilage degradation and the slow healing process cannot be completed properly. The painful flare-up continues.
By resting your joints during flare-up episodes they can finally "self cleanse" and heal: the cartilage regains its firm surface. Although it looks thin on the X-ray, it functions normally. After a few days you can thus resume your normal activities.
The evolution is thus a succession of painful flare-ups separated by intervals of variable duration, up to the stage of cartilage ulceration. At this stage, the cartilage has disappeared and part of the bone is exposed so the pain may intensify. Sometimes the episodes slow down or even disappear, replaced by pain proportional to the time of walking and standing. Twenty years may go by between the beginning of the first flare and the total destruction of the cartilage. However, the pain caused during osteoarthritic flare-ups is not always very pronounced, so that some people neglect their osteoarthritis with the risk of it being discovered at an advanced stage.
Thus, you need to know that it is not normal to suffer regularly from a painful joint. It is essential that you go and see your doctor as early as possible. He will prescribe the standard X-rays that will serve as a basis for regular monitoring. If they are normal, they will serve as a reference for this monitoring.
Generally, radiological lesions gradually and slowly increase. However, the pace of this progression can be very variable. In extreme cases, some cases of osteoarthritis may remain stable for decades, while others progress very rapidly to the complete destruction of the cartilage in the space of a few months.
It is difficult if not impossible today to predict how fast the evolution of your osteoarthritis will be.
In addition, the evolution of pain and lack of joint mobility is not always proportional to the size of the lesions.