The Basics of Osteoarthritis

Arthritis is a general term that means inflammation of the joints. Osteoarthritis, also called degenerative joint disease, is the most common type of arthritis. It is associated with a breakdown of cartilage in joints and can occur in almost any joint in the body. It most commonly occurs in the weight bearing joints of the hips, knees, and spine. It can also affect the fingers, thumb, neck, and large toe. Osteoarthritis -- also called OA -- usually does not affect other joints unless previous injury or excessive stress is involved.

Cartilage is a firm, rubbery material that covers the ends of bones in normal joints. Its main function is to reduce friction in the joints and serve as a "shock absorber." The shock-absorbing quality of normal cartilage comes from its ability to change shape when compressed (flattened or pressed together).

Osteoarthritis causes the cartilage in a joint to become stiff and lose its elasticity, making it more susceptible to damage. Over time, the cartilage may wear away in some areas, greatly decreasing its ability to act as a shock absorber. As the cartilage deteriorates, tendons and ligaments stretch, causing pain. If the condition worsens, the bones could rub against each other.

Who Gets Osteoarthritis?

Osteoarthritis affects nearly 21 million Americans. The chance of developing the disease increases with age. Most people over age 60 have osteoarthritis to some degree, but its severity varies. Even people in their 20s and 30s can get osteoarthritis. In people over 50, more women than men get osteoarthritis.

What Are the Symptoms of Osteoarthritis?

Symptoms of osteoarthritis most often develop gradually and include:

  • Joint aching and soreness, especially with movement.
  • Pain after overuse or after long periods of inactivity.
  • Bony enlargements in the middle and end joints of the fingers (which may or may not be painful).
  • Joint swelling and joint fluid accumulation.

 

What Causes Osteoarthritis?

There are several factors that increase a person's chances of developing osteoarthritis. These include:

  • Heredity. Some people have an inherited defect in one of the genes responsible for making cartilage. This causes defective cartilage, which leads to more rapid deterioration of joints. People born with joint abnormalities are more likely to develop osteoarthritis, and those born with an abnormality of the spine (such as scoliosis or curvature of the spine) are more likely to develop osteoarthritis of the spine.

     

  • Obesity. Obesity increases the risk for osteoarthritis of the knee and hip. Maintaining ideal weight or losing excess weight may help prevent osteoarthritis of the knee and hip or decrease the rate of progression once osteoarthritis is established.

     

  • Injury. Injuries contribute to the development of osteoarthritis. For example, athletes who have knee-related injuries may be at higher risk of developing osteoarthritis of the knee. In addition, people who have had a severe back injury may be predisposed to develop osteoarthritis of the spine. People who have had a broken bone near a joint are prone to develop osteoarthritis in that joint.

     

  • Joint Overuse. Overuse of certain joints increases the risk of developing osteoarthritis. For example, people in jobs requiring repeated bending of the knee are at increased risk for developing osteoarthritis of the knee.

How Is Osteoarthritis Diagnosed?

The diagnosis of osteoarthritis is based on a combination of the following factors:

  • Your description of symptoms.
  • The location and pattern of pain.
  • Physical exam.

Your doctor may use X-rays to help confirm the diagnosis and make sure you don't have another type of arthritis. X-rays show how much joint damage has occurred.

Sometimes blood tests will be given to determine if you have a different type of arthritis.

If fluid has accumulated in the joints, your doctor may remove some of the fluid (called joint aspiration) for examination under a microscope to rule out other diseases.

How Is Osteoarthritis Treated?

Osteoarthritis usually is treated by physical therapy with muscle strengthening exercises, oral medications, hot and cold compresses to the painful joint, removal of joint fluid, injection of medications into the joint, use of supportive devices such as crutches or canes, and weight control. Surgery may be helpful to relieve pain when other treatment options have not been effective.

The type of treatment prescribed will depend on several factors including your age, activities and occupation, overall health, medical history, location of your osteoarthritis, and severity of the condition.

What Medications Are Used to Treat Osteoarthritis?

Medications may be prescribed to reduce pain caused by osteoarthritis. Pain-relieving drugs include acetaminophen (for example, Tylenol) and anti-inflammatory drugs (often called NSAIDs), such as aspirin, ibuprofen, or Celebrex. Some medications in the form of creams, rubs, or sprays may be applied over the skin of affected areas to relieve pain. For some people with persistent pain despite these pills or creams, steroids can be injected directly into the joint. These injections can be given several times a year though some feel it may ultimately accelerate joint damage.

The antidepressant Cymbalta (duloxetine) has been approved for osteoarthritis pain as well. It's a serotonin-norepinephrine reuptake inhibitor, or SNRI, that was first approved by the FDA in 2004.

Synvisc, Supartz, Euflexxa, Orthovisc, and Hyalgan are drugs given as a series of three to five weekly joint injections that can relieve pain in some people with osteoarthritis. Currently, these drugs are only approved for knee osteoarthritis.

When osteoarthritis pain is severe and other treatments are not working, some doctors will give stronger pain pills, such as narcotics.

Unfortunately, none of these will reverse or slow the progression of joint damage caused by osteoarthritis.

How Does Weight and Exercise Impact Osteoarthritis?

Staying at your recommended weight helps prevent osteoarthritis of the knees, reduces the stress on weight-bearing joints, and reduces pain in joints already affected. Once you have osteoarthritis, losing weight also can relieve the stress and pain in your knees.

Exercise is important to improve joint movement and to strengthen the muscles that surround the joints. Gentle exercises, such as swimming or walking on flat surfaces, are recommended because they are less stressful on your joints. Avoid activities that increase joint pain, such as jogging or high impact aerobics. Exercises that strengthen the quadriceps muscle reduce knee pain in patients with osteoarthritis.

Are There Alternative Treatments for Osteoarthritis?

Some medical research has shown that the supplements glucosamine and chondroitin may relieve pain in some people with osteoarthritis -- especially in the knee. There is no evidence that glucosamine can help rebuild cartilage.

Some people also use methylsulfonylmethane (MSM) and S-adenosylmethionine (SAM-e) for arthritis but there is questionable medical evidence showing their benefits. MSM is a naturally occurring compound that is taken as a dietary supplement.

Acupuncture and bioelectric therapy also may be useful at relieving pain.

What Supportive Devices Are Available to Help With Osteoarthritis?

Supportive or assistive devices may be helpful to decrease pressure on the joints with osteoarthritis. Knee supports may be helpful for some people to stabilize the ligaments and tendons and decrease pain. Canes or crutches may be helpful to take pressure off certain joints.

In addition to pain relief, assistive devices improve function and prevent falls. A licensed physical therapist or other health care professional is needed to recommend what devices are best for you.

Is There a Surgery for Osteoarthritis?

When osteoarthritis pain is not controlled with medications and the other mentioned treatments, or when the pain prevents you from participating in your normal activities, you may want to consider surgery.

There are several types of surgery for osteoarthritis. They include:

  • Arthroscopy to clean out the damaged cartilage has not been proven in recent studies to be effective for osteoarthritis.
  • Joint replacement surgery to replace the damaged joint with an artificial one. Joint replacement surgery should be considered when the severity of the joint pain significantly interferes with a person’s function and quality of life. Even under the best of circumstances, surgery cannot return the joint to its normal state (artificial joints do not have all of the motion of a normal joint). However, an artificial joint will diminish pain. The two joints most often replaced are the hip and the knee. Artificial joints are now also available to replace shoulders, fingers, elbows, ankles, and back joints to treat severe pain that has not responded to other treatments.
  • Joint fusion removes the damaged joint and fuses the two bones on each side of the joint. This is done more often in areas in which joint replacement is not effective.
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