What is osteoarthritis?
- Osteoarthritis is a joint inflammation that results from cartilage degeneration.
- Osteoarthritis can be caused by aging, heredity, and injury from trauma or disease.
- The most common symptom of osteoarthritis is pain in the affected joint(s) after repetitive use.
- There is no blood test for the diagnosis of osteoarthritis.
- The goal of treatment in osteoarthritis is to reduce joint pain and inflammation while improving and maintaining joint function.
What is osteoarthritis?
Osteoarthritis is a form of arthritis that features the breakdown and eventual loss of the cartilage of one or more joints. Cartilage is a protein substance that serves as a "cushion" between the bones of the joints. Among the over 100 different types of arthritis conditions, osteoarthritis is the most common. Osteoarthritis occurs more frequently as we age. Before age 45, osteoarthritis occurs more frequently in males. After 55 years of age, it occurs more frequently in females. In the United States, all races appear equally affected. A higher incidence of osteoarthritis exists in the Japanese population, while South-African blacks, East Indians, and Southern Chinese have lower rates. Osteoarthritis is abbreviated as OA or referred to as degenerative arthritis or degenerative joint disease (DJD).
Osteoarthritis commonly affects the hands, feet, spine, and large weight-bearing joints, such as the hips and knees. Osteoarthritis usually has no known cause and is referred to as primary osteoarthritis. When the cause of the osteoarthritis is known, the condition is referred to as secondary osteoarthritis.
What are the symptoms for osteoarthritis?
OsteoArthritis symptoms often develop slowly and worsen over time. Signs and symptoms of osteoArthritis include:
- Pain. Your joint may hurt during or after movement.
- Tenderness. Your joint may feel tender when you apply light pressure to it.
- Stiffness. Joint stiffness may be most noticeable when you wake up in the morning or after a period of inactivity.
- Loss of flexibility. You may not be able to move your joint through its full range of motion.
- Grating sensation. You may hear or feel a grating sensation when you use the joint.
- Bone spurs. These extra bits of bone, which feel like hard lumps, may form around the affected joint.
When to see a doctor
If you have joint pain or stiffness that doesn't go away, make an appointment with your doctor.
What are the causes for osteoarthritis?
Osteoarthritis occurs when the cartilage that cushions the ends of bones in your joints gradually deteriorates. Cartilage is a firm, slippery tissue that permits nearly frictionless joint motion.
In osteoarthritis, the slick surface of the cartilage becomes rough. Eventually, if the cartilage wears down completely, you may be left with bone rubbing on bone.
What are the treatments for osteoarthritis?
Aside from weight reduction and avoiding activities that exert excessive stress on the joint cartilage, there is no specific treatment to halt cartilage degeneration or to repair damaged cartilage in osteoarthritis. The goal of treatment in osteoarthritis is to reduce joint pain and inflammation while improving and maintaining joint function. Some patients with osteoarthritis have minimal or no pain and may not need treatment. Others may benefit from conservative measures such as rest, exercise, diet control with weight reduction, physical therapy and/or occupational therapy, and mechanical support devices, such as knee braces. These measures are particularly important when large, weight-bearing joints are involved, such as the hips or knees. In fact, even modest weight reduction can help to decrease symptoms of osteoarthritis of the large joints, such as the knees and hips. Medications are used to complement the physical measures described above. Medication may be used topically, taken orally, or injected into the joints to decrease joint inflammation and pain. When conservative measures fail to control pain and improve joint function, surgery can be considered.
Resting sore joints decreases stress on the joints and relieves pain and swelling. Patients are asked to simply decrease the intensity and/or frequency of the activities that consistently cause joint pain.
Exercise usually does not aggravate osteoarthritis when performed at levels that do not cause joint pain. Exercise is helpful for relief of symptoms of osteoarthritis in several ways, including strengthening the muscular support around the joints. It also prevents the joints from "freezing up" and improves and maintains joint mobility. Finally, it helps with weight reduction and promotes endurance. Applying local heat before and cold packs after exercise can help relieve pain and inflammation. Swimming is particularly well suited for patients with osteoarthritis because it allows patients to exercise with minimal impact stress to the joints. Other popular exercises include walking, stationary cycling, and light weight training.
Physical therapists can provide support devices, such as splints, canes, walkers, and braces. These devices can be helpful in reducing stress on the joints. Occupational therapists can assess the demands of daily activities and suggest additional devices that may help people at work or home. Finger splints can support individual joints of the fingers. Paraffin wax dips, warm water soaks, and nighttime cotton gloves can help ease hand symptoms. Spine symptoms can improve with a neck collar, lumbar corset, or a firm mattress, depending on what areas are involved.
In many patients with osteoarthritis, mild pain relievers such as aspirin and acetaminophen (Tylenol) may be sufficient treatment. Studies have shown that acetaminophen given in adequate doses can often be equally as effective as prescription anti-inflammatory medications in relieving pain in osteoarthritis of the knees. Since acetaminophen has fewer gastrointestinal side effects than NSAIDS (see below), especially among elderly people, acetaminophen is generally the preferred initial drug given to patients with osteoarthritis. Medicine to relax muscles in spasm might also be given temporarily. Pain-relieving creams applied to the skin over the joints can provide relief of minor arthritis pain. Examples include capsaicin (ArthriCare, Zostrix), salycin (Aspercreme), methyl salicylate (Ben-Gay, Icy Hot), and menthol (Flexall).
New topical treatments include an anti-inflammatory lotion, diclofenac (Voltaren Gel) and diclofenac patch (Flector Patch), which are used for the relief of the pain of osteoarthritis.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are medications that are used to reduce pain and inflammation in the joints. Examples of NSAIDs include aspirin (Ecotrin), ibuprofen (Motrin), nabumetone (Relafen), and naproxen (Naprosyn). It is sometimes possible to use NSAIDs temporarily and then discontinue them for periods of time without recurrent symptoms, thereby decreasing the risk of side effects.
The most common side effects of NSAIDs involve gastrointestinal distress, such as stomach upset, cramping diarrhea, ulcers, and even bleeding. The risk of these and other side effects increases in the elderly. Newer NSAIDs called COX-2 inhibitors have been designed that have less toxicity to the stomach and bowels. Because osteoarthritis symptoms vary and can be intermittent, these medicines might be given only when joint pains occur or prior to activities that have traditionally brought on symptoms.
Some studies, but not all, have suggested that alternative treatment with the food supplements glucosamine and chondroitin can relieve symptoms of pain and stiffness for some people with osteoarthritis. These supplements are available in pharmacies and health-food stores without a prescription, although there is no certainty about the purity of the products or the dose of the active ingredients because they are not monitored by the U.S. FDA. The National Institutes of Health studied glucosamine in the treatment of the pain of osteoarthritis. Their initial research demonstrated only a minor benefit in relieving pain for those with the most severe osteoarthritis, and in most patients, there was no benefit greater than that from placebo pills. Further studies, it is hoped, will clarify many issues regarding dosing, safety, and effectiveness of different formulations of glucosamine for osteoarthritis. Patients taking blood thinners should be careful when taking chondroitin as it can increase the blood thinning and cause excessive bleeding. Fish-oil supplements have been shown to have some anti-inflammatory properties, and increasing the dietary fish intake and/or taking fish-oil capsules (omega-3 capsules) can sometimes reduce the inflammation of arthritis.
While oral cortisone is generally not used in treating osteoarthritis, when injected directly into the inflamed joints, it can rapidly decrease pain and restore function. Since repetitive cortisone injections can be harmful to the tissues and bones, they are reserved for patients with more pronounced symptoms.
For persisting pain of severe osteoarthritis of the knee that does not respond to weight reduction, exercise, or medications, a series of injections of hyaluronic acid (Synvisc, Hyalgan, Orthovisc, Supartz, Euflexa) into the joint can sometimes be helpful, especially if surgery is not being considered. These products seem to work by temporarily restoring the thickness of the joint fluid, allowing better joint lubrication and impact capability, and perhaps by directly affecting pain receptors.
Surgery is generally reserved for those patients with osteoarthritis that is particularly severe and unresponsive to the conservative treatments. Arthroscopy, discussed above, can be helpful when cartilage tears are suspected. Osteotomy is a bone-removal procedure that can help realign some of the deformity in selected patients, usually those with certain forms of knee disease. In some cases, severely degenerated joints are best treated by fusion (arthrodesis) or replacement with an artificial joint (arthroplasty). Total hip and total knee replacements are now commonly performed in community hospitals throughout the United States. These can bring dramatic pain relief and improved function.
What are the risk factors for osteoarthritis?
Factors that may increase your risk of osteoarthritis include:
- Older age. The risk of osteoarthritis increases with age.
- Sex. Women are more likely to develop osteoarthritis, though it isn't clear why.
- Obesity. Carrying extra body weight contributes to osteoarthritis in several ways, and the more you weigh, the greater your risk. Increased weight puts added stress on weight-bearing joints, such as your hips and knees. In addition, fat tissue produces proteins that may cause harmful inflammation in and around your joints.
- Joint injuries. Injuries, such as those that occur when playing sports or from an accident, may increase the risk of osteoarthritis. Even injuries that occurred many years ago and seemingly healed can increase your risk of osteoarthritis.
- Certain occupations. If your job includes tasks that place repetitive stress on a particular joint, that joint may eventually develop osteoarthritis.
- Genetics. Some people inherit a tendency to develop osteoarthritis.
- Bone deformities. Some people are born with malformed joints or defective cartilage, which can increase the risk of osteoarthritis.
Is there a cure/medications for osteoarthritis?
Although osteoarthritis has no known cure, it does not always get worse with time.
1. There are several treatments available to help with symptom relief. The major therapies for osteoarthritis symptoms include lifestyle changes, such as exercising frequently and maintaining a healthy weight.
2. Lifestyle changes, such as eating healthfully and exercising frequently, medicine to alleviate your pain, and supportive therapies to ease daily activities, are the main treatments for osteoarthritis symptoms.
3. Surgery to repair, strengthen, or replace damaged joints may also be considered in some situations when other treatments have failed to be effective.
Movement may hurt the affected joints during or after,Joint stiffness may be more apparent in the morning or after inactivity,When you lightly press on or close to your joint, it could feel tender,Your joint may not be able to move through its entire range of motion,When you utilize the joint, you could get a grating sensation and hear popping or cracking
The most prevalent type of arthritis, osteoarthritis, affects millions of individuals worldwide,When the protective cartilage that cushions the ends of the bones gradually deteriorates, it happens,Although osteoarthritis can harm any joint, it most frequently affects the hands, knees, hips, and spine joints
Osteoarthritis pain is commonly treated with over-the-counter NSAIDs, such as ibuprofen (Advil, Motrin IB, and others) and naproxen sodium (Aleve), when used in the recommended dosages,By prescription, stronger NSAIDs are available