Osteoarthritis

Definition:

Osteoarthritis is the breakdown of cartilage in the joints. This is followed by chronic inflammation of the joint lining. Healthy cartilage is a cushion between the bones in the joint. Osteoarthritis usually affects the hands, feet, spine, hips and knees. People with osteoarthritis usually have joint pain and limited movement of the affected joint.

Osteoarthritis (OA), sometimes called degenerative arthritis, is the most common type of arthritis. In OA, the cartilage that covers the bones in a joint thins and, in some cases, wears away entirely. This leaves bone rubbing against bone, which can cause inflammation. The inflammation causes swelling and pain, and eventually distorts the originally smooth surface of the joints. Bits of bone or cartilage can break off and float inside the joint space. This causes pain and interferes with the joint movement. Sometimes, bone spurs, called osteophytes, grow on the edges of the joint.

Causes:

Osteoarthritis is associated with aging. The exact cause is unclear. As osteoarthritis develops, you experience loss of cartilage, bone spurs around the joint, and muscle weakness of the extremity.

Risk Factors:

These factors increase your chance of developing osteoarthritis. Tell your doctor if you have any of these risk factors:

• Obesity
• Genetic factors, family history
• Injury to the joint surface, history of fractures
• Occupations and physical activities that put stress on joints as well as a history of competitive sports
• Neuromuscular disorders, like diabetes

Symptoms:

Symptoms include

• Mild to serve pain in the joint, especially after overuse or long periods of inactivity, such as sitting for a long time
• Crepitus, creaking or grating sound in the joint
• Swelling, stiffness, limited movement of the joint, especially in the morning
• Weakness in muscles around the sore joint
• Deformity of the joint

Diagnosis:

The doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may include:

• X-ray – a test that uses radiation to take a picture of structures inside the body, especially bones
• Blood tests
• Arthrocentesis- a procedure that involves withdrawing fluid from a joint.

Treatment:

There is no treatment that stops cartilage loss or repairs cartilage that is damaged. The goal of treatment is to reduce joint pain and inflammation and to improve joint function.

Treatments may include:

Medications

• Over-the-counter pain medicine

Acetaminophen (e.g. Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (eg. Advil) and naproxen (eg. Aleve)

• Topical pain medicines (eg. Creams, patches) that are applied to the skin, such as capsaicin, methyl, salicylate, menthol, diclofenac
• Viscosupplementation – injection of a substance called hyaluronan into the joint, which helps lubricate the joint.
• Corticosteroid injections – intraarticular (into the knee)

Dietary Supplements:

Glucosamine and chondroitin are two commonly used supplements. But, research has shown that these supplements are not beneficial for most people with osteoarthritis. Talk with your doctor before taking any herbs or supplements.

Mechanical Aids:

Shoes with shock-absorbing soles may provide some relief while you are doing daily activities or exercising. Canes, crutches, walkers, and orthopedic shoes also can help those with advanced osteoarthritis in the lower body.

Weight Reduction:

Losing weight can lessen the stress on joints affected by osteoarthritis. Losing five pounds can eliminate at least 15 pounds of stressful impact for each step taken. The more weight lost, the greater the benefit.

Exercise and Physical therapy:

Strengthening the muscles supporting and arthritic joint (particularly the knee, lower back, and neck) may decrease pain and absorb energy around the joint. For example, if you have arthritis in the knee, exercise, including strength training, can also help improve knee function. Cycling, elliptical training, swimming and water aerobics are good options because they do not put stress on the joint.

Assistive Devices:

If you are having difficulty getting around due to arthritis pain, your doctor might recommend that you install handrails and grips throughout your home. These are useful in the bathroom and shower. You may need elevated seats (including toilet seats) if you’re having difficulty rising after sitting.

Heat and Ice:

Applying heat (with hot water bottles or heating pads) helps joints and muscles move more easily. It can also lessen pain. Using ice packs after activity can also help.

Steroids:

Corticosteroid injections to the inflamed joint may be given if other pain medicines do not work. Because repeated cortisone injections can be harmful to the cartilage, they are reserved for those with severe symptoms.

Surgery:

Surgery can

• Reposition bones to redistribute stress on the joint
• Joint Replacement, partial and total

Prevention:

To reduce your chance of getting osteoarthritis

• Maintain a healthy weight.
• Do regular, gentle exercise (e.g. walking, stretching, swimming, yoga)
• Avoid repetitive motions and risky activities that may contribute to joint injury, especially after age 40.
• With advancing age, certain activities may have to be dropped or modified. But, continue to be active.

How to prevent Osteoarthritis:

Can you prevent OA?

At ounce of prevention is worth a pound of cure! The less unnecessary stress you put on your joints, the less likely they are to wear out prematurely. Keep your weight under control. When working and exercising, try to use good posture, and if a joint starts to bother you, rest it immediately. Your health care provider may be able to offer suggestions to minimize your risk for joint injury.

The arthritis Foundation makes the following recommendations to protect joints and prevent osteoarthritis:

• Maintain your ideal body weight. Excess weight puts stress on your joints, especially your hips, knees, back and feet.
• Move. Exercise strengthens muscles around joints; this can help prevent wear and tear on cartilage in a joint.
• Maintain good posture. Good posture protects your joints from excessive, pressure, especially your neck, back, hips and knees.
• Do a variety of physical activity. Alternate periods of heavy activity with periods of rest. For example, if you do weight training one day, do aerobic exercise the next day. Repetitive stress on joints for long periods of time can cause the excessive wear and tear that can lead to osteoarthritis.
• Pay attention to pain. If you have joint pain, don’t ignore it. Pain after activity or exercise can be an indication you have overstressed your joints and that they need to rest.
• Forget the weekend warrior. Start new activities slowly and safely until you know how your body will react to them. This will reduce the chance of injury.
• Avoid injury to joints. Wear proper safely equipment. Don’t leave helmets and wrist pads at home. Make sure safety gear is comfortable and this appropriately.

Making an accurate diagnosis:

Symptoms of OA include stiffness in a joint after a period of immobility, swelling in a joint, and hearing noise or feeling a crunch when a joint moves.

It’s important to see your doctor if you have joint pain, especially in your hip joints, or knees. Your doctor will evaluate the history of your pain and perform a physical examination to clearly diagnose arthritis and what type it is X-rays may be taken to look for cartilage loss, bone damage, and bone spurs. If an X-ray does not show a cause for the pain and MRI may be done to look for damage to other joint tissues such as a ligaments and meniscus. This is important because OA treatment differs from that for other forms of arthritis and joint injuries.

A number or other conditions can affect your joints, and only your health care provider can help you determine what type of arthritis you have. Once the diagnosis of OA is made. It is important to understand that there’s no cure. With your doctor’s help, you can effectively manage this chronic condition.