Article # 152. Osteoarthiritis

Osteoarthritis

Osteoarthritis is a joint disease that most often affects middle-age to elderly people. It is commonly referred to as OA or as "wear and tear" of the joints, but we now know that OA is a disease of the entire joint, involving the cartilage, joint lining, ligaments, and bone. Osteoarthritis is the most common form of arthritis, affecting millions of people around the world. Often called wear-and-tear arthritis, osteoarthritis occurs when the protective cartilage on the ends of your bones wears down over time.

While osteoarthritis can damage any joint in your body, the disorder most commonly affects joints in your hands, neck, lower back, knees and hips.

Osteoarthritis gradually worsens with time, and no cure exists. But osteoarthritis treatments can slow the progression of the disease, relieve pain and improve joint function.

Symptoms include:

·         Joint pain and stiffness

·         Knobby swelling at the joint

·         Cracking or grinding noise with joint movement

·         Decreased function of the joint

In osteoarthritis, the cartilage between the bones in the joint breaks down (left image). Slowly, affected bones get bigger, as in the hand at right.

Who gets osteoarthritis?

OA affects people of all races and both sexes. Most often, it occurs in
patients age 40 and above. However, it can occur sooner if you have
other risk factors (things that raise the risk of getting OA).

Risk factors include:

·         Older age

·         Having family members with OA

·         Obesity

·         Joint injury or repetitive use (overuse) of joints

·         Joint deformity such as unequal leg length, bowlegs or knocked knees

How is osteoarthritis diagnosed?

Most often doctors detect OA based on the typical symptoms (described earlier) and on results of the physical exam. In some cases, X-rays or other imaging tests may be useful to tell the extent of disease or to help rule out other joint problems.

How is osteoarthritis treated?

There is no proven treatment yet that can reverse joint damage from OA. The goal of treatment is to reduce pain and improve function of the affected joints. Most often, this is possible with a mixture of physical measures and drug therapy and, sometimes, surgery.

Circles indicate joints that osteoarthritis most often affects.

Physical measures – Weight loss and exercise are useful in OA. Excess weight puts stress on your knee joints and hips and low back. For every 10 pounds of weight you lose over 10 years, you can reduce the chance of developing knee OA by up to 50%. Exercise can improve your muscle strength, decrease joint pain and stiffness, and lower the chance of disability due to OA.

Also helpful are support ("assistive") devices, such as braces or a walking cane, that help you do daily activities. Heat or cold therapy can help relieve OA symptoms for a short time. Certain alternative treatments such as spa (hot tub), massage, acupuncture and chiropractic manipulation can help relieve pain for a short time. They can be costly, though, and require repeated treatments. Also, the long-term benefits of these alternative (sometimes called complementary or integrative) medicine treatments are unproven but are under study.

Drug Therapy – Forms of drug therapy include topical, oral (by mouth) and injections (shots). You apply topical drugs directly on the skin over the affected joints. These medicines include capsaicin cream, lidocaine and diclofenac gel. Oral pain relievers such as acetaminophen are common first treatments. So are nonsteroidal anti-inflammatory drugs (often called NSAIDs), which decrease swelling and pain.

Surgery – Surgical treatment becomes an option for severe cases. This includes when the joint has serious damage, or when medical treatment fails to relieve pain and you have major loss of function. Surgery may involve arthroscopy, repair of the joint done through small incisions (cuts). If the joint damage cannot be repaired, you may need a joint replacement.

Supplements – Many over-the-counter nutrition supplements have been used for treatment of OA. Most lack good research data to support their effectiveness and safety. Among the most widely used are glucosamine/chondroitin sulfate, calcium and vitamin D, and omega-3 fatty acids. To ensure safety and avoid drug interactions, consult your doctor or pharmacist before using any of these supplements. This is especially true when you are combining these supplements with prescribed drugs.

 

Living with osteoarthritis

There is no cure for OA, but you can manage how it affects your lifestyle. Some tips include:

·         Properly position and support your neck and back while sitting or sleeping.

·         Adjust furniture, such as raising a chair or toilet seat.

·         Avoid repeated motions of the joint, especially frequent bending.

·         Lose weight if you are overweight or obese, which can reduce pain and slow progression of OA.

·         Exercise each day.

·         Use arthritis support devices that will help you do daily activities.

You might want to work with a physical therapist or occupational therapist to learn the best exercises and to choose arthritis assistive devices.

Points to remember

·         OA is the most common form of arthritis and can occur together with other types of arthritis.

·         The goal of treatment in OA is to reduce pain and improve function.

·         Exercise is an important part of OA treatment because it can decrease joint pain and improve function.

·         At present, there is no treatment that can reverse the damage of OA in the joints. Researchers are trying to find ways to slow or reverse this joint damage.

The rheumatologist's role in the treatment of osteoarthritis

Rheumatologists are doctors who are experts in diagnosing and treating arthritis and other diseases of the joints, muscles and bones. You may also need to see other health care providers, for instance, physical or occupational therapists and orthopaedic doctors.