Arthritis is a general term that means inflammation in 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, neck and large toe. It rarely affects other joints unless prior 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 20's and 30's can 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.
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.
The diagnosis of osteoarthritis is based on a combination of the following factors:
- Your description of symptoms.
- The location and pattern of pain.
- Certain findings on physical examination, when necessary.
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) and examine it under a microscope to rule out other diseases.
How Is Osteoarthritis Treated?
Osteoarthritis usually is treated by medications, exercise, hot and cold compresses to the painful 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?
For some people with persistent pain despite these pills or creams, steroids can be injected directly into the joint for pain relief. These injections are typically limited since prolonged use can lead to bone and cartilage deterioration and weakness.
Medications may be prescribed to reduce pain caused by osteoarthritis. Pain-relieving medications 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 for pain relief. These injections are typically limited since prolonged use can lead to bone and cartilage deterioration and weakness.
Synvisc, Supartz, Euflexxa, Orthovisc and Hyalgan are medications given as a series of 3 to 5 weekly joint injections that can relieve pain in some people with 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 affected joints. 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.
Are There Alternative Treatments for Osteoarthritis?
Some medical research has shown that the supplements glucosamine and chondroitin can relieve pain in some people with osteoarthritis -- especially in the knee. There is also evidence that glucosamine can help rebuild cartilage.
Some people also use methylsulfonylmethane (MSM) and S-adenosylmethionine (SAM-e) for arthritis but there is less medical evidence showing their benefits. MSM is a naturally occurring sulfur that is taken as a dietary supplement. SAM-e helps our bodies to produce hormones and other chemicals and 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. 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.
When Is Surgery Necessary?
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 surgical procedures that could be used. They include:
- Arthroscopy to clean out the damaged cartilage.
- Joint replacement surgery to replace the damaged joint with an artificial one. 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 very likely diminish pain. The two joints most often replaced are the hip joint and the knee joint. Artificial joints are now also available to replace shoulders, fingers, elbows 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, such as the ankle. However, an artificial joint will very likely diminish pain. The two joints most often replaced are the hip joint and the knee joint. Artificial joints are now also available to replace shoulders, fingers, elbows and back joints to treat severe pain that has not responded to other treatments.
Talk to your doctor to determine if any of these treatment options are right for you.
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