What is Osteoarthritis ?

Definition

Osteoarthritis (OA) is the most common joint disorder.

Symptoms

The symptoms of osteoarthritis include:

• Deep aching joint pain that gets worse after exercise or putting weight on it, and is relieved by rest
• Pain that is worse when you start activities after a period of no activity
• Over time, pain is present even when you are at rest
• Grating of the joint with motion
• Increase in pain during humid or moist weather
• Joint swelling
• Limited movement
• Muscle weakness around arthritic joints

Some people might not have symptoms.

Causes & Risk Factors

In osteoarthritis, the cushioning (cartilage) between the bones wears away in the joints. As osteoarthritis gets worse, the cartilage disappears and bone rubs on bone. Bony spurs or growths usually form around the joint. The ligaments and muscles around the joint loosen and become weaker.

Often, the cause of OA is unknown. It is mainly related to aging, but other factors can also lead to OA.

• Osteoarthritis tends to run in families
• Being overweight increases the risk
• Fractures or other joint injuries can lead to osteoarthritis later in life
• Long-term overuse at work or in sports can lead to osteoarthritis

Medical conditions that can lead to osteoarthritis include:

• Bleeding disorders that cause bleeding in the joint, such as hemophilia
• Disorders that block the blood supply near a joint, such as avascular necrosis
• Other types of arthritis, such as chronic gout, pseudogout, or rheumatoid arthritis

The symptoms of osteoarthritis usually appear in middle age and almost everyone has them by age 70. Before age 55, the condition occurs equally in men and women. After age 55, it is more common in women.

Tests & Diagnostics

A physical exam can show:

• Joint movement may cause a cracking (grating) sound
• Joint swelling (bones around the joints may feel larger than normal)
• Limited range of motion
• Tenderness when the joint is pressed
• Normal movement is often painful

No blood tests are helpful in diagnosing osteoarthritis.

An x-ray of affected joints will show a loss of the joint space. In advanced cases, there will be a wearing down of the ends of the bone and bone spurs.

Treatments

The goals of treatment are to:

• Increase the strength of the joints
• Maintain or improve joint movement
• Reduce the disabling effects of the disease
• Relieve pain

The treatment depends on which joints are involved.

MEDICATIONS

Over-the-counter pain relievers can help with symptoms. Most doctors recommend acetaminophen (Tylenol) first, because it has fewer side effects than other drugs.

If your pain continues, your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs help relieve pain and swelling. Types of NSAIDs include aspirin, ibuprofen, and naproxen.

However, long-term use of NSAIDs can cause stomach problems, such as ulcers and bleeding. These drugs may also increase the risk for heart attacks and strokes.

The prescription drug, Celebrex (a COX-2 inhibitor) may work as well as other NSAIDs. Because of a risk for heart attacks and stroke, it is given only at the lowest possible dose for the shortest possible period of time.

Corticosteroids injected right into the joint can also be used to reduce swelling and pain. However, relief only lasts for a short time.

Many people use over-the-counter remedies such as glucosamine and chondroitin sulfate. There is some evidence that these supplements can help control pain, although they do not seem to grow new cartilage. Some doctors recommend a trial period of 3 months to see whether glucosamine and chondroitin work.

Capsaicin (Zostrix) skin cream may help relieve pain. You may feel a warm, stinging sensation when you first apply the cream. This sensation goes away after a few days of use. Pain relief usually begins within 1 - 2 weeks.

Artificial joint fluid (Synvisc, Hyalgan) can be injected into the knee. It may relieve pain for 3 - 6 months.

LIFESTYLE CHANGES

Exercise helps maintain joint and overall movement. Ask your health care provider to recommend an appropriate home exercise routine. Water exercises, such as swimming, are especially helpful.

Other lifestyle recommendations include:

• Applying heat and cold
• Eating a healthy, balanced diet
• Getting rest
• Losing weight if you are overweight
• Protecting the joints

People whose work is causing stress in certain joints should find ways to reduce trauma. You may need to adjust the work area or change work tasks.

PHYSICAL THERAPY

Physical therapy can help improve muscle strength and the motion at stiff joints. Therapists have many techniques for treating osteoarthritis. If therapy does not make you feel better after 3 - 6 weeks, then it likely will not work at all.

BRACES

Splints and braces can sometimes support weakened joints. Some prevent the joint from moving; others allow some movement. You should use a brace only when your doctor or therapist recommends one. Using a brace the wrong way can cause joint damage, stiffness, and pain.

SURGERY

Severe cases of osteoarthritis might need surgery to replace or repair damaged joints. Surgical options include:

• Arthroscopic surgery to trim torn and damaged cartilage
• Changing the alignment of a bone to relieve stress on the bone or joint (osteotomy)
• Surgical fusion of bones, usually in the spine (arthrodesis)
• Total or partial replacement of the damaged joint with an artificial joint (knee arthroplasty, hip arthroplasty)

Drugs

Patients with mild OA may be treated only with pain relievers such as acetaminophen (i.e., Tylenol). Most patients with OA, however, are given nonsteroidal anti-inflammatory drugs (NSAIDs). These include compounds such as ibuprofen (e.g., Motrin, Advil), ketoprofen (e.g., Orudis), and naproxen (e.g. Naprosyn). NSAIDs have the advantage of relieving slight inflammation as well as pain. Patients taking NSAIDS, however, may experience side effects, including stomach ulcers, sensitivity to sun exposure, kidney disturbances, and nervousness/anxiety or depression. Topical capsaicin cream (e.g., AthriCare) may provide relief when applied to affected areas.

Some OA patients are treated with corticosteroids, which are injected directly into the joints to reduce inflammation. As of 2001, studies were being conducted regarding the use of hyaluronic acid, which is more commonly injected into the knee. Because the joint naturally contains some hyaluronic acid (for joint lubrication), the addition of extra hyaluronic acid can protect the joint, in some cases, for six months to one year.

Alternative Therapies

For more information and support, see arthritis resources.

Complications

• Adverse reactions to drugs used for treatment
• Decreased ability to perform everyday activities, such as personal hygiene, household chores, or cooking
• Decreased ability to walk
• Surgical complications