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Osteoarthritis

Osteoarthritis

 

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Osteoarthritis

Definition

Osteoarthritis (OA) is the most common joint disorder.

Alternative Names

Hypertrophic osteoarthritis; Osteoarthrosis; Degenerative joint disease; DJD; OA; Arthritis - osteoarthritis

Causes

Osteoarthritis is caused by 'wear and tear' on a joint.

• Cartilage is the firm, rubbery tissue that cushions your bones at the joints, and allows bones to glide over one another.
• Cartilage can break down and wear away. As a result, the bones rub together, causing pain, swelling, and stiffness.
• Bony spurs or extra bone may form around the joint, and the ligaments and muscles around the hip become weaker and stiffer.

Often, the cause of OA is unknown. It is mainly related to aging. The symptoms of OA usually appear in middle age. Almost everyone has some symptoms by age 70. However, these symptoms may be minor. Before age 55, OA occurs equally in men and women. After age 55, it is more common in women.

Other factors can also lead to OA.

• OA tends to run in families
• Being overweight increases the risk of OA in the hip, knee, ankle, and foot joints
• Fractures or other joint injuries can lead to OA later in life
• Long-term overuse at work or in sports can lead to OA

Medical conditions that can lead to OA include:

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

Symptoms

Pain and stiffness in the joints are the most common symptoms. The pain is often worse after exercise and when placing weight or pressure on the joint.

Your joints become stiff and harder to move over time. You may notice a rubbing, grating, or crackling sound when you move the joint.

The phrase "morning stiffness" refers to the pain and stiffness people feel when they first wake up in the morning. Stiffness usually lasts for 30 minutes or less. It is improved by mild activity that "warms up" the joint.

During the day, the pain may get worse with activity and feel better when you are resting. After a while, the pain may be present when you're resting. It may even wake you up at night.

Some people might not have symptoms, even though x-rays show the changes of OA.

Exams and Tests

A physical exam can show:

• Joint movement may cause a cracking (grating) sound, called crepitation
• 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 OA.

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.

Treatment

OA cannot be cured. It will also most likely become worse over time. However, your OA symptoms can be controlled.

While you can always have surgery, other therapies can improve your pain and make your life much better. Although these treatments cannot make the arthritis go away, they can often delay surgery.

MEDICATIONS

Over-the-counter pain relievers, which you can buy without a prescription, can help with OA 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.
• Taking acetaminophen or another pain pill before exercising is okay. However, do not overdo the exercise because you have taken medicine.
• If you are taking pain relievers on most days, tell your doctor. You may need to be watched for side effects, such as ulcers and bleeding. These drugs may also increase the risk for heart attacks and strokes.

Corticosteroids injected right into the joint can also be used to reduce swelling and pain. However, relief only lasts for a limited time. More than two or three injections a year may be harmful.

Many people use over-the-counter remedies such as glucosamine and chondroitin sulfate.

• These supplements may help control pain, although they do not seem to help your joint 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

As the pain from your hip or knee OA becomes worse, keeping up with everyday activities may become more difficult or painful.

• Sometimes making changes around the home will take some stress off your joints, and relieve some of the pain.
• People whose work is causing stress in certain joints should find ways to reduce trauma. You may need to adjust your work area or change work tasks.

PHYSICAL THERAPY

Physical therapy can help improve muscle strength and the motion of stiff joints, as well as your sense of balance. Therapists have many techniques for treating OA. If therapy does not make you feel better after 6 - 8 weeks, then it likely will not work at all.

Massage therapy may also help provide short-term pain relief. Make sure you work with an experienced massage therapist who understands how to work with sensitive joint areas.

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.

ALTERNATIVE TREATMENTS

Acupuncture is a treatment based on Chinese medicine. How it works is not entirely clear. Some studies have found that acupuncture may provide short-term pain relief for people with OA.

S-adenosylmethionine (SAMe, pronounced "Sammy") is a man-made form of a natural byproduct of the amino acid methionine. It has been marketed as a remedy for arthritis, but scientific evidence to support these claims is lacking.

SURGERY

Severe cases of OA 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 replacement, hip replacement, shoulder replacement, ankle replacement, elbow replacement)

Support Groups

For more information and support, see arthritis resources.

Outlook (Prognosis)

Every person with OA is different. Pain and stiffness may prevent one person from performing simple daily activities, while others are able to maintain an active lifestyle that includes sports and other activities.

Your movement may become very limited. Treatment generally improves function.

Possible 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

When to Contact a Medical Professional

Call your health care provider if you have symptoms of OA.

Prevention

Weight loss can reduce the risk of knee OA in overweight women.

References

Gregory PJ, Sperry M, Wilson AF. Dietary supplements for osteoarthritis. Am Fam Physician. 2008;77:177-184.

Hunter DJ. In the clinic: Osteoarthritis. Ann Intern Med. 2007;147(3):ITC8-1-ITC8-16.

Hunter DJ, Lo GH. The management of osteoarthritis: an overview and call to appropriate conservative treatment. Med Clin North Am. 2009;93:127-43, xi.

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