What is Osteoarthritis?
Arthritis is a general term that means inflammation of the joints. Osteoarthritis, (OA) commonly known as wear and tear arthritis, is the most common type of arthritis. Sometimes it is called degenerative joint disease and is associated with a breakdown of cartilage in joints and can occur in almost any joint in the body. It commonly occurs in the weight-bearing joints of the hips, knees, and spine. It also affects the fingers, thumb, neck, and large toe. Healthy cartilage allows bones to glide over one another and absorbs energy from the shock of physical movement.
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.
Most people over age 60 have osteoarthritis to some degree, but its severity varies. Even people in their 20s and 30s can get osteoarthritis, although there is often an underlying reason, such as joint injury or repetitive joint stress from overuse. In people over age 50, more women than men have 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.
- Stiffness after periods of rest.
- Bony enlargements in the middle and end joints of the fingers (which may or may not be painful).
- Joint swelling.
What are the contributing factors to developing Osteoarthritis?
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.
- Obesity. Obesity increases the risk for osteoarthritis of the knee, hip, and spine.
- 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. 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.
- Other diseases. People with rheumatoid arthritis, the second most common type of arthritis, are more likely to develop osteoarthritis. In addition, certain rare conditions, such as iron overload or excess growth hormone, increase the chance of developing OA.
How Is Osteoarthritis Diagnosed?
The diagnosis of osteoarthritis is based on a combination of the following factors:
- Your description of symptoms.
- The location and pattern of pain.
- Physical exam.
Your doctor may use X-rays to help confirm the diagnosis and make sure you don't have another type of arthritis. X-rays show how much joint damage has occurred. Sometimes, blood tests will be performed 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) for examination under a microscope to rule out other diseases.
How Is Osteoarthritis Treated?
Osteoarthritis usually is treated by a combination of treatments, including exercise, weight loss if needed, medications, physical therapy with muscle strengthening exercises, hot and cold compresses to the painful joint, removal of joint fluid, injection of medications into the joint, and use of supportive devices such as crutches or canes. Surgery may be helpful to relieve pain when other treatment options have not been effective.
The type of treatment will depend on several factors, including your age, activities and occupation, overall health, medical history, location of your osteoarthritis, and severity of the condition.
How Does Weight and Exercise Impact Osteoarthritis?
Staying at your recommended weight helps prevent osteoarthritis of the knees, hips, and spine, reduces the stress on these weight-bearing joints, and reduces pain in joints already affected. 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. Exercises that strengthen the muscles reduce pain in patients with osteoarthritis, particularly with osteoarthritis of the knee.
What Medications Are Used to Treat Osteoarthritis?
The first step with medication is often over-the-counter pain relievers as needed. These include acetaminophen (Tylenol), ibuprofen (Advil, Motrin), and naproxen (Aleve). Don't take over-the-counter medications for more than 10 days without checking with your doctor. If over-the-counter treatments aren't effective, your doctor may decide to prescribe a stronger anti-inflammatory drug or other medication to help ease the pain. 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.
Injections of hyaluronic acid directly into the knee joint 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.
What Supportive Devices Are Available to Help With Osteoarthritis?
Supportive or assistive devices can help to decrease pressure on the joints with osteoarthritis. 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.
In addition to pain relief, assistive devices improve function and prevent falls. There are also many available devices to help you perform routine daily activities that may be difficult, such as housework or cooking.
Is There a Surgery for Osteoarthritis?
When osteoarthritis pain is not controlled with other treatments, or when the pain prevents you from participating in your normal activities, you may want to consider surgery.
There are several types of surgery for osteoarthritis. They include:
- Arthroscopy to clean out the damaged cartilage or repair tissues. It is most commonly performed on the knee and shoulder.
- Joint resurfacing surgery to replace the damaged joint with an artificial one. Joint resurfacing surgery should be considered when function and quality of life are impacted. Even under the best of circumstances, surgery cannot return the joint to its normal state, but movement and function will be significantly improved. In addition, an artificial joint will greatly diminish pain. The two joints most often replaced are the hip and the knee. Artificial joints are now also available to replace shoulders, fingers, elbows, and ankles to treat severe pain that has not responded to other treatments.
- Joint fusion to remove the damaged joint and fuse the two bones on each side of the joint. This is done more often in areas in which joint replacement is not effective.
Together, you and Dr. Hayter, will discuss a treatment plan that best fits your specific diagnosis and to help improve your quality of life.