Osteoarthritis

What is osteoarthritis?

Osteoarthritis (OA) is the most common degenerative joint disease, affecting nearly 30 million Americans. It occurs most frequently in the fingers, neck, spine, hips, knees, and feet but it can occur in any joint on the body. OA is generally an age-related condition.

Over time, the cartilage between joints gets gradually worn down. Cartilage is a slippery tissue that covers bone endings, allowing for frictionless joint movement. When OA occurs, the slippery cartilage surface becomes bumpy and rough. This loss of cartilage can cause pain and deformity, and sometimes swelling of a joint. Eventually, if enough cartilage is worn away, the underlying bone is exposed and the range of motion becomes limited and painful.

Both men and women get OA and no race or ethnic background is impacted more than another; age is the greatest risk factor for OA. After age 55, women tend to have an even higher risk for OA than men. Arthritis and osteoarthritis are sometimes used synonymously because OA is the most common form of arthritis.

What causes osteoarthritis?

Despite the pervasiveness of the disease, the causes are not wholly understood. Scientists view OA as a disease of the joint, influenced by risk factors such as age, obesity, overuse of the joint, and heredity.

If you have had joint injuries, either from an accident or from playing a sport, you are also at risk for developing OA. These joint injuries, even if they occurred years ago and have not caused lasting symptoms, can lead to OA later in life. Similarly, there are some occupations and hobbies that cause repetitive stress on specific joints that can lead to OA over time.

Everyone is at risk for OA as we age and women are at greater risk than men as they age.

What are the symptoms of osteoarthritis?

OA symptoms gradually develop over time, tending to improve at rest and become more painful during and after the joint is active. In addition to joint pain, specific symptoms of OA include:

• grating noise or a grating sensation when you use the joint
• joint stiffness and difficulty moving your joints through their typical range of motion after a period of inactivity
• tender and sensitive, or even painful joint when light pressure is applied. Over time, you may feel a hard lump or spur that can form around the affected joint.

How is osteoarthritis diagnosed?

To diagnose OA, your rheumatologist will examine your joints to assess your range of motion and determine whether the joint is red, swollen, or painful if touched. Your physician will pay close attention to your knees and hips, the weight-bearing joints, as well as any joints where you are experiencing pain. It will be important to assess how symptoms occur over the course of the day.

Your rheumatologist may ask you questions such as: do you feel joint pain in the morning that is relieved after you start moving? Do your joints ever “lock” or feel like they are going to give out on you (another symptom of OA)?

There is no blood test for OA, but your physician may take samples of your blood to rule out other causes of joint pain such as rheumatoid arthritis. Your doctor may also draw a sample of the joint fluid to rule out gout or infection.

After your examination, you may be sent for imaging of a joint, either by X-ray or MRI (magnetic resonance imaging). X-ray is a less expensive and more conventional way to confirm advanced OA. An X-ray does not show cartilage but its loss can be measured by seeing loss of space around joints; it also shows bony spurs that may have formed. MRI has the added benefit of showing more than just bone; it can also image cartilage and tendons. MRI is more sensitive for detecting early OA but its expense limits its use.

How is osteoarthritis treated?

There is no cure for OA. Treatment is aimed at symptom management. Treatments can be very effective at controlling symptoms by alleviating pain, improving quality of life, and maintaining functional independence. Your physician will likely suggest starting with lifestyle changes and non-drug interventions before prescribing medications and being more aggressive in their treatment plan.

Treatment can be divided into three types: non-pharmacological management, medication (either over-the-counter or prescribed medications), and surgical intervention.

Non-pharmacological Management

• Weight reduction: Overweight and obese OA patients have experienced meaningful pain reduction by losing weight, which reduces stress on weight-bearing joints.
• Exercise: Exercise is a demonstrated tool for managing OA pain. Strength and flexibility training have the dual benefits of stabilizing joints and improving mobility, even preventing falls. You can do this on your own or with a physical therapist who will design a personalized exercise program to strengthen muscles around your joints, increase your range of motion, and reduce pain. Avoid exercises that stress your joints or cause pain.
• Occupational therapy: Occupational therapists work with OA patients to teach them how to do everyday tasks like brush your teeth or open the refrigerator in ways that minimize stress on your joints.
• Tai chi and yoga: These are two examples of movement therapies that combine deep breathing with exercises and stretching. Like other forms of exercise, avoid moves that cause joint pain.
• Acupuncture: An ancient Chinese medical practice that involves pricking the skin with thin needles and leaving the pins in place for up to an hour. Acupuncture can be used to alleviate pain and treat various physical, mental, and emotional conditions.
• Nutritional supplements: Health food stores sell nutritional supplements that are not necessarily of proven benefit. Be sure to tell your doctor what supplements you take to avoid the risk of interference with your other medications.

Medication

When self-care treatments do not relieve your symptoms, there are some prescription medicines your rheumatologist may prescribe. These include nonsteroidal anti-inflammatory agents (NSAIDs), which can be given as pills or as ointments and gels; pain medications; and corticosteroid and lubricant injections directly into the joint.

Surgical Management

Some OA patients eventually need more than medications and non-pharmacological treatments to manage their pain and mobility. This is when your rheumatologist will have you consider surgical intervention. Surgery options range from arthroscopic repair of meniscal tears to joint replacement. The artificial joints and cartilage are made of metal and plastic and mimic the action of the original, undamaged joint. Recovery involves physical therapy to rebuild muscle tissue. Artificial joints have a life span of around 20 years, possibly needing replacement over time.