Osteoarthritis (OA, also known as degenerative arthritis or degenerative joint disease, and sometimes referred to as “arthrosis” or “osteoarthrosis” or in more colloquial terms “wear and tear”), is a condition in which low-grade inflammation results in pain in the joints, caused by wearing of the cartilage that covers and acts as a cushion inside joints. As the bone surfaces become less well protected by cartilage, the patient experiences pain upon weight bearing, including walking and standing. Due to decreased movement because of the pain, regional muscles may atrophy, and ligaments may become more lax. OA is the most common form of arthritis. The word is derived from the Greek word “osteo”, meaning “of the bone”, “arthro”, meaning “joint”, and “itis”, meaning inflammation, although many sufferers have little or no inflammation.
Osteoarthritis is known by many different names, including degenerative joint disease, ostoarthrosis, hypertrophic arthritis and degenerative arthritis. Your doctor might choose to use one of these terms to better describe what is happening in your body, but for our purposes, we will refer to all of these as osteoarthritis.
OA affects nearly 21 million people in the United States, accounting for 25% of visits to primary care physicians, and half of all NSAID (Non-Steroidal Anti-Inflammatory Drugs) prescriptions. It is estimated that 80% of the population will have radiographic evidence of OA by age 65, although only 60% of those will be symptomatic.

Signs and Symptoms of Osteoarthritis

While each person is an individual and may be affected differently by osteoarthritis, we will discuss the general symptoms you want to look for if you suspect you have arthritis. Remember, it is crucial that you go to your doctor for a diagnosis before you treat your OA. Several other conditions seem similar to OA, but are treated in different ways.

While many people think of OA as the inevitable result of aging and wear on the joints, this isn’t true. The knees, hips, fingers, neck and lower back are most commonly affected by OA, while the knuckles, wrists elbows, shoulders and ankles are rarely affected except in usually cases of overuse or injury. “If OA was caused by simple wear and tear, you would expect these body parts to be affected more often,” notes David S. Pisetsky, MD, in his book The Duke University Medical Center Book of Arthritis.

Most often, OA develops gradually. It may start as soreness or stiffness that seems more a nuisance than a medical concern. Pain may be moderate, intermittent and not interfere with your day-to-day existence. Some people’s OA will never progress past this early stage. Others will have their OA progress to a point where it interferes with daily activities and pain and stiffness make it difficult to walk, climb stairs or sleep. Rarely, a person with OA will experience sudden signs of inflammation such as redness, pain and swelling, known as inflammatory or erosive osteoarthritis.

The most common signs and symptoms of osteoarthritis are:

  • Joint soreness after periods of overuse or inactivity.
  • Stiffness after periods of rest that goes away quickly when activity resumes.
  • Morning stiffness, which usually lasts no more than 30 minutes.
  • Pain caused by the weakening of muscles surrounding the joint due to inactivity.
  • Joint pain is usually less in the morning and worse in the evening after a day’s activity.
  • Deterioration of coordination, posture and walking due to pain and stiffness.

If OA is in the hips, you may experience:

  • Pain in groin, inner thigh and buttock
  • Referred pain in knee and side of thigh
  • Limping when walking

If OA is in the knees, you may experience:

  • Pain when moving the knee
  • Grating or catching when moving the knee
  • Pain when walking up and down stairs or getting up from a chair
  • Pain that prevents you from exercising your leg
  • Weakened large thigh muscles

If OA is in the fingers, you may experience:

  • Pain and swelling of the finger joints.
  • Bony growth spurs at the joint at the end of the finger, called Heberden’s nodes, or at the middle joint, called Bouchard’s nodes.
  • Redness, tenderness and swelling in the affected joints, especially early on when the nodes are forming.
  • Enlarged joints.
  • Difficulty with pinching movements, such as picking an item up from a table or grasping a pencil or pen.

If OA is in the feet, you may experience:

  • Pain and tenderness in the large joint at the base of the big toe.
  • Pain when wearing tight shoes or high heels.

If OA is in the spine, you may experience:

  • A breakdown of the spinal discs resulting in bony overgrowth.
  • Stiffness and pain in the neck and lower back.
  • Pressure on the nerves in the spinal cord (pinched nerves).
  • Pain in the neck, shoulder, arm, lower back and legs.
  • Weakness or numbness in arms and legs due to pinched nerves.

Causes of Osteoarthritis

While there isn’t any single known cause of osteoarthritis (OA), there are several risk factors that should be considered. Knowing and controlling these risk factors can help you minimize your risk or even help you prevent getting OA altogether. Keep in mind that having risk factors for OA doesn’t mean you will definitely get it. No single risk factor is enough to cause OA; it is more likely that a combination of risk factors works together to cause the disease.
There are two distinct types of osteoarthritis – primary and secondary. Primary osteoarthritis is the type associated with aging and is thought of as “wear and tear” osteoarthritis. The older you are, the more likely it is that you will have some degree of primary arthritis. In fact, if we live long enough, most of us will experience primary osteoarthritis, even if it is just a touch. There is no apparent cause for this type of osteoarthritis.
In contrast, when someone is diagnosed with secondary osteoarthritis, it is because there is an apparent cause for the disease. In other words, the breakdown of cartilage can be associated to injury, heredity, obesity or something else.

Listed below are the risk factors for osteoarthritis.

  1. Age. Incidences of OA increase as you age. Since “wear and tear” does play a part in the development of OA, the older you are, the more you have used your joints. Although age is an important risk factor, it doesn’t mean that OA is inevitable.
  2. Obesity. Obesity is a nationwide epidemic and you hear about the danger from it every day on the news. Increased body weight is a serious factor in the development of OA, particularly in your knees, which carry the brunt of your weight day in and day out. For every pound you gain, you add 3 pounds of pressure on your knees and six times the pressure on your hips. Since weight gain gradually increases the stress on joints, the weight you gain the decade before you have OA symptoms, particularly in middle age, plays a big role in determining if you will have OA.
  3. Injury or Overuse. Athletes and people who have jobs that require doing repetitive motion, such as landscaping, typing or machine operating, have a higher risk of developing OA due to injury and increase stress on certain joints. OA also develops in later years in joints where bones have been fractured or surgery has occurred. It is important for athletes to learn to take precautions to avoid injury and for people in repetitive jobs to modify their movements to lessen this stress. Note: Avoiding repetitive movement shouldn’t be interpreted as not exercising. Regular moderate exercise strengthens the joint causing it to be more stable, thereby, reducing the risk of OA in that joint.
  4. Genetics or Heredity. It is becoming more and more clear that genetics plays a role in the development of OA, particularly in the hands. This shows itself in many ways. Inherited abnormalities of the bones that affect the shape or stability of the joints can lead to OA. It is also more common in joints that don’t fit together smoothly. For example, a bowlegged person is more likely to develop OA. Increased laxity or being double jointed also increases the risk of OA. Recently, researchers have been looking at a defect in the gene responsible for manufacturing cartilage as a risk factor. Just because you have one of these inherited traits, doesn’t mean that you are going to develop OA. It just means that your doctor should check you more closely and more frequently for signs and symptoms of the disease.
  5. Muscle Weakness. Studies of the knee muscles not only show that weakness of the muscles surrounding the knee can lead to OA, but that strengthening exercises for thigh muscles are important in reducing the risk.
  6. Other Diseases and Types of Arthritis. People with rheumatoid arthritis tend to have a greater chance of developing OA. Also, hemochromotosis, or having too much iron, can damage cartilage to the point of chronic deterioration. Acromegaly, or excess growth hormone, also has adverse affects on the bones and joints and can lead to OA.

Diagnosis of Osteoarthritis

Diagnosis is normally done through x-rays. This is possible because loss of cartilage, subchondral (“below cartilage”) sclerosis, subchondral cysts, narrowing of the joint space between the articulating bones, and bone spur formation (osteophytes) show up clearly on x-rays. Plain films, however, often do not correlate well with the findings of physical examination of the affected joints.
With or without other techniques, such as MRI (magnetic resonance imaging), arthrocentesis and arthroscopy, diagnosis can be made by a careful study of the duration, location, the character of the joint symptoms, and the appearance of the joints themselves. As yet, there are no methods available to detect OA in its early and potentially treatable stages.
In 1990, the American College of Rheumatology, using data from a multi-center study, developed a set of criteria for the diagnosis of hand osteoarthritis based on hard tissue enlargement and swelling of certain joints. These criteria were found to be 92% sensitive and 98% specific for hand osteoarthritis versus other entities such as rheumatoid arthritis and spondyloarthropities.

Treatment of Osteoarthritis

It is important that you get your osteoarthritis (OA) diagnosed and treated as early as possible. Generally speaking, the process of clinically detectable osteoarthritis is irreversible, and typical treatment consists of medication or other interventions that can reduce the pain of OA and thereby improve the function of the joint.

Coping skills and lifestyle changes

No matter what the severity, or where the OA lies, conservative measures, such as weight control, appropriate rest and exercise, and the use of mechanical support devices are usually beneficial to sufferers. In the case of OA of the knees, knee braces, a cane, or a walker can be a helpful aid for walking and support. Regular exercise, if possible, in the form of walking or swimming, is encouraged. Applying local heat before, and cold packs after exercise, can help relieve pain and inflammation, as can relaxation techniques. Weight loss can relieve joint stress and may delay progression. Proper advice and guidance by a health care provider is important in OA management, enabling people with this condition to improve their quality of life. In 2002, a randomized, blinded assessor trial was published showing a positive effect on hand function with patients who practiced home joint protection excercises (JPE). Grip strength, the primary outcome parameter, increased by 25% in the excericse group versus no improvement in the control group. Global hand function improved by 65% for those undertaking JPE. Dealing with chronic pain can be difficult and result in depression. Communicating with other patients and carers can be helpful, as can maintaining a positive attitude. People who take control of their treatment, communicate with their health care provider, and actively manage their arthritis experience can reduce pain and improve function.

Dietary

Supplements which may be useful for treating OA include:

  • Antioxidants, including vitamins C and E in both foods and supplements, provide pain relief from OA.
  • Chondroitin sulphate improves symptoms of OA, and delays its progression (Poolsup N et al, 2005).
  • Hydrolyzed collagen (hydrolysate) (a gelatin product) may also prove beneficial in the relief of OA symptoms, as substantiated in a German study by Beuker F. et. al. and Seeligmuller et. al. In their 6-month placebo-controlled study of 100 elderly patients, the verum group showed significant improvement in joint mobility.
  • Ginger (rhizome) extract – has improved knee symptoms moderately.
  • Glucosamine: A molecule derived from glucosamine is used by the body to make some of the components of cartilage and synovial fluid. Supplemental glucosamine may improve symptoms of OA and delay its progression (Poolsup N et al, 2005). However, a recent large study suggests that glucosamine is not effective in treating OA of the knee.
  • Methylsulfonylmethane (MSM): A small study by Kim et al. suggested that MSM significantly reduced pain and improved physical functioning in OA patients without major adverse events (Kim et al). The authors cautioned that although this short pilot study did not address the long-term safety and usefulness of MSM, they suggest that physicians should consider its use for certain osteoarthritis patients.
  • S-adenosyl methionine: small scale studies have shown it to be as effective as NSAIDs in reducing pain, although it takes about four weeks for the effect to take place.
  • Selenium deficiency has been correlated with a higher risk and severity of OA, therefore selenium supplementation may reduce this risk.
  • Vitamin B9 (folate) and B12 (cobalamin) taken in large doses significantly reduced OA hand pain, presumbably by reducing systemic inflammation.
  • Vitamin D deficiency has been reported in patients with OA, and supplementation with Vitamin D3 is recommended for pain relief.

Other nutritional changes shown to aid in the treatment of OA include decreasing saturated fat intake and using a low energy diet to decrease body fat. Lifestyle change may be needed for effective symptomatic relief, especially for knee OA.[15] Reducing sugar, processed foods, fatty foods and nightshade vegetables have helped many. According to Dr. John McDougall,[16] a low fat vegetarian diet can reduce arthritis symptoms. A macrobiotic diet has been known to reduce symptoms as well.

Medications

Most people with osteoarthritis will use drug therapy to ease the symptoms of the disease. Most drugs focus mainly on relieving pain, but some are targeted at other symptoms and slowing disease progression. You and your doctor should work together to find the combination of medications that works best for you. Following are examples of medications your doctor might consider.

  • Analgesics – Analgesics relieve pain without relieving inflammation or swelling. If you are only interested in pain relief, these drugs tend to have fewer side effects. They are recommended for people with mild-to-moderate pain. Examples of analgesics include acetaminophen, propoxyphene hydrochloride, and tramadol.
  • Topical Analgesics – Topical analgesics include creams or rubs that are applied directly over the painful area. These are available over-the-counter and often can be used in combination with oral medications to relieve pain. Never use topical analgesics with heat treatments; the combination can cause serious burns. Active ingredients include counterirritants (wintergreen oil, camphor, eucalyptus), which stimulate nerve endings to distract the brain from joint pain; salicylates, which hamper the activity of prostaglandins, which are chemicals in the body involved in pain and inflammation; and capsaicin, which uses the natural ingredient found in cayenne peppers to relieve pain by depleting a neurotransmitter that sends pain messages to the brain.
  • Nonsteroidal anit-inflammatory drugs (NSAIDs) – NSAIDs reduce inflammation and swelling as well as aid in pain relief and are recommended for people who have moderate-to-severe pain and signs of inflammation associated with OA. Examples of NSAIDs include aspirin, ibuprofen, ketoprofen, naproxen, naproxen sodium and meloxicam.
  • Cox-2 Drugs – Cox-2 drugs are targeted NSAIDs that don’t cause the stomach irritation associated with traditional NSAIDs. Examples of cox-2 drugs are celecoxib and valdecoxib.
  • Injectable glucocorticoids – Injectable glucocorticoids are steroids that are injected into the joint for fast, targeted pain relief. They are recommended as an alternative initial therapy for people with moderate-to-severe knee pain and signs of inflammation who do not get relief from acetaminophen. You may only have these injections in the same joint three or four times a year.
  • Viscosupplements – Viscosupplementation is used specifically for knee osteoarthritis and must be administered by an orthopaedic surgeon. It involves a series of injections over a period of weeks into the joint of hylauronic acid, a substance found in the body that gives joint fluid its viscosity. Examples are Synvisc and Hyalgan.

Surgery

If the above management is ineffective, joint replacement surgery may be required. Individuals with very painful OA joints may require surgery such as fragment removal, repositioning bones, or fusing bone to increase stability and reduce pain.

Other approaches

There are various other modalities in use for osteoarthritis:

  • After three years trial at Indian Air Force run Institute of Aerospace Medicine, Bangalore (India), a new non-invasive treatment has been found quite effective. It applies the revolutionary Rotational Field Quantum Magnetic Resonance (“RFQMR”) for regeneration of cartilage in the knee joints. RFQMR Technology utilizes highly complex quantum electromagnetic beams in the sub-radio and near-radio frequency spectrum. The beams are precisely controlled and focused onto tissues to alter the proton spin inside and outside the cells generating streaming voltage potentials resulting in stimulation of cartilage growth in case of degenerative diseases such as Osteoarthritis. The treatment is painless, safe and scientifically proven through successful clinical trials involving more than 500 patients over the span of 3 years. Now this treatment is available at Bangalore and Mumbai, India.(www.cartigen.org)
  • Low level laser therapy ; this is a light wave based treatment that may reduce pain. The treatment is painless, inexpensive and without risks or side effects. Unfortunately, it may not actually have any real benefits.
  • Prolotherapy (proliferative therapy); this is the injection of an irritant substance (such as dextrose) to create an acute inflammatory reaction. It is claimed to strengthen and heal damaged tissues including ligaments, tendons and cartilage as part of this reaction. The injection is painful (like corticosteroids or hyaluronic acid) and may cause an increase in pain for a few days afterwards. The only other significant risk is the rare possibility of infection.
  • Radiosynoviorthesis: A radioactive isotope (a beta-ray emitter with a brief half-life) is injected into the joint to soften the tissue. Due to the involvement of radioactive material, this is an elaborate and costly procedure, but it has a success rate of around 80%.

Prognosis

The most common course of OA is an intermittent, progressive worsening of symptoms over time, although in some patients the disease stabilizes. Prognosis also varies depending on which joint is involved.
Factors associated with progression of OA:

  • Knees: High body mass index, varus or valgus knee deformity.
  • Hips: Night pain, presence of femoral osteophytes, and subchondral sclerosis in females.
  • Hands: Older age.

Sources: wikipedia, disease center, realage

Related Posts