Osteoarthritis

What is Osteoarthritis?

Sometimes called degenerative joint disease or degenerative arthritis, osteoarthritis (OA) is the most common chronic condition of the joints, affecting approximately 27 million Americans. OA can affect any joint, but it occurs most often in knees, hips, lower back and neck, small joints of the fingers and the bases of the thumb and big toe.

In normal joints, a firm, rubbery material called cartilage covers the end of each bone. Cartilage provides a smooth, gliding surface for joint motion and acts as a cushion between the bones. In OA, the cartilage breaks down, causing pain, swelling and problems moving the joint. As OA worsens over time, bones may break down and develop growths called spurs. Bits of bone or cartilage may chip off and float around in the joint. In the body, an inflammatory process occurs and cytokines (proteins) and enzymes develop that further damage the cartilage. In the final stages of OA, the cartilage wears away and bone rubs against bone leading to joint damage and more pain.

Who’s Affected?

Although OA occurs in people of all ages, osteoarthritis is most common in people older than 65. Common risk factors include increasing age, obesity, previous joint injury, overuse of the joint, weak thigh muscles, and genes.

• One in two adults will develop symptoms of knee OA during their lives.
• One in four adults will development symptoms of hip OA by age 85.
• One in 12 people 60 years or older have hand OA.

Osteoarthritis Symptoms

Symptoms of osteoarthritis vary, depending on which joints are affected and how severely they are affected. However, the most common symptoms are pain and stiffness, particularly first thing in the morning or after resting. Affected joints may get swollen, especially after extended activity. These symptoms tend to build over time rather than show up suddenly. Some of the common symptoms include:

Sore or stiff joints – particularly the hips, knees, and lower back – after inactivity or overuse.

• Limited range of motion or stiffness that goes away after movement
• Clicking or cracking sound when a joint bends
• Mild swelling around a joint
• Pain that is worse after activity or toward the end of the day

Here are ways OA may affect different parts of the body:

• Hips. Pain is felt in the groin area or buttocks and sometimes on the inside of the knee or thigh.
• Knees. A “grating” or “scraping” sensation occurs when moving the knee.
• Fingers. Bony growths (spurs) at the edge of joints can cause fingers to become swollen, tender and red. There may be pain at the base of the thumb.
• Feet. Pain and tenderness is felt in the large joint at the base of the big toe. There may be swelling in ankles or toes.

OA pain, swelling or stiffness may make it difficult to perform ordinary tasks at work or at home. Simple acts like tucking in bed sheets, opening a box of food, grasping a computer mouse or driving a car can become nearly impossible. When the lower body joints are affected, activities such as walking, climbing stairs and lifting objects may become difficult. When finger and hand joints are affected, osteoarthritis can make it difficult to grasp and hold objects, such as a pencil, or to do delicate tasks, such as needlework.

Many people believe that the effects of osteoarthritis are inevitable, so they don’t do anything to manage it. OA symptoms can hinder work, social life and family life if steps are not taken to prevent joint damage, manage pain and increase flexibility.

How OA May Affect Overall Health

The pain, reduced mobility, side effects from medication and other factors associated with osteoarthritis can lead to negative health effects not directly related to the joint disease.

Diabetes and Heart Disease

Knee or hip pain may lead to a sedentary lifestyle that promotes weight gain and possible obesity. Being overweight or obese can lead to the development of diabetes, heart disease and high blood pressure. 

Falls

People with osteoarthritis experience as much as 30 percent more falls and have a 20 percent greater risk of facture than those without OA. People with OA have risk factors such as decreased function, muscle weakness and impaired balance that make them more likely to fall. Side effects from medications used for pain relief can also contribute to falls. Narcotic pain relievers can cause people to feel dizzy and unbalanced.

Osteoarthritis Causes

Although osteoarthritis was long believed to be caused by the “wear and tear” of joints over time, scientists now view it as a disease of the joint. Here are some of the factors that contribute to the development of OA:

Genes: Various genetic traits can make a person more likely to develop OA. One possibility is a rare defect in the body’s production of collagen, the protein that makes up cartilage. This abnormality can cause osteoarthritis to occur as early as age 20. Other inherited traits may result in slight defects in the way the bones fit together so that cartilage wears away faster than usual. Researchers have found that a gene called FAAH, previously linked to increased pain sensitivity, is higher in people with knee OA than in people who don’t have the disease.

Weight: Being overweight puts additional pressure on hips and knees. Many years of carrying extra pounds can cause the cartilage that cushions joints to break down faster. Research has shown there is a link between being overweight and having an increased risk of osteoarthritis in the hands. These studies suggest that excess fat tissue produces inflammatory chemicals (cytokines) that can damage the joints. 

Injury and overuse: Repetitive movements or injuries to joints (such as a fracture, surgery or ligament tears) can lead to osteoarthritis. Some athletes, for example, repeatedly damage joints, tendons and ligaments, which can speed cartilage breakdown. Certain careers that require standing for long periods of time, repetitive bending, heavy lifting or other movements can also make cartilage wear away more quickly. An imbalance or weakness of the muscles supporting a joint can also lead to altered movement and eventual cartilage breakdown in joints.

Others: Several other factors may contribute to osteoarthritis. These factors include bone and joint disorders like rheumatoid arthritis, certain metabolic disorders such as hemochromatosis, which causes the body to absorb too much iron, or acromegaly, which causes the body to make too much growth hormone. 

Osteoarthritis Diagnosis

To diagnose osteoarthritis, the doctor will collect information on personal and family medical history, perform a physical examination and order diagnostic tests.

Health History and Symptoms

The information needed to help diagnose osteoarthritis includes:

• Description of the symptoms
• Details about when and how the pain or other symptoms began
• Details about other medical problems that exist
• Location of the pain, stiffness or other symptoms
• How the symptoms affect daily activities
• List of current medications

Physical Examination

During the exam, the doctor will examine the joints and test their range of motion (how well each joint moves through its full range). He will be looking for areas that are tender, painful or swollen as well as signs of joint damage. The doctor will examine the position and alignment of the neck and spine.

Diagnostic Tests

A diagnosis of osteoarthritis may be suspected after a medical history and physical examination is done. Blood tests are usually not helpful in making a diagnosis. However, the following tests may help confirm it:

• Joint aspiration. The doctor will numb the affected area and insert a needle into the joint to withdraw fluid. The fluid will be examined for evidence of crystals or joint deterioration. This test can help rule out other medical conditions or other forms of arthritis.
• X-ray. X-rays can show damage and other changes related to osteoarthritis to confirm the diagnosis.
• MRI. Magnetic resonance imaging (MRI) does not use radiation. It is more expensive than X-rays, but will provide a view that offers better images of cartilage and other structures to detect early abnormalities typical of osteoarthritis.

Osteoarthritis Treatment

Osteoarthritis is a chronic (long-term) disease. There is no cure, but treatments are available to manage symptoms. Long-term management of the disease will include several factors:

• Managing symptoms, such as pain, stiffness and swelling
• Improving joint mobility and flexibility
• Maintaining a healthy weight
• Getting enough of exercise 

Physical Activity

One of the most beneficial ways to manage OA is to get moving. While it may be hard to think of exercise when the joints hurt, moving is considered an important part of the treatment plan. Studies show that simple activities like walking around the neighborhood or taking a fun, easy exercise class can reduce pain and help maintain (or attain) a healthy weight.

Strengthening exercises build muscles around OA-affected joints, easing the burden on those joints and reducing pain. Range-of-motion exercise helps maintain and improve joint flexibility and reduce stiffness. Aerobic exercise helps to improve stamina and energy levels and also help to reduce excess weight. Talk to a doctor before starting an exercise program.

The U.S. Department of Health and Human Services recommends that everyone, including those with arthritis, get 150 minutes of moderate exercise per week.

Weight Management

Excess weight adds additional stress to weight-bearing joints, such as the hips, knees, feet and back. Losing weight can help people with OA reduce pain and limit further joint damage. The basic rule for losing weight is to eat fewer calories and increase physical activity.

Stretching

Slow, gentle stretching of joints may improve flexibility, lessen stiffness and reduce pain. Exercises such as yoga and tai chi are great ways to manage stiffness.

Pain and Anti-inflammatory Medications

Medicines for osteoarthritis are available as pills, syrups, creams or lotions, or they are injected into a joint. They include:  

• Analgesics. These are pain relievers and include acetaminophen, opioids (narcotics) and an atypical opioid called tramadol. They are available over-the-counter or by prescription.
• Nonsteroidal anti-inflammatory drugs (NSAIDs). These are the most commonly used drugs to ease inflammation and related pain. NSAIDs include aspirin, ibuprofen, naproxen and celecoxib. They are available over-the-counter or by prescription.

• Corticosteroids. Corticosteroids are powerful anti-inflammatory medicines. They are taken by mouth or injected directly into a joint at a doctor’s office.

• Hyaluronic acid. Hyaluronic acid occurs naturally in joint fluid, acting as a shock absorber and lubricant. However, the acid appears to break down in people with osteoarthritis. The injections are done in a doctor’s office.

Physical and Occupational Therapy

Physical and occupational therapists can provide a range of treatment options for pain management including:

• Ways to properly use joints
• Heat and cold therapies
• Range of motion and flexibility exercises
• Assistive devices

Assistive Devices

Assistive devices can help with function and mobility. These include items, such as like scooters, canes, walkers, splints, shoe orthotics or helpful tools, such as jar openers, long-handled shoe horns or steering wheel grips. Many devices can be found at pharmacies and medical supply stores. But some items, such as custom knee braces and shoe wedges are prescribed by a doctor and are typically fitted by a physical or occupational therapist.

Natural and Alternative Therapies

Many people with OA use natural or alternative therapies to address symptoms and improve their overall well-being. These include nutritional supplements, acupuncture or acupressure, massage, relaxation techniques and hydrotherapy, among others.

Surgery

Joint surgery can repair or replace severely damaged joints, especially hips or knees. A doctor will refer an eligible patient to an orthopaedic surgeon to perform the procedure.

Positive Attitude

Many studies have demonstrated that a positive outlook can boost the immune system and increase a person's ability to handle pain.