Osteoarthritis

Arthritis refers to biomechanical changes within a joint. Osteoarthritis (OA) is the most common kind of arthritis. There are a number of contributing factors to osteoarthritis, including age.

Causes #

• Obesity, which puts more stress on your joints, especially your knees.

• Injury or surgery to the joint - Even if a joint seems to heal the way it should, it’s at higher risk for osteoarthritis later on.

• Unusual joints at birth (congenital abnormalities). These are more likely to wear down, especially in the hip.

• Body mechanics - Things that change the way your body works, such as an unusual way of walking or joints that have a wider range of motion than usual (called hypermobility), can put more stress on them.

• Your job or hobby - Using a joint to make the same motion over and over again like squatting or lifting may be linked to osteoarthritis.

• Gout - Crystal deposits in the cartilage can cause damage and osteoarthritis. Uric acid crystals cause arthritis in gout, while calcium pyrophosphate crystals cause arthritis in pseudogout.

• Rheumatoid arthritis and other inflammatory conditions of the joints, which lead to joint damage and cartilage breakdown.

• Diabetes and other hormone disorders, which can cause inflammation that leads to osteoarthritis.

• Menopause - Levels of estrogen, which protects your bones and cartilage, fall after menopause.

Symptoms #

• The most common symptom of osteoarthritis is pain in the affected joints after repetitive use. Joint pain is usually worse later in the day.

• There can be swelling, warmth, and creaking of the affected joints.

• Pain and stiffness of the joints can also occur after long periods of inactivity, for example, sitting in a theater.

• In severe osteoarthritis, complete loss of cartilage causes friction between bones, causing pain at rest or pain with limited motion.

• Symptoms of osteoarthritis vary greatly from patient to patient. Some patients can be debilitated by their symptoms.

• On the other hand, others may have remarkably few symptoms in spite of dramatic degeneration of the joints seen on X-rays.

• Symptoms also can be intermittent. It is not unusual for patients with osteoarthritis of the hands and knees to have years of pain-free intervals between symptoms.

Diagnosis #

• X-rays of the affected joints are the main way osteoarthritis is identified.

• The common X-ray findings of osteoarthritis include loss of joint cartilage, narrowing of the joint space between adjacent bones, and bone spur formation.

• Arthroscopy is a surgical technique whereby a doctor inserts a viewing tube into the joint space.

• Abnormalities of and damage to the cartilage and ligaments can be detected and sometimes repaired through the arthroscope.

• If successful, patients can recover from the arthroscopic surgery much more quickly than from open joint surgery.

• Finally, a careful analysis of the location, duration, and character of the joint symptoms and the appearance of the joints helps the doctor in diagnosing osteoarthritis.

• Bony enlargement of the joints from spur formations is characteristic of osteoarthritis.

• Therefore, Heberden’s nodes and Bouchard’s nodes of the fingers and bunions of the feet can help the doctor make a diagnosis of osteoarthritis.

Treatment #

Nonsteroidal anti-inflammatory drugs (NSAIDs) #

• These drugs reduce inflammation as well as ease pain.

• These are some of the most popular medications given for arthritis.

• NSAIDs include aspirin, celecoxib, ibuprofen, and naproxen. They are usually taken in pill form but may cause stomach upset or bleeding.

• Make sure to follow the maximum daily dosage limits for each medication. Some are also available as creams to rub on your joints (for instance, Aspercreme).

• Some NSAIDs may increase your risk of heart disease or stroke.

• It’s actually recommended that you don’t use NSAIDs if you have an ongoing health condition such as heart disease, liver disease, or kidney disease. NSAIDs are non-narcotic and non-addictive.

Whether you should take opioids or NSAIDs is up to you and your doctor. One study showed that opioids and NSAIDS were equally effective for reducing the pain of OA of the knee about 30% pain reduction for each.

Counterirritants #

These are creams and ointments containing ingredients like menthol or capsaicin, the ingredient that makes hot peppers burn. Rubbing these on your painful joints may stop the pain signals from the joint to the brain.

Glucosamine and chondroitin #

These are over-the-counter dietary supplements that are taken by mouth. Study results show no significant benefits, so taking these may or may not help you.

Corticosteroids (steroids) #

• These are powerful medications (like cortisone and prednisone) that reduce swelling and suppress the immune system. Your doctor may give you a prescription for a pill or inject it directly at the site of your pain.

• The effects can be felt in a few days and will last for about 2 months.

• Doctors say you shouldn’t get more than four steroid shots a year and you shouldn’t stay on them indefinitely.

• Corticosteroid injections can cause nerve damage and thinning of your bone near the site of the shot, as well as the breakdown of more cartilage.

Hyaluronic Acid #

This naturally occurs in the fluid of your joints and acts as a lubricant. However, hyaluronic acid breaks down in people who have arthritis, so your doctor may give you injections of this fluid.