Osteoarthritis

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Osteoarthritis (OA) is a form of arthritis caused by degeneration of the cartilage that covers the bone ends in a joint and prevents the bones from direct contact with each other. It is also known as wear and tear arthritis or alternatively as degenerative joint disease.

Osteoarthritis is the most common type of arthritis among North American adults and most typically occurs in the knees, hands and hips..

The deterioration of cartilage that is at the root of OA typically occurs slowly and gradually. It is usually accompanied by changes in the bone underlying the cartilage as well.

As these changes occur, you feel pain, swelling and stiffness of the affected joint. The joint will tend to lose its flexibility, strength and range of motion. Asa a result, people with osteoarthritis experience increasing difficulty performing basic functions like, for example, taking a walk or climbing stairs. The pain and discomfort will eventually start to reduce your sleeping hours.

Unfortunately, to date there is no fundamental treatment for OA that will either reverse or even halt the underlying changes in bone or cartilage. Instead, treatment of osteoarthritis usually involves slowing the rate of progression of the disease and taking steps to preserve as much joint range of motion as possible. To this end, doctors may at first  suggest activity modification, pain relief or anti inflammatory medications and undergoing physical therapy programs.

As the disease progresses, surgical intervention may be considered to either change the shape of bones in the joint  or to fuse them together. As a last resort, joint replacement surgery (e.g. knee replacement) may be suggested.

Osteoarthritis Risk Factors

Your are more likely to develop osteoarthritis may be higher if any of the following is true in your case:

  • You are over age 50 – the incidence of the disease increases with age;
  • You are female – women tend to develop OA at higher rates than men;
  • You have either suffered a traumatic joint injury in the past or subjected the joint to repetitive stress over an extended period. This increases the likelihood that OA may appear in the same joint at a later time;
  • You are carrying excess body weight or are obese. This places more stress on weight bearing joints like the knees and hips.
  • There is also some evidence to suggest that metabolic changes that accompany obesity  may play a role in the joint damage that causes osteoarthritic pain;;
  • Family history – you may have higher OA risk if a close family member has suffered from the disease;
  • Ethnicity – the OA risk appears to vary with this factor. For example, people who belong to some Asian ethnic groups appear to have a lower OA incidence.

Osteoarthritis Symptoms

Symptoms of osteoarthritis include the following:

  • Joint pain or ache while you are using the joint and after a long period of use;
  • Joint stiffness upon awakening in the morning or after a period of daytime rest;
  • Reduced range of joint motion. Your range of motion may gradually recover after you begin moving the joint;
  • You may hear a clicking or cracking sound when attempting joint flexion or extension, a phenomenon known as joint crepitus;
  • The affected joint may be swollen;
  • Muscles around the joint may feel weak;
  • Weight bearing joints like the knee or hip may start to give way when weight is placed on them, i.e. you may start to experience joint instability.

These symptoms will appear gradually over time instead of appearing suddenly.

As your osteoarthritis worsens, the once smooth and slick cartilage covering  the bone ends inside the joint may start to develop uneven edges and cracks. In addition, your bones may harden and develop lumps (known as bone spurs). The shape of the joint bone may also change. These changes are unfortunately irreversible.

Possible Complications

Osteoarthritis has a number of long term complications, including the following:

  • Lost mobility – as the arthritis pain experienced during movement increases, you may find yourself changing your lifestyle so as to avoid movement and the associated pain;
  • The knock on effect of reduced mobility is increased obesity;
  • Obesity may in turn produce elevated blood pressure, cholesterol – health problems that together tend to produce a condition known as metabolic syndrome;
  • The result of the preceding can be an elevated risk of heart disease or stroke;
  • The forced changes in lifestyle and activity level can lead to a dramatic loss of quality of life and, with it, possible depression.

In addition to the above complications of OA, the treatment of the disease may involve taking medications that bring their own side effects such as increased occasional dizziness. This in turn increases the risk of falling and experiencing bone fractures.

If you think you are experiencing some of the symptoms listed above, you should consult a doctor as soon as possible. As with many other health conditions, early diagnosis of OA and timely commencement of managing the disease are key to keeping the symptoms at a tolerable level.

Diagnosis

Medical History

To diagnose the cause of joint pain and stiffness, your doctor may start by reviewing your medical history. As we have mentioned above, a past  joint injury can be a trigger for later development of OA in the same joint.

Physical Examination

The doctor may then discuss the symptoms in detail to understand when the pain and stiffness are at their worst and how they vary over time. He or she may want to move your joints to check for reduced range of motion.

Fluid Tests

In this part of the diagnosis, your doctor may use a needle to extract fluid from the affected joint (a process known as aspiration).

Analysis of this fluid can help doctors (i) determine what type of arthritis may be present or (ii) eliminate the involvement of other forms of arthritis such as rheumatoid arthritis. The fluid may also help to identify the presence of an infection and, if so, what type.

Imaging

X ray scans may be useful in revealing the nature and extent of bone damage due to OA. MRI scans can also be useful in highlighting the damage suffered by soft tissues such as bone cartilage.

Osteoarthritis Treatment

In formulating a treatment plan for osteoarthritis, doctors will probably prefer to start with non invasive approaches and only attempt surgery if other approaches fail.

Non Invasive Treatments

These may include:

  • Taking pain relief medications or non steroidal anti inflammatory drugs (NSAIDs), either orally or via direct injection into the joint. Examples of pain relievers include acetaminophen or opioids. For NSAIDs, aspirin, naproxen or ibuprofen may be considered ;
  • Counterirritants are a class of medications that use capsaicin, menthol or lidocaine to stimulate nerve endings via application of cold, warm or itchy sensations to distract you from arthritic pain. Motion Medicine is an example of this type of product;
  • Corticosteroids may be taken either orally or via injection to combat inflammation;
  • Platelet rich plasma (PRP) a product that contains proteins to combat pain and inflammation.

Besides the medicines listed above, exercise programs should be regarded as essential components of a treatment plan for osteoarthritis. The purpose is twofold:

  • To improve joint function through greater strength and range of motion, as well as to improve balance (as mentioned above, frequent falling is a possible complication.of OA);
  • As part of a weight loss program that will reduce pressure on affected joints.

You can achieve many of the benefits of exercise by working with a physical therapist who can devise such a program for you. Ask your doctor about referring you to such a therapist.

If you are suffering from knee osteoarthritis, an unloader knee brace can help to reduce pressure on vulnerable areas of the knee and slow the rate of joint damage. Shoe inserts can be prescribed by a podiatrist to give you similar benefits.

Surgery

Some of the more widely used surgical approaches for managing osteoarthritis include:

  • Fusing adjacent bones in the joint to prevent them rubbing against each other and causing pain. This will result in a partial loss of joint function, however;
  • Changing the relative positions of bones in the joint to increase the space between them and make bone on bone contact less frequent;
  • Replacement of the entire joint with an artificial metal or plastic one. Knee or hip replacement surgeries are the best known examples of such a procedure.

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