“Osteoarthritis / What Is It?”

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Osteoarthritis

What Is It? Symptoms Diagnosis Expected Duration Prevention

Treatment When To Call A Professional Prognosis Additional Info

What Is It?

Also called degenerative joint disease, osteoarthritis is one of the most common and, doubtless, one of the most uncomfortable medical conditions, afflicting an estimated 15.8 million Americans. For many, it goes unrecognized. It is estimated that as many as half of all those who have osteoarthritis do not know that the pain and stiffness they are experiencing are actually symptoms of osteoarthritis. Consequently, a tremendous number of cases go untreated, until perhaps an X-ray reveals that the joint has begun to deteriorate.

Usually chronic, osteoarthritis occurs when the cartilage that normally cushions the joint and protects it from impact erodes. As bone rubs against bone, a person will feel pain and have difficulty moving the joint. Nearby bones are affected. Sometimes, tiny fractures intensify the discomfort. In addition, painful bone spurs (osteophytes)can form on the side of a damaged vertebra or other bones.

Osteoarthritis can range from mild to severe. The pain associated with osteoarthritis can be considerable and is usually made worse by movement. The degenerative process can be limited to or start in one joint — usually the knee, hip, hands, feet or spine — or it can involve a number of joints in the body. If the hand is affected, usually many joints of the fingers become arthritic.

There probably is no single cause of osteoarthritis, and, for most people, no cause can be identified. Age is a leading risk factor, although research suggests that joint deterioration is not an inevitable part of aging. Other factors seem to contribute to osteoarthritis. People who sustain injuries or small repetitive injuries as a consequence of repeated movements on the job may be at increased risk of developing osteoarthritis.There may be a genetic component involved, especially in the development of osteoarthritis in the hands. Obesity seems to be a factor in osteoarthritis of the knees. Other recognized risk factors for osteoarthritis include:

Repeated episodes of bleeding into the joint, as may occur in hemophilia or related bleeding disorders Repeated episodes of gout or pseudogout, in which episodes of inflammation follow the deposition of uric acid or calcium crystals into the joint Avascular necrosis, a condition in which the blood supply to the bone near the joint is interrupted, leading to bone death and eventually joint damage. The hip is the most commonly affected joint. Chronic inflammation caused by previous rheumatic illness, such as rheumatoid arthritis Metabolic disorders, such as hemochromatosis, in which a genetic abnormality leads to too much iron in the joints and other parts of the body Previous joint infection

Currently, research is looking into the notion that abnormal enzymes released by cartilage cells may lead to cartilage breakdown and joint destruction. Another theory is that some people are born with defective cartilage or slight defects in the way joints fit, and as these people age, they are more likely to experiencecartilage breakdown in the joint.

Women commonly are more affected by osteoarthritisthan are men. The disease generally affects older people,although young people, especially those who are involved in athletics, are particularly prone to developing osteoarthritis in the knee.

People who have osteoarthritis often complain of a deep ache, centered in the joint. Typically, the pain is aggravated by joint use and relieved by rest. However, as the disease progresses, the pain becomes more constant. Often, when the pain is significant during the night, it interferes with sleep.

Symptoms

Symptoms of osteoarthritis include:

Joint pain and swelling as a result of activity or in response to a change of weather Limited flexibility, especially after not moving for a while ("gelling") Heberden's nodes, bony lumps at the end of fingers,and Bouchard's nodes, on the middle joint of fingers Grinding sensation with joint motion Numbness or tingling in an extremity (if the arthritis had led to pressure on a nerve, for example in the neck or lower back)

Diagnosis

Most people visit their health-care providers with reports of pain in and around one or more joints. Also, bony lumps that develop along the fingers (Heberden's or Bouchard's nodes) will suggest the presence of osteoarthritic condition. Because there appears tobe a genetic predisposition to developing these lumps, your health-care provider may ask about your parents' hands.

Your health-care provider may note tenderness, warmth and swelling around the joint when he or she examines you. In the later stages of the disease, X-rays will reveal that the space around the joint has become narrower and that the shape of the joints has changed. Even when the X-rays reveal little bony disfigurement or erosion, the pain you feel may be related to osteoarthritis in its early stages.

If your health -are provider suspects osteoarthritis, he or she may order blood tests, although mostly to look for evidence of another arthritic condition.

Expected Duration

Osteoarthritis is generally a chronic condition that will typically progresses quite slowly over time.

Prevention

There is no reliable way to prevent most cases of osteoarthritis, although preventing risk factors for its development may be helpful. These include maintaining ideal body weight, prevention of osteoporosis (with exercise, adequate vitamin D and calcium and sometimes additional medications) and preventing major trauma. Treating or preventing any associated conditions that might contribute to joint damage (for example, gout or infection) also may prove beneficial.

Treatment

As with many arthritic conditions, treatment involves a long-term approach to managing pain and maintaining joint function.

An analgesic, such as acetaminophen (Tylenol), can help alleviate stiffness and pain. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin and others) or naproxen (Aleve, Naprosyn and others) may be effective. The newer cyclooxygenase (COX-2) inhibitors, including celecoxib (Celebrex) and rofecoxib (Vioxx) may be safer anti-inflammatory agents for patients at higher risk of ulcer disease, such as people who have had ulcers in the past or the elderly. These medications should be taken under the supervisionof a physician. Do not combine them with other drugs without consulting your physician. Stomach problems, including ulcers, are the most common side effects of these medications. Stronger pain medications, such as tramadol (Ultram) or codeine-type medicines may be suggested rarely when the other medicines fail.

In rare instances, when inflammation is severe, your health-care provider may remove the fluid from the joint and consider an injection of corticosteroid drug. This is recommended for acute problems with weight-bearing joints, chiefly the knee. However, overuse of these drugs can damage the joint, so your health-care provider will use them onlyinfrequently and only when absolutely necessary. A newer treatment that may help is a series of hyaluronate injections (including Synvisc or Hyalgam). Hyaluronate is a chemical that ordinarily provides lubrication and nutrition to the joint, and synthesized forms may be injected weekly into an osteoarthritic knee. Studies suggest mild benefit to such an approach. Studies also suggest that glucosamine sulfate and chondroitin sulfate, over-the-counter supplements, may safely provide some benefit for those with osteoarthritis in the knees. A study published in the medical journal, Lancet, in Jan. 2001 described improvement over three years for patients taking glucosamine (1500 mg/day) compared with a placebo (an inactive pill). In addition, joint deterioration slowed or stopped in the glucosamine group while it continued in the placebo group. A more definitive study sponsored by the U.S. National Institutes of Health is ongoing and should help sort out many unknowns about glucosamine and chondroitin therapy. Capsaicin cream applied to the skin over painful joints may also help.

Applying heat or cold can relieve pain temporarily. Your health-care provider also can advise you on the use of heating pads, hot baths and ice packs to ease the discomfort.

It order to limit damage and prevent stiffness and other problems down the line, your health care professional likely will suggest that you engage in certain exercises, including range-of-motion and muscle strengthening exercises. In some instances, joint protection can reduce stress and strain on tender joints.

Because extra pounds put pressure on sensitive joints,it is important that you control your weight. In addition, if you have osteoarthritis of the spine, it is important to maintain good posture to distribute weight and pressure evenly throughout the body.

In severe cases where deterioration is significant, your health-care provider may recommend surgery to correct deformity or reconstruct or replace a hip or knee joint.

When To Call A Professional

If you have joint symptoms suggestive of osteoarthritis (including a grinding sensation, limited motion, pain with joint use), you should contact your health-care provider.

Prognosis

When treated properly, osteoarthritis rarely is crippling. However, it is a chronic disease that may require ongoing care and reconsideration of the various treatment options.

Additional Info

Arthritis Foundation1330 West Peachtree St. Atlanta, GA 30309 Phone: (404) 872-7100 Toll-free: (800) 283-7800 http://www.arthritis.org/

American College of Rheumatology60 Executive Park SouthSuite 150 Atlanta, GA 30329 Phone: (404) 633-3777 http://www.rheumatology.org

Martha Murdock, DirectorNational Silicone Implant Foundation | Dallas Headquarters"Supporting Survivors of Medical Implant Devices"4416 Willow LaneDallas, TX 75244-7537