Osteoarthritis

The most common form of arthritis, osteoarthritis comprises more than 100 diseases. Sometimes called degenerative arthritis or degenerative joint disease, osteoarthritis occurs when the cartilage (smooth connective tissue that lines the joints between the bones) breaks down. This breakdown leads to pain, stiffness and swelling. Osteoarthritis affects 20 million Americans, occurring most often in women and adults older than 45.

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Symptoms

Osteoarthritis can affect any joint, but it most often occurs in the knees, hips, spine and fingers. At first it may affect only one joint, but if the joint is in the fingers, multiple hand joints may become affected. The photo at right shows the hard, bony swellings (called Heberden's and Bouchard's nodes) in the finger joints that are typical of osteoarthritis.

People with osteoarthritis may have:

  • Pain in a joint during or after use. The acute pain of early osteoarthritis often fades within a year but may come back if the joint is overused. The amount of pain varies from mildly inconvenient to disabling.
  • Discomfort in a joint when the weather changes
  • Swelling and stiffness in a joint, particularly after using it
  • Bony knobs (nodes) on the finger joints may create a gnarled appearance. Early on, the joints may feel tender, painful or stiff. After one or two years, the pain often grows less, leaving just the nodes that affect the ability to move the finger joints. Nodes affect women more than men and tend to run in families.
  • Back and neck pain and stiffness from slow deterioration of discs between the bones of the spine

 

Causes and Risk Factors

Some scientists believe the osteoarthritis may be due to a mechanical stress, which causes the cartilage cells or lining of the joint to release an imbalance of enzymes. When balanced, these enzymes allow for the natural breakdown and repair of cartilage, but too much of the enzymes can cause the joint cartilage to break down faster than it's rebuilt. Over time, the smooth cartilage protecting the ends of the bones at the joint wears down and gets rough. Eventually, if it wears down completely, the bone rubs against bone, damaging the ends of the bones and making joints painful.

The body works to repair the damage, but when these repairs don't work well, new bone may grow along the sides of the existing bone. This growth makes large lumps, most noticeable on the hands and feet. Each of the steps in this repair process produces pain. The pain and tenderness over the bony lumps may be most marked early in the disease and less so later on.

The risk of osteoarthritis is greater for those who:

  • Are 45 or older
  • Are women
  • Have heredity conditions, such as defective cartilage and malformed joints
  • Have joint injuries caused by work or sports
  • Are obese
  • Have diseases that change the structure and function of cartilage, such as rheumatoid arthritis, hemochromatosis (a condition in which iron collects in the body to dangerous levels), Paget's disease, gout or pseudogout
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Diagnosis

The doctor may use a physical examination, blood tests and certain imaging techniques to diagnose osteoarthritis. Blood tests are used to identify or rule out specific types of arthritis. Fluid may also be withdrawn from a joint for analysis. Imaging techniques used may include X-rays, bone scans, computerized tomography (CT) scans, magnetic resonance imaging (MRI) and arthrography (an image taken after dye has been injected into the joint). These techniques can show bone spurs and worn-down cartilage, indicating osteoarthritis.

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Treatments

There is currently no cure for osteoarthritis, but treatments are improving.

Available treatments include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). These both relieve pain and reduce inflammation. NSAIDs range from aspirin, ibuprofen (found in Advil and Motrin), ketoprofen (Actron and Orudis) and naproxen sodium (Aleve) to more powerful prescription drugs. Possible side effects of NSAIDs include ringing in the ears, ulcers, stomach or intestinal bleeding, kidney damage, heart failure, fluid retention and cognitive changes.
  • Topical pain relievers. Over-the-counter creams, gels, ointments and sprays can temporarily relieve arthritis pain and reduce inflammation in joints close to the surface of the skin, such as fingers, knees and elbows. Topical pain relievers include trolamine salicylate (found in Aspercreme and Sportscreme); methyl salicylate, menthol and camphor (found in Double Ice ArthriCare, Eucalyptamint, Icy Hot and Ben-Gay); or capsaicin from the seeds of hot chili peppers (found in Zostrix and Capzasin-P).
  • COX-2 inhibitors. These are as effective for managing pain and inflammation as NSAIDs, but they have fewer stomach-injuring side effects. Examples include celecoxib (Celebrex) and rofecoxib (Vioxx). They are more expensive than NSAIDs and do have side effects of their own, including fluid retention (which may worsen heart failure). They may also be associated with an increased risk of heart attack, transient ischemic attack or stroke.
  • Antidepressants. One in five people with a chronic disease and pain also has depression. Antidepressants can alleviate depression and help reduce chronic pain. The most common ones used for arthritis treatment are amitriptyline (Elavil, Endep), desipramine (Norpramin, Pertofrane), imipramine (Tofranil, Norfranil) and nortriptyline (Pamelor, Aventyl).
  • Corticosteroids. Injected into the joint, corticosteroids can relieve some pain for four to six months. Knee joints may be treated with Hylan G-F20 (Synvisc) and hyaluronate (Hyalgan) but requires three to five weekly injections. Pain relief is usually achieved more slowly with shots than with corticosteroids, but it lasts longer.
  • Joint replacement. In recent years, joint replacement surgery has become the most important surgical treatment for arthritis. Although hip joints are the most commonly replaced joints, replacements can be done for knee, shoulder, elbow, finger or ankle joints.
  • Other surgical procedures. Surgery may be performed to remove loose pieces of bone or cartilage that may cause pain or locked joints. These procedures usually use the assistance of an arthroscope (a small tube inserted into the joint through which the surgeon works). Surgery can also be used to reposition the bones, help correct deformities or fuse bones to increase stability and reduce pain. The fused joint, however, has no flexibility.

To effectively manage the condition, those with osteoarthritis can also:

  • Exercise regularly. Exercise can strengthen muscles, increase range of motion, improve balance and help reduce stress. Good exercises include walking, stationary bicycle riding, water exercises or Tai chi. Be sure to stand up straight while exercising. Avoid exercise if your joint is tender, injured or severely inflamed. If you feel a pain you haven't had before, stop exercising. New pain that lasts more than two hours after exercise usually means you've overdone it.
  • Control weight. Excess body weight adds stress on joints in back, hips, knees and feet - where arthritis pain is commonly felt. Excess weight also can make joint surgery more difficult and risky.
  • Eat a healthy diet. Eating a diet high in vegetables, whole grains and fruits helps maintain a proper weight and good health. There is, however, no special diet for treating arthritis, and eating any particular foods has not been proven to make joint pain or inflammation better or worse.
  • Know your limits. Rest when tired. Arthritis can make people prone to fatigue and muscle weakness. A rest or short nap that does not interfere with nighttime sleep may help.

    Avoid actions that strain finger joints. For example, instead of a clutch-style purse, select one with a shoulder strap. Use hot water to loosen a jar lid and pressure from your palm to open it, or use a jar opener. Don't twist or use your joints forcefully.
  • Spread the weight of an object over several joints. Use both hands, for example, to lift a heavy pan. Try using a walking stick or cane.
  • Take breaks to relax, and stretch regularly.
  • Maintain good posture. The easiest way to improve your posture is by walking. The faster you walk, the harder your muscles must work to keep you upright. Some people find that swimming also helps improve their posture.
  • Use your strongest muscles and favor large joints. Don't push open a heavy glass door. Lean into it. To pick up an object, bend your knees and squat while keeping your back straight.
  • Apply heat. Heat may ease your pain, relax painful muscles and increase blood flow. You may find it helpful before exercising. An easy way to apply heat is to take a 15-minute hot shower or bath. Other options are a hot pack, an electric heating pad on its lowest setting or a radiant heat lamp with a 250-watt reflector heat bulb. If your skin has poor sensation or if you have poor circulation, don't use heat treatment.
  • Apply cold for occasional flare-ups. Cold may dull the sensation of pain in the first day or two. Cold also decreases muscle spasms. Don't use cold treatments if you have poor circulation or numbness.
  • Shoes. Wear comfortable, cushioned shoes that support your weight.
  • Practice relaxation. Hypnosis, guided imagery, deep breathing and muscle relaxation can all help control pain.
  • Keep a positive attitude. Studies show that people who take control of their treatment and actively manage their arthritis have less pain and function better. Make a plan with your doctor for managing your arthritis. This may help you feel that you're in charge of your disease, rather than vice versa.
  • Use braces, a cane or special tools and gadgets that help you have an active, independent life without joint strain.
  • Take medications as recommended. Taking them regularly instead of waiting for pain to build will lessen the overall intensity of discomfort.
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