Osteoarthritis is the breakdown of articular cartilage in the joints, usually followed by chronic inflammation of the lining of the joint. Healthy cartilage serves as a cushion between the bones in a joint. Osteoarthritis usually affects the hands, feet, spine, hips, and knees. People with osteoarthritis usually have joint pain and limited movement of the affected joint.
Osteoarthritis is usually a condition associated with aging. The exact cause is unclear. As osteoarthritis develops, you experience progressive loss of articular cartilage, bone spurs around the joint, and muscle weakness of the extremity.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Mild to severe pain in a joint, especially after overuse or long periods of inactivity, such as sitting for a long time
Creaking or grating sound in the joint
Swelling, stiffness, limited movement of the joint, especially in the morning
Weakness in muscles around the sore joint
Deformity of the joint
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam.
Tests may include:
X-rays
of the affected joints—to look for cartilage loss, signified by narrowing of the joint, bone damage, or bone spurs
Blood tests—to rule out other medical conditions
Arthrocentesis
—removal of fluid from the joint for testing
Treatment
There is no treatment that absolutely stops the degeneration of cartilage or repairs cartilage that is already damaged. The goal of treatment is to reduce joint pain and inflammation and to improve joint function.
Treatments may include:
Medications
Over-the-counter pain medication
Acetaminophen
(Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
and naproxen
(Advil, Aleve)
A study looked at topical vs. oral ibuprofen to relieve chronic knee pain. Comparing the two groups, there were no significant differences in pain, stiffness, or difficulty. Those in the oral group, however, experienced more side effects.
*
Prescription Pain Relief Medication
NSAIDs—Arthrotec is a NSAID that may reduce the risk for gastrointestinal bleeding.
Opiates, and opiate-like medications
***Please Note:
On September 30, 2004, Merck & Co., Inc. announced a voluntary withdrawal of Vioxx® (rofecoxib) from the US and worldwide market due to safety concerns. A study showed a small but significant increased risk of cardiovascular events (such as
heart attack
) in patients taking the prescription medication. Vioxx® is a so-called "selective" nonsteroidal anti-inflammatory drug (NSAID) specially designed to lower the risk of stomach irritation. It is commonly used in the treatment of acute and chronic pain associated with arthritis, menstruation, and other conditions. Since Merck's withdrawal of Vioxx®, evidence has come to light regarding similar dangers posed by the other popular selective NSAID, Celebrex® (celecoxib), which is produced by Pfizer. Most physicians now question the wisdom of prescribing any medications from the COX-2 class.
Viscosupplementation—injection of a substance called hyaluronan into the joint, which helps to lubricate the joint
Pain relief creams—capsaicin, methyl salicylate, and menthol
Dietary Supplements
There is some evidence that glucosamine and chondroitin may relieve pain and/or decrease the progression of osteoarthritis. Talk with your doctor before taking any herbs and supplements.
Alternative Treatments
Some clinicians report that acupuncture has been successful in reducing the pain of osteoarthritis, although there is inconsistent evidence on this treatment.
While more studies are needed, balneotherapy (hot water therapy), relaxation therapy, exercise, yoga, and tai chi may be helpful.
Mechanical Aids
Shoes with shock-absorbing soles can provide some relief while you are doing daily activities or exercising. Splints or braces help to properly align joints and distribute weight. Knee and wrist joints may benefit from elastic supports. A neck brace or corset may relieve back pain, and a firm mattress may help chronic back pain. Canes, crutches, walkers, and orthopedic shoes also can benefit patients with advanced osteoarthritis of the lower extremity.
Weight Reduction
Losing weight can lessen the stress on joints affected by osteoarthritis. A modest loss of five pounds can eliminate at least 15 pounds of stressful impact for each step taken and thus help the affected joint. The more weight lost, the greater the benefit.
Exercise and Physical Therapy
Strengthening the muscles supporting an arthritic joint (particularly the knee, lower back, and neck) may decrease pain and help absorb energy around the joint. Swimming and water aerobics are particularly good because they don't put stress on the joint.
Assist Devices
If you are having difficulty getting around due to arthritis pain, your doctor might recommend that you install handrails and grips throughout your home. These are especially useful in the bathroom and shower. You may need elevated seats (including toilet seats) if you're having difficulty rising after sitting.
Heat and Ice
Applying heat (with hot water bottles, heating pads, hot paraffin) helps joints and muscles to move more easily and can decrease pain, as can using ice packs after activity.
Steroids
When less potent pain relievers are ineffective, corticosteroid injections to the inflamed joint may be given. Because repeated cortisone injections can be harmful to the articular cartilage, they are reserved for patients with more pronounced symptoms.
Surgery
Surgery can:
Reposition bones to redistribute stress on the joint
Replace joints
Remove loose pieces of bone or cartilage from joints
Prevention
To reduce your chance of getting osteoarthritis:
Maintain a healthy weight.
Do regular, gentle exercise, including walking, stretching, swimming, and yoga.
Avoid repetitive motions and risky activities that may contribute to joint injury, especially after age 40.
With advancing age, certain activities may have to be dropped or modified. But, you should continue to be active.
RESOURCES:
American College of Rheumatology
http://www.rheumatology.org
The Arthritis Foundation
http://www.arthritis.org
CANADIAN RESOURCES:
The Arthritis Society
http://www.arthritis.ca
Seniors Canada On-line
http://www.seniors.gc.ca/
References:
American College of Rheumatology Subcommittee on Osteoarthritis. Recommendations for the medical management of osteoarthritis of the hip and knee. 2000 update.
Arthritis Rheum
. 2000;43:1905-1915.
Jordan K, Arden N, Doherty M, et al. EULAR recommendations 2003: an evidence based approach to the management of knee osteoarthritis: report of a task force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT).
Ann Rheum Dis
. 2003;62:1145-1155.
National Institute of Arthritis and Musculoskeletal and Skin Disorders website. Available at:
http://www.niams.nih.gov/
.
Osteoarthritis. EBSCO Publishing Health Library, Natural and Alternative Treatment website. Available at:
http://healthlibrary.epnet.com/GetContent.aspx?token=da29d243-e573-4601-8b42-77cd0ccb14b2chunkiid=21505
. Accessed March 4, 2008.
Pathophysiology of osteoarthritis.
Joint Bone Spine
. 2000.
*2/7/2008 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed/what.php
: Underwood M, Ashby D, Cross P, et al. Advice to use topical or oral ibuprofen for chronic knee pain in older people: randomised controlled trial and patient preference study.
BMJ.
2008;336:138-142. Epub 2007 Dec 4.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
