Osteoarthritis

Osteoarthritis is a chronic disease of the joint cartilage and bone. It can affect any joint and results from the gradual wearing away of the cushioning (cartilage) between the bone joints that eventually results in bone rubbing against bone. Sometimes new pieces of bone, called bone spurs, grow around the joints. All of these effects result in pain, stiffness and inflammation.

What causes Osteoarthritis and who is at risk?

Osteoporosis is often thought to result from mechanical "wear and tear" on a joint, although there are other causes such as congenital defects, trauma and metabolic disorders. Primarily, however, osteoarthritis is associated with the aging process. The symptoms of osteoarthritis usually appear in middle age but they are present in almost everyone by the age of 70. Before the age of 55, the condition occurs equally in both sexes. However, after 55 it is more common in women.

Types of Osteoarthritis

Osteoarthritis is classified as either primary or secondary. Primary osteoarthritis occurs without any type of injury or identifiable cause. Secondary osteoarthritis develops as a result of another disease or underlying condition. The most common causes of secondary osteoarthritis are metabolic conditions, such as acromegaly, anatomical problems (for example, being bow-legged), injury, or inflammatory disorders like septic arthritis.

What are the symptoms of Osteoarthritis?

 Some of the symptoms of osteoarthritis are:

• a gradual and subtle onset of deep aching joint pain that is worse after exercise or weight bearing and is often relieved by rest
• joint swelling
• limited movement
• morning stiffness
• grating of the joint with motion
• joint pain in rainy weather

However, it is also possible for osteoarthritis to develop without any symptoms.

How is Osteoarthritis diagnosed?

Your doctor will conduct a physical exam that can show limited range of motion, grating of a joint with motion, joint swelling, and tenderness.

He/she may then request an x-ray of the affected joints. If you have osteoarthritis, the x-ray will show a loss of joint space and, in advanced cases, wearing down of the ends of the bone and bone spurs.

Treatment Options

The goals of treatment for osteoarthritis are to relieve pain, maintain or improve joint mobility, increase the strength of the joints, and minimize the disabling affects of the disease. The specific treatment prescribed depends on which joints are involved.

Medications

The most common medications used to treat osteoarthritis are nonsteroidal anti-inflammatory drugs (NSAIDs). These are pain relievers that also reduce swelling. Aspirin, ibuprofen (Motrin, Advil, Nuprin), and naproxen (Aleve, Naprosyn, Naprelan, Anaprox) are all NSAIDs.

Although NSAIDs work well, long-term use of these drugs can cause stomach problems, such as ulcers and bleeding. In April 2005, the FDA asked manufacturers of NSAIDs to include a warning label on their product that alerts users of an increased risk for cardiovascular events (heart attacks and strokes) and gastrointestinal bleeding.

Other medications used to treat osteoarthritis include:

• COX-2 inhibitors (coxibs). Coxibs block an inflammation-promoting enzyme called COX-2. This class of drugs was initially believed to work as well as traditional NSAIDs, but with fewer stomach problems. However, numerous reports of heart attacks and strokes have prompted the FDA to re-evaluate the risks and benefits of the COX-2 inhibitors. Rofecoxib (Vioxx) and valdecoxib (Bextra) have been withdrawn from the U.S. market following reports of heart attacks in some patients taking the drugs. Celecoxib (Celebrex) was still available at the time of this report, but the drug has been labeled with strong warnings and a recommendation that it be prescribed at the lowest possible dose for the shortest duration possible. Patients should ask their doctor whether the drug is appropriate and safe for them.
• Steroids. These medications are injected directly into the joint. They may also be used to reduce inflammation and pain.
• Supplements. Many people find that over-the-counter remedies such as glucosamine and chondroitin sulfate help relieve the symptoms of osteoarthritis. There is some evidence that these supplements are helpful in controlling pain, although they do not appear to grow new cartilage.
• Artificial joint fluid (Synvisc, Hyalgan) can be injected into the knee and may relieve pain for up to six months.

Lifestyle changes

Exercise helps maintain joint and overall mobility. Ask your health care provider to recommend an appropriate home exercise routine. Water exercises, such as swimming, are especially helpful.

Heat and cold treatments, protection of the joints, the use of self-help devices and rest are all recommended.

Good nutrition and careful weight control are also important. Weight loss for overweight individuals will reduce the strain placed on the knee and ankle joints.

Physical Therapy

Physical therapy can be useful for improving muscle strength and motion at stiff joints. Therapists have many techniques for treating osteoarthritis. If therapy does not make you feel better after 3-6 weeks, then it is likely that it will not work at all.

BRACES

Splints and braces can sometimes support weakened joints. Some prevent the joint from moving, while others allow some movement. You should use a brace only when your doctor or therapist recommends one. The incorrect use of a brace can cause joint damage, stiffness, and pain.

SURGERY

Surgery to replace or repair damaged joints may be needed in severe, debilitating cases. Surgical options include:

• Arthroplasty (total or partial replacement of the deteriorated joint with an artificial joint -- see knee arthroplasty, hip arthroplasty)
• Arthroscopic surgery to trim torn and damaged cartilage and wash out the joint
• For some younger patents with arthritis, cartilage restoration is a surgical option to replace the damaged or missing cartilage
• Osteotomy (change in the alignment of a bone to relieve stress on the bone or joint)
• Arthrodesis (surgical fusion of bones, usually in the spine)