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 strength of the joints, and minimize the disabling effects of the disease. The specific treatment prescribed depends on which joints are involved.

Management of osteoarthritis involves simple analgesics, oral and topical NSAIDS (non steroidal anti-inflammatory drugs) and intra-articular steroid injections to provide symptomatic relief. No drug treatment, to date, has shown to delay the progression of osteoarthritis.

Most patients with osteoarthritis have pain as a result of damage to bone and cartilage. In the absence of inflammation, regular or 'as required' acetaminophen 1g every 4 to 6 hours (maximum of 4 g in 24 hours) is appropriate for most patients. Combination of acetaminophen and propoxyphene can also be used.

As well as degeneration there can be an inflammatory component to osteoarthritis. In this situation NSAIDS provide better pain control than simple analgesics, and also reduce swelling. As many osteoarthritis patients are elderly, the choice of NSAID should be strongly influenced by the side effect profile. Topical NSAIDS or rubefacients may be useful when the pain is localized. However, topical NSAID use can also produce systemic side effects.

Medicines Used To Treat Osteoarthritis

Acetaminophen and Combination Medicines

Most people can take acetaminophen without any problems so long as they do not exceed the recommended dose. It reduces mild pain but does not help with inflammation or swelling. Combinations of acetaminophen and other narcotics are also available.

NSAIDs (Non steroidal anti-inflammatory drugs)

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

Taking a combination of NSAIDs or NSAIDs and aspirin together increases the incidence of stomach ulcers or bleeding.

Cycloxygenase 2 Inhibitor (COX-2 inhibitors or Coxibs)

COX 2 Inhibitors 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. The available drugs in this class has been labeled with strong warnings and a recommendation that these be prescribed at the lowest possible dose and for the shortest duration possible.

Salicylates

Steroids (Glucocorticoids)

Steroid injections are given directly into the joint (intra-articular). They reduce pain and inflammation.

Supplements

Nutraceuticals

Many people find that over-the-counter nutraceuticals and vitamins, 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.

Vitamins

Bioflavonoids are found in the rind of green citrus fruits and in rose hips and black currants. They have been used historically in a variety of disease states including rheumatic fever, habitual abortion, poliomyelitis, prevention of bleeding, rheumatoid arthritis, periodontal disease, diabetic retinitis, and others.

Topical Pain Relief Agents

Diclofenac topical is a non-steroidal anti-inflammatory drug.

Trolamine salicylate is a topical salicylate pain reliever, used for minor pain and inflammation. It works by reducing swelling and inflammation in the muscle and joints.

Capsaicin is extracted from chillies (genus Capsicum). Capsaicin topical causes a decrease in a substance (substance P) in the body that causes pain. It is used to relieve minor aches and pains of muscle and joints associated with arthritis, simple backache, strains and sprains.

Artificial Joint Fluid

Hyaluronic acid is normally present in joint fluid, and in osteoarthritis sufferers this gets thin. Hyaluronic acid can be injected into the joint to help protect it. This may relieve pain for up to six months.

Combination Drug Preparations

Arthrotec and Prevacid contain an NSAID with a stomach protecting agent.

Non-Drug Treatment

Non-drug treatment is also important. It is important to make 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. You also need to balance rest with activity. Non-drug pain relief techniques may help to control pain. Heat and cold treatments, protection of the joints and the use of self-help devices are recommended. Good nutrition and careful weight control are 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 e.g. knee arthroplasty, hip arthroplasty.
• Arthroscopic - surgery to trim torn and damaged cartilage and wash out the joint.
• Cartilage Restoration - 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.

See Also:

• Arthritis
• Rheumatoid Arthritis