Osteoarthritis

Osteoarthritis, the most common type of arthritis, is especially common in older people. The disease is thought to affect over 20 million people in the United States.

Osteoarthritis starts when cartilage begins to become ragged and wears away. Cartilage is the tissue that pads bones in a joint. At its worst, the disease causes all of the cartilage in a joint to wear away, leaving bones that rub against each other.

You are most likely to have osteoarthritis in your hands, neck, lower back, or the large weight-bearing joints of your body, such as knees and hips.

Osteoarthritis is sometimes called degenerative joint disease or osteoarthrosis.

Causes of Osteoarthritis or Just Risk Factors?

While scientists are still searching for causes of osteoarthritis, they do know a number of factors that increase a person's chances of developing it.These are known as risk factors. Risk factors are not the same as osteoarthritis causes. While they do increase the chances of developing osteoarthritis, they do not guarantee that a person will develop it.

Some risk factors for osteoarthritis include:

• Getting older
• Gender
• Being overweight
• Genetics
• Having weak muscles
• Certain medical conditions
• Joint injuries
• Repetitive stresses on the joints.

Getting Older

As people get older, they are increasingly likely to develop osteoarthritis. By age 65, half of the population has x-ray evidence of osteoarthritis in at least one joint, most often in the hips, knees, or fingers.

Gender

Before the age of 45, men are more likely than women to develop osteoarthritis. After the age of 45, women are more likely then men to develop it. Also, more women than men develop knee arthritis, while more men than women develop hip osteoarthritis.

Being Overweight or Obese

Extra weight may place extra pressure on joints and cartilage, causing them to wear away. In fact, for every pound you gain, you add three pounds of pressure on your knees and six times the pressure on your hips. In addition, people with more body fat may have higher blood levels of substances that cause inflammation. Inflammation at the joints may raise the risk of osteoarthritis.

Weight loss can decrease stress on your knees, hips, and lower back, as well as lessen inflammation in your body. If you have osteoarthritis, losing weight may help improve your symptoms. Overweight or obese people who do not have osteoarthritis may reduce their risk of developing it by losing weight.

Genetics

Genetics play a role in the development of osteoarthritis. For example, if your grandmother or mother had osteoarthritis in the hand, you also are at an increased risk of developing it in the hand. Why this occurs is not known, but scientists continue to search for the specific gene or genes that increase the risk of osteoarthritis.

Gene mutations may be a factor in predisposing individuals to develop osteoarthritis. For example, scientists have identified a mutation (or gene defect) affecting collagen, an important part of cartilage, in people with an inherited kind of osteoarthritis that starts at an early age. The mutation weakens collagen protein, which may break or tear more easily under stress.

Weak Muscles

Research has shown that people with weak quadriceps (thigh muscles) are at an increased risk of developing knee osteoarthritis. This may be due to the fact that the quadriceps act as shock absorbers for the knees. The stronger the thigh muscles, the more shock and stress they are able to keep off the knees. This is why strengthening these muscles decreases the chances of developing osteoarthritis.

Certain Medical Conditions

Certain medical conditions can cause damage to the cartilage or create a deformity, which increases stress on the joints. Some examples of these conditions include:

• Rheumatoid arthritis
• Gout
• Hemochromatosis
• Acromegaly.

Joint Injuries

People who suffer knee and hip injuries to the joint are at an increased risk of developing osteoarthritis. The earlier in one's life the injury occurred, the greater this risk appears to be.

Repetitive Stress on Joints

People in certain occupations -- such as landscaping or jobs that involve operating machinery or doing a lot of typing -- appear to be at an increased risk of osteoarthritis. This increased risk is thought to be due to microscopic damage that can occur with repetitive actions. Athletes also appear to be at an increased risk, but not all athletes have the same risk. It appears that runners have no increased risk, while soccer players, football players, and baseball pitchers are at increased risk.

One interesting study illustrates this point particularly well. The study showed that using chopsticks contributes to osteoarthritis in the hand. Chopstick use puts stress on certain joints, specifically, joints of the thumb and second and third fingers. In this study, osteoarthritis was more common in several of the joints in the three fingers of the chopstick hand than in the hand not holding chopsticks.

It is important that people who do repetitive tasks learn how to modify their movements in order to decrease the repetitive stress.

Common Osteoarthritis Symptoms

In the early stages of osteoarthritis, joints may simply ache a little after physical work or exercise. But over time, as more and more of the cartilage wears down, the bare bone ends begin to rub against each other. This may cause other osteoarthritis symptoms, including:

• Steady or intermittent pain in a joint.
• Stiffness in a joint after getting out of bed or sitting for a long time. The stiffness goes away when you begin to move the joint.
• Swelling or tenderness in one or more joints.
• Loss of motion in the joint.
• Having a joint lock or "give way."
• Feeling like the joint is unstable.
• A crunching feeling or the sound of bone rubbing on bone.

Hot, red, or tender joints are probably not osteoarthritis. If you have these symptoms, check with your healthcare provider about other possible causes, such as rheumatoid arthritis.

Other Symptoms of Osteoarthritis -- By Location

Osteoarthritis symptoms can occur in any joint. Most often, they occur in the hands (especially at the ends of the fingers and thumbs), knees, hips, or spine (neck or lower back).

Hands

Osteoarthritis in the hands may cause many of the symptoms explained above. People with hand osteoarthritis may also have small, bony knobs that appear on the end joints of the fingers. These are called Heberden nodes. Similar knobs, called Bouchard nodes, can appear on the middle joints of the fingers.

Fingers can also become enlarged and gnarled, and they may ache or be stiff and numb. The base of the thumb joint also is commonly affected by osteoarthritis.

Knees

The knees are the body's primary weight-bearing joints. For this reason, they are among the joints most commonly affected by osteoarthritis. In a person who has osteoarthritis, they may be stiff, swollen, and painful, making it hard to walk, climb, and get in and out of chairs and bathtubs.

Hips

Symptoms of osteoarthritis in the hips may include pain, stiffness, and severe disability. People may feel the osteoarthritis pain in their hips, groin, inner thigh, buttocks, or knees. Walking aids, such as canes or walkers, can reduce stress on the hip.

Osteoarthritis in the hip may also limit moving and bending. This can make daily activities, such as dressing and foot care, a challenge.

Spine

Stiffness and pain in the neck or in the lower back are common osteoarthritis symptoms in the spine.

Weakness or numbness of the arms or legs can also result. Some people feel better when they sleep on a firm mattress or sit using back support pillows.

Final Thoughts on Osteoarthritis Symptoms

As mentioned above, there are many possible symptoms of osteoarthritis. But a number of these symptoms are shared with other medical conditions. Therefore, if you have any possible symptoms of osteoarthritis and they last longer than two weeks, you should see your regular doctor or a rheumatologist. He or she will be able to help diagnose and treat the problem. If you have a fever, feel physically ill, suddenly have a swollen joint, or have problems using your joint, see your healthcare provider sooner.

Finally, remember that most people with osteoarthritis live active, productive lives despite any limitations. They do so by using treatment strategies such as rest and exercise, pain-relief medications, education and support programs, learning self-care, and having a "good attitude."

Diagnosing Osteoarthritis

There is no one specific test that can be used to make an osteoarthritis diagnosis.Therefore, in order to make a diagnosis, the healthcare provider will begin by asking a number of questions. This is known as taking a person's medical history. Some of these questions may be related to:

• Current symptoms
• Other medical conditions
• Current medications
• A family history of any medical conditions, including arthritis.

In answering these questions, be sure to give a good description of pain, stiffness, and joint function -- as well as how these symptoms have changed over time. Providing these details will allow the healthcare provider to give you a better assessment. It is also important for your healthcare provider to know how the condition affects your work and daily life.

After asking a number of questions, the healthcare provider will perform a physical exam looking for osteoarthritis symptoms. This physical exam involves examining the joints, skin, reflexes, and muscle strength. The healthcare provider will also observe your ability to walk, bend, and carry out activities of daily living.

After the medical history and physical exam, the healthcare provider may recommend certain tests to help with diagnosing osteoarthritis.

Tests your healthcare provider may recommend to help diagnose osteoarthritis include:

• X-rays
• Other tests.

X-rays

Doctors take x-rays to see how much joint damage is present. X-rays of the affected joint can show things such as cartilage loss, bone damage, and bone spurs. Often, there is a big difference between the severity of osteoarthritis as shown by the x-ray and the degree of pain and disability the person feels. Also, x-rays may not show early osteoarthritis damage -- that is, damage that occurs before much cartilage loss has taken place.

Other Tests

Your doctor may order blood tests to rule out other causes of symptoms. Another common test is called joint aspiration. This test involves drawing fluid from the joint for examination.

Your doctor will also try to identify conditions that may make osteoarthritis symptoms worse. The severity of your symptoms will be influenced greatly by:

• Your attitude
• Your anxiety level
• Whether you have depression
• Your daily activity level.

Final Thoughts on Diagnosing Osteoarthritis

It usually is not difficult to tell if a person has osteoarthritis. What is more difficult is determining whether the disease is causing the person's symptoms. Osteoarthritis is so common -- especially in older people -- that symptoms that seem to be caused by the disease can actually be due to other medical conditions.

Osteoarthritis Treatment

Although there is no cure for osteoarthritis, various therapies can help people manage symptoms and improve their overall quality of life. The choice of treatment depends on the severity of symptoms, the person's general health, and other factors.

Treatment for osteoarthritis is generally focused on treating pain and improving function. There are usually four goals:

• Improve joint care through rest and exercise
• Control pain with medicine and other measures
• Maintain an acceptable body weight
• Achieve a healthy lifestyle.

Most successful osteoarthritis treatment programs involve a combination of methods tailored to the person's needs, lifestyle, and health. These treatments can include:

• Exercise
• Weight control
• Rest and joint care
• Medicines
• Other pain-relief techniques
• Surgery
• Alternative therapies.

Exercise as a Treatment for Osteoarthritis

Osteoarthritis research has shown that exercise is one of the best osteoarthritis treatments. Exercise can improve mood and outlook, decrease pain, increase flexibility, improve the heart and blood flow, maintain weight, and promote general physical fitness. Exercise is also inexpensive and, if done correctly, it has few negative side effects.

The amount and form of exercise will depend on which joints are involved, how stable the joints are, and whether a joint replacement has already been done.You can use exercises to keep strong and limber, extend your range of movement, and reduce your weight. A few of the different types of exercises used to treat osteoarthritis include:

• Strength exercises: These exercises can be performed with exercise bands, which are inexpensive devices that add resistance
• Aerobic activities: These exercises keep your lungs and circulation system in shape
• Range-of-motion activities: These activities keep your joints limber
• Agility exercises: These exercises can help you maintain daily living skills
• Neck and back strength exercises: These exercises can help you keep your spine strong and limber.

Ask your healthcare provider or physical therapist what exercises are best for you. You should also ask for guidelines on exercising when a joint is sore or if swelling is present. Also ask if you should do any or all of the following:

• Use pain-relieving drugs, such as analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs) to make exercising easier
• Use ice after exercising.

Rest and Joint Care as Part of Treating Osteoarthritis

Osteoarthritis treatment plans include regularly scheduled rest. People must learn to recognize the body's signals and know when to stop or slow down, which prevents pain caused by overexertion.

Some people find that relaxation techniques, stress reduction, and biofeedback help. Using canes and splints can also help by protecting and taking pressure off of joints. Splints or braces provide extra support for weakened joints. They also keep the joint in proper position during sleep or activity. Splints should be used only for limited periods, however, since joints and muscles need to be exercised to prevent stiffness and weakness. An occupational therapist or a doctor can help you get a properly fitting splint.

Medicines Used in Osteoarthritis Treatment

Doctors prescribe medicines to eliminate or reduce osteoarthritis pain and to improve functioning. Doctors consider a number of factors when choosing medicines for osteoarthritis treatment.

Two important factors are the intensity of the pain and the potential side effects of the medicine. People must use osteoarthritis medication carefully and tell their doctors about any changes that occur.

The following types of medicines are commonly used to treat osteoarthritis:

• Acetaminophen, such as Tylenol^®
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as:

• Ibuprofen (Motrin^®, Advil^®)
• Naproxen (Naprosyn^®) or naproxen sodium (Aleve^®,Anaprox^®, Naprelan^®)
• Celecoxib (Celebrex^®)
• Meloxicam (Mobic^®)

• Other medications.

Pain-Relief Techniques Used to Treat Osteoarthritis

As part of their treatment plan, people with osteoarthritis may find ways to relieve pain without the use of medications. Warm towels, hot packs, or a warm bath or shower can help relieve pain and stiffness in a joint. In some cases, cold packs (a bag of ice or frozen vegetables wrapped in a towel) can relieve pain or numb the sore area. (Check with your healthcare provider or physical therapist to find out if heat or cold is the best treatment.)

Water therapy in a heated pool or whirlpool may also relieve pain and stiffness. For knee osteoarthritis, people may wear insoles or cushioned shoes to redistribute weight and reduce joint stress.

Transcutaneous electrical nerve stimulation (TENS) is a technique that uses a small electronic device to direct mild electric pulses to nerve endings that lie beneath the skin in the painful area. TENS may relieve some arthritis pain. It seems to work by blocking pain messages to the brain and by modifying pain perception.

Massage may also be helpful. With this pain-relief approach, a massage therapist will lightly stroke and/or knead the painful muscles. This may increase blood flow and bring warmth to a stressed area. However,arthritis-stressed joints are sensitive, so the therapist must be familiar with the problems of the disease.

Surgery as an Osteoarthritis Treatment

For many people, surgery helps relieve the pain and disability of osteoarthritis. Surgery may be performed as part of treating osteoarthritis to:

• Remove loose pieces of bone and cartilage from the joint if they are causing mechanical symptoms of buckling or locking
• Resurface (smooth out) bones
• Reposition bones
• Replace joints.

The two most common surgeries to replace joints are hip replacement surgery (total hip replacement) and knee replacement surgery(total knee replacement). For these types of joint replacement surgeries, surgeons may replace affected joints with artificial joints called prostheses. These joints can be made from metal alloys, high-density plastic, and ceramic material. They can be joined to bone surfaces by special cements.

Artificial joints can last 10 to 15 years or longer. About 10 percent of artificial joints may need revision. Surgeons choose the design and components of a prosthesis according to their patient's weight, sex, age, and activity level, as well as other medical conditions he or she may have.

The decision to use surgery depends on several things, such as how much the osteoarthritis symptoms are interfering with the person's lifestyle. Some other factors that both the surgeon and the patient will consider include the affected person's:

• Level of disability
• Intensity of pain
• Age
• Occupation.

Currently, more than 80 percent of osteoarthritis surgery cases involve replacing the hip or knee joint. After surgery and rehabilitation, the person usually feels less pain and swelling, and can move more easily.

Alternative Therapies Used as Treatments for Osteoarthritis

Many people with osteoarthritis become discouraged with typical treatments because the disease progresses over time and the symptoms worsen. Consequently, they search for alternative therapies aimed at treating osteoarthritis. But people living with osteoarthritis need to be careful because treatments that are not shown to be safe and effective through controlled scientific studies may be dangerous. Also, since arthritis symptoms may come and go, a person using an unproven remedy may mistakenly think the remedy worked simply because he or she tried it when symptoms were going into a natural remission.

Among the alternative therapies often used to treat osteoarthritis are:

• Acupuncture
• Folk remedies
• Nutritional supplements.

Acupuncture

Some people have found pain relief through acupuncture (the use of fine needles inserted at specific points on the skin). Preliminary research shows that acupuncture may be a useful component in an osteoarthritis treatment plan for some people.

Folk Remedies

Some people seek alternative treatments for their pain and disability. Some of these alternative therapies include wearing copper bracelets, drinking herbal teas, and taking mud baths. While these practices are not harmful, some can be expensive. And any unproven remedy, no matter how harmless, can become harmful if it stops or delays someone from seeking a prescribed treatment program from a knowledgeable physician. To date, no scientific research shows these approaches to be helpful in as an osteoarthritis treatment.

Nutritional Supplements

Nutrients such as glucosamine and chondroitin sulfate have claimed to improve the symptoms of people with osteoarthritis. However, based on a large study funded by the National Institutes of Health (NIH), these two supplements were shown to offer no pain-relief benefits, either alone or combined, compared to a placebo (sugar pill).

Osteoarthritis Research

Scientists continue to try to better understand osteoarthritis and how to effectively deal with it. Some current areas of research on osteoarthritis include tools to detect the condition earlier, genes and their impact on osteoarthritis, and treatment strategies like gene therapy and stem cell transplantation. Talk with your healthcare provider to learn about the potential benefits of participating in research studies.