Osteoarthritis
Sometimes called degenerative joint disease or degenerative
arthritis, osteoarthritis (OA) is the most common chronic condition of
the joints, affecting approximately 27 million Americans. OA can affect
any joint, but it occurs most often in knees, hips, lower back and neck,
small joints of the fingers and the bases of the thumb and big toe.
In normal joints, a firm, rubbery material called cartilage covers
the end of each bone. Cartilage provides a smooth, gliding surface for
joint motion and acts as a cushion between the bones. In OA, the
cartilage breaks down, causing pain, swelling and problems moving the
joint. As OA worsens over time, bones may break down and develop growths
called spurs. Bits of bone or cartilage may chip off and float around
in the joint. In the body, an inflammatory process occurs and cytokines
(proteins) and enzymes develop that further damage the cartilage. In the
final stages of OA, the cartilage wears away and bone rubs against bone
leading to joint damage and more pain.
Symptoms of osteoarthritis vary, depending on which joints are affected
and how severely they are affected. However, the most common symptoms
are pain and stiffness, particularly first thing in the morning or after
resting. Affected joints may get swollen, especially after extended
activity.
Although osteoarthritis was long believed to be caused by the “wear
and tear” of joints over time, scientists now view it as a disease of
the joint. Here are some of the factors that contribute to the
development of OA:
Genes: Various genetic traits can make a person more
likely to develop OA. One possibility is a rare defect in the body’s
production of collagen, the protein that makes up cartilage. This
abnormality can cause osteoarthritis to occur as early as age 20. Other
inherited traits may result in slight defects in the way the bones fit
together so that cartilage wears away faster than usual. Researchers
have found that a gene called FAAH, previously linked to increased pain
sensitivity, is higher in people with knee OA than in people who don’t
have the disease.
Weight: Being overweight puts additional pressure on
hips and knees. Many years of carrying extra pounds can cause the
cartilage that cushions joints to break down faster. Research has shown
there is a link between being overweight and having an increased risk of
osteoarthritis in the hands. These studies suggest that excess fat
tissue produces inflammatory chemicals (cytokines) that can damage the
joints.
Injury and overuse: Repetitive movements or injuries
to joints (such as a fracture, surgery or ligament tears) can lead to
osteoarthritis. Some athletes, for example, repeatedly damage joints,
tendons and ligaments, which can speed cartilage breakdown. Certain
careers that require standing for long periods of time, repetitive
bending, heavy lifting or other movements can also make cartilage wear
away more quickly. An imbalance or weakness of the muscles supporting a
joint can also lead to altered movement and eventual cartilage breakdown
in joints.
Others: Several other factors may contribute to osteoarthritis. These factors include bone and joint disorders like rheumatoid arthritis,
certain metabolic disorders such as hemochromatosis, which causes the
body to absorb too much iron, or acromegaly, which causes the body to
make too much growth hormone.
Osteoarthritis is a chronic (long-term) disease. There is no cure,
but treatments are available to manage symptoms. Long-term management of
the disease will include several factors:
- Managing symptoms, such as pain, stiffness and swelling
- Improving joint mobility and flexibility
- Maintaining a healthy weight
- Getting enough of exercise
Physical Activity
One of the most beneficial ways to manage OA is to get moving. While
it may be hard to think of exercise when the joints hurt, moving is
considered an important part of the treatment plan. Studies show that
simple activities like walking around the neighborhood or taking a fun,
easy exercise class can reduce pain and help maintain (or attain) a
healthy weight.
Strengthening exercises build muscles around OA-affected joints,
easing the burden on those joints and reducing pain. Range-of-motion
exercise helps maintain and improve joint flexibility and reduce
stiffness. Aerobic exercise helps to improve stamina and energy levels
and also help to reduce excess weight. Talk to a doctor before starting
an exercise program.
The U.S. Department of Health and Human Services recommends that
everyone, including those with arthritis, get 150 minutes of moderate
exercise per week.
Weight Management
Excess weight adds additional stress to weight-bearing joints, such
as the hips, knees, feet and back. Losing weight can help people with OA
reduce pain and limit further joint damage. The basic rule for losing
weight is to eat fewer calories and increase physical activity.
Stretching
Slow, gentle stretching of joints may improve flexibility, lessen
stiffness and reduce pain. Exercises such as yoga and tai chi are great
ways to manage stiffness.
Pain and Anti-inflammatory Medications
Medicines for osteoarthritis are available as pills, syrups, creams
or lotions, or they are injected into a joint. They include:
-
Analgesics. These are pain relievers and include
acetaminophen, opioids (narcotics) and an atypical opioid called
tramadol. They are available over-the-counter or by prescription.
-
Nonsteroidal anti-inflammatory drugs (NSAIDs). These
are the most commonly used drugs to ease inflammation and related pain.
NSAIDs include aspirin, ibuprofen, naproxen and celecoxib. They are
available over-the-counter or by prescription.
- Corticosteroids. Corticosteroids are powerful anti-inflammatory medicines. They are taken by mouth or injected directly into a joint at a doctor’s office.
- Hyaluronic acid. Hyaluronic acid occurs naturally in joint fluid, acting as a shock absorber and lubricant. However, the acid appears to break down in people with osteoarthritis. The injections are done in a doctor’s office.
These are drugs that helped patients feel and function better, but they weren’t capable of inducing remission.
Physical and Occupational Therapy
Physical and occupational therapists can provide a range of treatment options for pain management including:
- Ways to properly use joints
- Heat and cold therapies
- Range of motion and flexibility exercises
- Assistive devices
Assistive Devices
Assistive devices can help with function and mobility. These include
items, such as like scooters, canes, walkers, splints, shoe orthotics or
helpful tools, such as jar openers, long-handled shoe horns or steering
wheel grips. Many devices can be found at pharmacies and medical supply
stores. But some items, such as custom knee braces and shoe wedges are
prescribed by a doctor and are typically fitted by a physical or
occupational therapist.
Natural and Alternative Therapies
Many people with OA use natural or alternative therapies to address
symptoms and improve their overall well-being. These include nutritional
supplements, acupuncture or acupressure, massage, relaxation techniques
and hydrotherapy, among others.
Surgery
Joint surgery can repair or replace severely damaged joints,
especially hips or knees. A doctor will refer an eligible patient to an
orthopaedic surgeon to perform the procedure.
Positive Attitude
Many studies have demonstrated that a positive outlook can boost the
immune system and increase a person's ability to handle pain.
