The Basics of Osteoarthritis
Arthritis is a general term that means inflammation of the joints. Osteoarthritis, commonly known as wear and tear arthritis, is the most common type of arthritis. It is associated with a breakdown of cartilage in joints and can occur in almost any joint in the body. It commonly occurs in the weight-bearing joints of the hips, knees, and spine. It also affects the fingers, thumb, neck, and large toe.
Cartilage is a firm, rubbery material that covers the ends of bones in normal joints. Its main function is to reduce friction in the joints and serve as a “shock absorber.” The shock-absorbing quality of normal cartilage comes from its ability to change shape when compressed (flattened or pressed together).
Osteoarthritis causes the cartilage in a joint to become stiff and lose its elasticity, making it more susceptible to damage. Over time, the cartilage may wear away in some areas, greatly decreasing its ability to act as a shock absorber. As the cartilage deteriorates, tendons and ligaments stretch, causing pain. If the condition worsens, the bones could rub against each other.
Osteoarthritis affects an estimated 27 million Americans. The chance of developing the disease increases with age. Most people over age 60 have osteoarthritis to some degree, but its severity varies. Even people in their 20s and 30s can get osteoarthritis, although there is often an underlying reason, such as joint injury or repetitive joint stress from overuse. In people over age 50, more women than men have osteoarthritis.
Symptoms of osteoarthritis most often develop gradually and include:
There are several factors that increase a person’s chances of developing osteoarthritis. These include:
The diagnosis of osteoarthritis is based on a combination of the following factors:
Your doctor may use X-rays to help confirm the diagnosis and make sure you don’t have another type of arthritis. X-rays show how much joint damage has occurred. An MRI may be necessary to get a better look at the joint and surrounding tissues if the X-ray results do not clearly point to arthritis or another condition.
Sometimes, blood tests will be performed to determine if you have a different type of arthritis.
If fluid has accumulated in the joints, your doctor may remove some of the fluid (called joint aspiration) for examination under a microscope to rule out other diseases.
Osteoarthritis usually is treated by a combination of treatments, including exercise, weight loss if needed, medications, physical therapy with muscle strengthening exercises, hot and cold compresses to the painful joint, removal of joint fluid, injection of medications into the joint, and use of supportive devices such as crutches or canes. Surgery may be helpful to relieve pain when other treatment options have not been effective.
The type of treatment will depend on several factors, including your age, activities and occupation, overall health, medical history, location of your osteoarthritis, and severity of the condition.
Staying at your recommended weight helps prevent osteoarthritis of the knees, hips, and spine, reduces the stress on these weight-bearing joints, and reduces pain in joints already affected. Once you have osteoarthritis, losing weight also can relieve the stress and pain in your knees.
Exercise is important to improve joint movement and to strengthen the muscles that surround the joints. Gentle exercises, such as swimming or walking on flat surfaces, are recommended, because they are less stressful on your joints. Avoid activities that increase joint pain, such as jogging or high impact aerobics. Exercises that strengthen the muscles reduce pain in patients with osteoarthritis, particularly with osteoarthritis of the knee.
The first step with medication is often over-the-counter pain relievers as needed. These include acetaminophen (Tylenol), ibuprofen (Advil, Motrin), and naproxen (Aleve). Don’t take over-the-counter medications for more than 10 days without checking with your doctor. Taking them longer than that increases the chance of side effects. If over-the-counter treatments aren’t effective, your doctor may decide to prescribe a stronger anti-inflammatory drug or other medication to help ease the pain. Some medications in the form of creams, rubs, or sprays may be applied over the skin of affected areas to relieve pain. For some people with persistent pain despite these pills or creams, steroids can be injected directly into the joint. These injections can be given several times a year, though some experts believe this may ultimately accelerate joint damage.
Injections of hyaluronic acid directly into the knee joint can relieve pain in some people with osteoarthritis.
When osteoarthritis pain is severe and other treatments are not working, some doctors will give stronger pain pills, such as narcotics.
Unfortunately, none of these will reverse or slow the progression of joint damage caused by osteoarthritis.
While recent research has questioned their usefulness, some medical research has shown that the supplements glucosamine and chondroitin may relieve pain in some people with osteoarthritis, especially in the knee. There is no evidence that glucosamine can help rebuild cartilage. SAMe is another supplement with potential benefits for osteoarthritis. In fact, some research has shown it may be as effective an anti-inflammatory drugs. Remember to always let your doctor know about any supplements you’re taking, because they can have side effects and interact with medications.
Acupuncture has also been shown to provide significant and immediate pain relief in some people with osteoarthritis.
Supportive or assistive devices can help to decrease pressure on the joints with osteoarthritis. Knee supports may be helpful for some people to stabilize the ligaments and tendons and decrease pain. Canes or crutches may be helpful to take pressure off certain joints.
In addition to pain relief, assistive devices improve function and prevent falls. A licensed physical therapist or other health care professional is needed to recommend what devices are best for you.
There are also many available devices to help you perform routine daily activities that may be difficult, such as housework or cooking. Ask your doctor about talking to an occupational therapist to give you ideas about which devices may help.
When osteoarthritis pain is not controlled with other treatments, or when the pain prevents you from participating in your normal activities, you may want to consider surgery.
There are several types of surgery for osteoarthritis. They include:
Talk to your doctor to determine if any of these treatment options are right for you.
National Institute of Arthritis and Musculoskeletal and Skin Diseases.
American Academy of Orthopaedic Surgeons.
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The Basics of Osteoarthritis
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