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What is osteoarthritis(pronounced
ah-stee-oh-arth-rite-iss)?
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Osteoarthritis (OA), or degenerative joint disease, is the most common form of arthritis. It most often affects middle-aged and older people, involving the neck, lower back, knees, hips and fingers. Nearly 70 percent of people over the age of 70 have x-ray evidence of the disease, but only half of these people ever develop symptoms. It may also occur in joints that have suffered previous injury, been subjected to prolonged heavy use, or damaged by prior infection or inflammatory arthritis. Patients with OA experience pain and loss of function that
- It is caused by the breakdown of cartilage. Cartilage is the tough elastic material that covers and protects the ends of bones. Bits of cartilage may break off and cause pain and swelling in the joint between bones. This pain and swelling is called inflammation.
- Over time the cartilage may wear away entirely, and the bones will rub together.
Osteoarthritis (OA) is often called 'wear and tear' of the joints. OA causes certain parts of the joints to weaken and break down. Cartilage, the tough elastic material that cushions the ends of the bones, begins to crack and get holes in it. Bits of cartilage can break off into the joint space and irritate soft tissues, such as muscles, and cause problems with movement. Much of the pain of OA is a result of muscles and the other tissues that help joints move (such as tendons and ligaments) being forced to work in ways for which they were not designed, as a result of damage to the cartilage. Cartilage itself does not have nerve cells, and therefore cannot sense pain, but the muscles, tendons, ligaments and bones do. After many years of cartilage erosion, bones may actually rub together. This grinding of bone against bone adds further to the pain. Bones can also thicken and form growths, called spurs or osteophytes, which rub together. Also, when cartilage is weak or damaged, the surrounding bones place extra force on it, and this may cause excessive blood flow (hyperemia) that can cause pain, especially at night
How common is osteoarthritis?
- It affects 3,000,000 (1 in 10) Canadians.
- It affects men and women in equal numbers.
- Most people develop osteoarthritis after the age of 45, but it can occur at any age.
What are the warning signs of osteoarthritis? Symptoms of OA usually come on slowly, and involve the area around
the joints. If you have joint pain, stiffness, or swelling for more than two weeks, see
your doctor. Damage due to OA progresses slowly over time and may result
in several problems. You may have pain, especially when moving a joint. Sometimes, you may
hear a grating sound when the roughened cartilage on the surface of the bones rubs
together. Bumps or swelling may appear, especially on the fingers and feet. A joint may
feel sore and stiff, and the joint won't move as easily or as far as it once did. All
these changes can make it hard to move around and to do everyday tasks, such as opening a
jar or walking up stairs. Joints Affected
The joints that are usually affected are the hips,
knees, feet and spine. Finger and thumb joints might also be affected.
OA commonly affects weight-bearing joints such as hips, knees, feet and spine. However,
non-weight bearing joints such as finger joints and the joint at the base of the thumb may
be affected as well. It usually does not affect other joints, except when they have been
injured or been put under unusual stress.
- The exact cause is unknown.
- The chances of getting osteoarthritis seem to increase with age.
- Some people with osteoarthritis have other family members with it.
- Being overweight can increase your risk of getting osteoarthritis.
- Excess weight puts stress on joints such as hips and knees.
- Injury to a joint or repeated overuse of it can also damage the cartilage and lead to osteoarthritis.
- Other types of arthritis can also damage joints and lead to osteoarthritis.
No one knows for sure what causes OA, although scientists are well on their way to understanding the events that lead to the breakdown of cartilage. Researchers now think that there are several factors that may increase your risk for getting OA. Key risk factors include: heredity; excess weight; injury; joint damage from another type of arthritis.
Heredity
Some families may pass along the tendency for defective cartilage; others may pass along slight defects in the way joints fit together. The results of such defects may not show up until a person is middle-aged or older.
Excess Weight
Excess weight puts extra stress on the weight-bearing joints, especially the knees and hips. The good news is that research has shown that for women, losing as little as 11 pounds in middle age can help prevent OA in the knees. While this study was done in women, it probably holds true for men also. Even if you already have OA in the knees, losing weight can help reduce stress on your joints.
Injury
Your risk of developing OA can increase if you had injuries to the joints from accidents or from repeated use through activities like sports or work.
Complications of Another Type of Arthritis
Sometimes joint damage caused by another type of arthritis, such as rheumatoid arthritis, can eventually lead to OA.
What can you do about osteoarthritis?
- If your doctor thinks you have osteoarthritis, he or she may perform a physical examination and order tests such as x-rays.
- Although there is no cure for osteoarthritis, there are a number of steps you can take to manage your pain and lead an active life.
- Learn as much as you can about this disease. Speaking with people who are specialists in arthritis care can provide you with the information you need.
Establishing the correct diagnosis is very important, because
something can be done to manage most forms of arthritis, and most therapies work best when
started early in the disease.
Your doctor may be able to diagnose OA based on your medical history and a physical
examination. Sometimes, your doctor may order certain tests to help confirm the diagnosis,
to determine how much joint damage exists, or to distinguish among different types of
arthritis. These tests may include x-rays, blood tests or joint fluid tests.
Although there is no cure for OA, a lot can be done to help manage the condition. A
variety of treatments can help to lessen pain and stiffness and to make movement easier.
Your active involvement in developing your prescribed treatment plan is essential.
Medicine
- Acetaminophen is often the first medication chosen to treat osteoarthritis. A common form of acetaminophen is TylenolŽ. It can relieve pain but does not reduce inflammation.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are a type of medication that helps reduce the pain and swelling of the joints and decrease stiffness. However, they do not prevent further joint damage.
- Cortisone may be injected into the joint to relieve severe inflammation. Cortisone is a steroid that reduces inflammation and swelling.
- Another treatment is viscosupplementation, in which a clear gel-like substance is injected into the knee. This substance lubricates the cartilage (much like oil lubricates an engine), reducing pain and allowing greater movement of the knee.
For mild to moderate OA doctors often recommend acetaminophen (TylenolŽ, PanadolŽ, ExdolŽ, etc.). Acetaminophen is a pain reliever, but has no anti-inflammatory properties. For this reason it can usually be safely taken along with most prescription medications, should these also be needed. However, there are daily limits of acetaminophen that can be taken, so caution should be exercised, particularly if other medications that contain acetaminophen (for example, it's found in many cold remedies) are being used. A serious overdose of acetaminophen can cause liver damage.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are a type of medication that helps reduce the pain and swelling of the joints and decrease stiffness. However, they do not prevent further joint damage.
NSAIDs reduce pain when taken at a low dose, and relieve
inflammation when taken at a higher dose. NSAIDs such as ASA (Aspirin, Anacin, etc.) and
ibuprofen (Motrin IB, Advil, etc.) can be purchased without a prescription. Examples of
NSAIDs that require a prescription include Naprosyn, Relafen, Indocid, Voltaren, Feldene,
and Clinoril. The various NSAIDs and AspirinŽ, if taken in full doses, usually have the
same levels of anti-inflammatory effect. However, different individuals may experience
greater relief from one medication than another. Taking more than one NSAID at a time
increases the possibility of side effects, particularly stomach problems such as
heartburn, ulcers and bleeding. People taking these medications should consider taking
something to protect the stomach, such as misoprostol (Cytotec).
- Cortisone may be injected into the joint to relieve severe inflammation. Cortisone is a steroid that reduces inflammation and swelling.
For severe pain and inflammation, doctors can inject a
powerful anti-inflammatory drug, called a corticosteroid, directly into the affected
joint. Cortisone is a steroid that reduces inflammation and swelling. It is a
hormone naturally produced by the body. Corticosteroids are man-made drugs that
closely resemble cortisone. An injection can provide almost immediate relief for a
tender, swollen and inflamed joint. However, this treatment can only be used rarely, since
corticosteroids can weaken the cartilage and remove the minerals from (and therefore
weaken) the bone, resulting in further joint weakness.
- Another treatment is viscosupplementation, in which a clear gel-like substance is injected into the knee. This substance lubricates the cartilage (much like oil lubricates an engine), reducing pain and allowing greater movement of the knee.
Viscosupplementation is a relatively new treatment in Canada
for people with osteoarthritis of the knee. A clear gel-like substance is injected into
the knee that helps the joint fluid regain its viscoelasticity - that is, its ability to
lubricate joint cartilage and absorb the mechanical shocks of daily living.
Viscosupplementation restores frictionless movement within the joint, thus reducing pain
and allowing greater mobility. For more information on this procedure, ask your doctor.
Exercise
Muscles and the other tissues that hold joints together weaken when they aren't moved enough, so the joint loses its shape and function. Exercise helps lessen the symptoms of OA and can help make you feel better overall. Moderate stretching exercises will help relieve the pain and keep the muscles and tendons around the affected joint more flexible and strong. Low-impact exercises like swimming, walking, water aerobics and stationary bicycling can all reduce pain while maintaining strength and flexibility. Always consult a doctor before beginning an exercise program.
Heat/Cold
Heat or cold application can provide temporary relief of pain. Heat helps to reduce pain and stiffness by relaxing aching muscles and increasing circulation to the area. There is some concern that heat may worsen the symptoms in an already inflamed joint. Cold helps numb the area by constricting the blood vessels and blocking nerve impulses in the joint. Applying ice or cold packs appears to decrease inflammation and therefore is the method of choice when joints are inflamed.
Protect Your Joints
- Be kind to your body. After doing heavy work, or doing the same task over and over, stop. Slow down by doing an easy task, or by taking a rest.
- Use your back, arms and legs in safe ways to avoid putting stress on joints. For example, carry a heavy load close to your body.
- Use helpful devices such as a cart to carry your grocery bags, or an enlarged handle that fits over a knife handle so you can hold it easily. A cart will help you to walk more safely. A grab bar, which attaches to a shower, will help you to get in and out of the tub more easily.
- Maintain a healthy weight to avoid putting extra stress on your joints.
Protecting your joints means using your joints in ways that avoid
excess stress. Benefits include less pain and greater ease in doing tasks. Three
main techniques to protect your joints are:
Pacing, by alternating heavy or repeated tasks with easier tasks or breaks, reduces the
stress on painful joints and allows weakened muscles to rest.
Positioning joints wisely helps you use them in ways that avoid extra stress. Use
larger, stronger joints to carry loads. For example, use a shoulder bag instead of a
hand-held one. Also, avoid keeping the same position for a long period of time.
Using helpful devices, such as canes, luggage carts, grocery carts and reaching aids, can
help make daily tasks easier. Small appliances such as microwaves, food processors
and bread makers can be useful in the kitchen. Using grab bars and shower seats in
the bathroom can help you to conserve energy and avoid falls.
Staying at your recommended weight or losing weight helps reduce the risk of OA of the knees, and it lessens pain by reducing stress on the joints. If you plan to lose a lot of weight, discuss the best program for you with your doctor and a dietician.
Relaxation Developing good relaxation and coping skills can give you a
greater feeling of control over your arthritis and a more positive outlook. Some people with severe, advanced OA may require surgery. Benefits
include less pain, better movement and function, and in some cases, better physical
appearance, such as in the hands. There are a number of different kinds of surgery for OA -
some less invasive than others. Arthroscopic surgery, for example, involves making small
incisions through which surgeons can clean cartilage debris from the joint. Some kinds of
surgery repair bone deformity, fuse joints, or rebuild part of a joint. Other kinds of
surgery replace your own joint with an artificial joint. Joints that may benefit from surgery include knees, hips,
shoulders and certain joints in the hands or the feet.
Surgery
Arthritis - Literally means joint inflammation but is often used to indicate a group of more than 100 rheumatic diseases. These diseases can affect not only the joints but also muscles, tendons, and ligaments as well as the skin and certain internal organs.
Osteoarthritis (OA) - Degenerative joint disease in which cartilage that covers the ends of the bones in the joint deteriorates, causing pain and loss of movement. OA is commonly found in the middle aged and elderly, with an estimated 85 per cent of the population affected by the age of 70.
Cartilage - A tough, stretchy tissue that covers the ends of bones to form a low-friction, shock-absorbing surface for joints.
Rheumatologist - A doctor who specializes in
diagnosing and treating disorders that affect the joints, muscles, tendons, ligaments and
bones.
Arthroscopy- A technique in which a tiny camera and/or various surgical instruments are inserted inside a joint through small incisions to determine damage or make repairs.
Assistive device - Any device that is designed, and/or adapted to assist a person to perform a particular task. For example, canes, crutches, walkers, wheel chairs, and shower chairs are all assistive devices.
Anti-inflammatory - Offsetting or controlling inflammation