Osteoarthritis

Osteoarthritis DiagramOsteoarthritis (OA) is a chronic (long term) disease characterized by a loss of cartilage and bony spur (osteophyte) formation in joint spaces, which affects most individuals by age 701. Normally cartilage cushions the joints preventing adjacent bones from contacting each other. This cartilage can’t be repaired, and when lost, bony spur formations can rub together causing pain and inflammation.

The specific cause of osteoarthritis is unknown; however it is not just a disease of aging, but rather the result of a combination of factors including genetics, joint degeneration, and other mechanical processes3. Symptoms of osteoarthritis typically include joint pain with movement (alleviated by rest), limited range of motion, joint swelling and joint stiffness after periods of inactivity1. This pain usually occurs within minutes but can last hours. As osteoarthritis progresses, pain can occur during rest and at night.

Osteoarthritis-InformationJoints most affected by osteoarthritis include the knee, hip, distal interphalangeal joints (closest to the fingertips), the thumb, and the spine- both in cervical (neck) and lumbosacral (lower back) regions1. Advancing age is the most significant risk for developing osteoarthritis, but other risk factors include obesity, female gender, muscle weakness, joint overuse/repetitive use, joint trauma, and joint instability1, 3.

A doctor will take a history and perform a comprehensive physical exam, paying close attention to joint tenderness, limited range of motion, deformity and joint enlargement, swelling and crepitus (crackling sounds heard in joints)1. Diagnosis of osteoarthritis, however, is primarily confirmed by x-ray showing narrowing of the joint spaces, cartilage loss and spur formation. X-ray radiography can also determine the severity and follow the progression of over time. A doctor may order laboratory tests to rule out other potential causes of arthritis1, 4.

The goal for treating osteoarthritis is to control pain and minimize disability through a large spectrum of treatment options1, 2. These options depend on the progression of disease and the severity of pain, and include lifestyle changes, medications and surgery.

Osteoarthritis HandsLifestyle changes and non-medical therapies include patient education on resting and restricting use of affected joints, weight reduction, physical therapy, exercise and more1. At early stages of osteoarthritis, pain can be alleviated with conservative treatment; primarily rest and over-the-counter analgesics such as acetaminophen (Tylenol™) and non-steroidal anti-inflammatory drugs such as ibuprofen (Advil ™)1, 5. Additionally, for severe cases of pain and inflammation, more selective anti-inflammatory and opioid medications can be prescribed.

For certain joints, steroid and hyaluronic acid injections may be effective for the short term control of pain1. If osteoarthritis progresses to the point where surgical intervention is necessary because more conservative treatments have failed, joint replacement, arthroscopy, or an osteotomy, in which bone is removed from the joint, may be beneficial1, 2. Surgery does involve certain risks, however; if diagnosed with osteoarthritis, a pain management specialist can help navigate the proper course of treatment.

The best way to treat OA is to prevent progression of the disease through lifestyle changes like exercise and weight reduction1.

References

  1. Brasington, R.; et al. (2010). Osteoarthritis. First Consult. MD Consult Web site, Core Collection. Retrieved from www.mdconsult.com.ezproxy1.library.arizona.edu/das/pdxmd/.
  2. Kalunian, K.C. (2010). Surgical therapy of osteoarthritis. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.
  3. Kalunian, K.C. (2011). Risk factors for and possible causes of osteoarthritis. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.
  4. Kalunian, K.C. (2007). Diagnosis and classification of osteoarthritis. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.
  5. Kalunian, K.C. (2011). Pharmacologic therapy of osteoarthritis. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.