Osteoarthritis

Arthritis is a disease of a joint, the place where moving bones meet. Osteoarthritis affects the entire joint -- particularly the cartilage, a tough rubbery tissue that protects and cushions the ends of the bones. With osteoarthritis, progressive breakdown of joint tissues leads to friction and pain with joint movement.


Causes/associated factors
Osteoarthritis, also known as degenerative joint disease, is the most common form of arthritis and a leading cause of disability in older adults. The disease most often develops in the hands, hips, knees, neck and lower back.
By age 65, more than 80 percent of adults in the United States have evidence of osteoarthritis on X-rays and up to 10 percent have symptoms. Women are affected more often than men.

The cause of joint degeneration remains a mystery. Researchers suspect genetic factors may be involved. A collagen defect has been detected in some families with a history of early-onset osteoarthritis.

The risk of developing arthritis increases with:

excess weight
joint injury
participation in sports or occupations that involve repetitive joint stress or heavy bending and lifting (such as soccer, football, marathon running, farming, mining or using a jack hammer)
birth defects of the joints

Signs/symptoms
Osteoarthritis usually develops slowly. Symptoms don't typically appear until middle age or even later. At first, you may notice pain in the affected joint(s) after exercise or weight-bearing activity. The pain is relieved by rest. In advanced cases, the pain may persist even with rest.
Other symptoms may include:

a "grating" sensation or sound when the joint is in motion
joint stiffness after inactivity or morning stiffness (usually lasting less than 30 minutes)
joint swelling or tenderness
limited range of motion
The course of osteoarthritis may vary. Some people notice cycles of flare-ups and remissions, when symptoms are less noticeable.


Diagnosis
The doctor will review your medical history and do a physical exam. You may be asked to describe your activities and anything that aggravates or relieves your pain or symptoms. X-rays of the affected joints may be done to help the doctor diagnose osteoarthritis or distinguish between different types of arthritis.
Sometimes the synovial fluid of the affected joint is examined. To do this, the doctor will use a sterile needle and syringe to remove a small amount of the synovial fluid from the joint. Local anesthesia can help minimize discomfort during the procedure.

Additional tests may be needed if the doctor suspects other or additional conditions.


Treatment
Treatment can help prevent as much destruction to the joint as possible. Your treatment plan will be designed to:
relieve pain
decrease any inflammation that may be present
help you remain as active as possible
Medication
Medication is often an important aspect of pain management. Before prescribing medication, your doctor will consider various factors, including:

the specifics of your condition
the presence of other medical conditions
how often the medications must be taken
how long the effects last
the cost
any personal preferences
Before taking any medication, make sure you understand the possible side effects. If you develop side effects, contact your doctor or seek medical attention immediately.

Remember not to mix over-the-counter and prescription arthritis medications.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, are the most commonly used medications for joint pain and swelling. Valdecoxib (Bextra, for example) and Celecoxib (Celebrex, for example), also known as COX-2 inhibitors, are two newer prescription NSAIDs.
Because of recent safety concerns regarding the COX-2 inhibitors, the U.S. Food and Drug Administration (FDA) has advised doctors to evaluate alternatives to these medications. If your doctor determines that COX-2 inhibitors are appropriate for you, the FDA recommends using the lowest effective dose.

It's important to remember that NSAIDs don't alter the course of the disease or prevent joint destruction.

The major side effects of NSAIDs are gastrointestinal problems such as upset stomach, damage to the stomach lining and gastrointestinal bleeding. Concern over a possible increased risk of heart attack or stroke in people taking COX-2 inhibitors is prompting more research about the risks of this class of NSAIDs.


Acetaminophen can be used to treat mild, moderate or even severe pain without the risk of gastrointestinal bleeding. Acetaminophen is not an anti-inflammatory drug, but many people have found it as effective for pain relief as NSAIDs.
As with all over-the-counter medications, read the package insert carefully to determine safe doses and warnings, especially those concerning alcohol.


Capsaicin cream (Zostrix, for example) is an over-the counter medicated cream. It's applied directly to the painful areas -- often to the small joints of the hand. After applying the cream to your hands, wear gloves and avoid touching any mucous membranes, such as your eyes or mouth.
You may notice burning or stinging at first, but this should lessen with continued use. If you're concerned about burning or stinging, consult your doctor before using this cream.


Corticosteroids can be injected directly into a joint to provide quick pain relief. This is a temporary measure that's not usually done more than three times in a year. Hyaluronate joint injections (Hyalgan or Synvisc, for example) may help reduce knee pain for several months.
Corticosteroids can have significant side effects, most of which are dose- or duration-related. You may notice gastrointestinal disturbances such as peptic ulcers, nausea and vomiting. The medication may also affect your central nervous system in the form of insomnia, headaches and dizziness.

Although rare, more serious side effects may include seizures and thromboembolism (the blocking of a blood vessel by a blood clot).

Long-term use may cause osteoporosis, elevated blood sugar or diabetes. Sudden withdrawal can be fatal if you've taken corticosteroids for a prolonged period of time.

Application of heat
Applying heat through warm baths or showers, warm compresses and the careful use of heat lamps can relax your muscles and temporarily alleviate pain and stiffness. Apply heat for no longer than 20 minutes at a time. Be careful not to burn your skin, especially if you're an older adult or have an impaired circulatory or nervous system.

Another note of caution: Don't use heat on any red, warm joint. Instead, notify your doctor. If you have diabetes or nerve damage to extremities, don't apply heat unless your doctor recommends it.

Protection of the joint
To reduce damage to your joints, appropriately protect and rest them -- especially during periods of inflammation, swelling or severe pain. Proper posture can help reduce strain on your joints and spine. Also, crutches, canes or special braces for weight-bearing joints may help with walking and reduce the load on your weight-bearing joints.

Remember to discuss your activities with your doctor. He or she may offer other suggestions to help reduce strain on your joints.

Exercise
Regular exercise can help improve your overall health and well-being, as well as improve motion of the joint, improve muscle strength and reduce pain. Before you start, however, get your doctor's approval. The doctor may ask a physical therapist to help you plan an appropriate exercise program. A physical therapist can teach you safe exercises, encourage you to exercise on a daily basis and evaluate your progress.

With range-of-motion exercises, you'll move the joint through its entire range of motion. The goal is to maintain flexibility, lessen pain and stiffness, and improve joint function. If the joint is inflamed, you may do range-of-motion exercises with the help of another person or a special piece of equipment.

The goal of muscle-strengthening exercises is to strengthen specific muscle groups. Conditioned muscles can offer support and eliminate some of the stress placed on particular joints.

Endurance exercises such as swimming, walking and bicycling can improve your overall fitness. To spare your joints, avoid or minimize involvement in repetitive impact sports such as running, jogging or tennis, however. Also, avoid exercising on hilly areas or hard surfaces.
Be cautious with exercises that increase your pain an hour later. These exercises may need to be avoided. Minimize or avoid strength and endurance exercises during flare-ups or when you're in severe pain. Remember, however, complete inactivity isn't recommended.

Weight reduction
Reducing excess weight can be an important way to relieve symptoms and prevent joint dysfunction. Being overweight puts added stress on your joints, which further complicates osteoarthritis. Even a small amount of weight loss (5 to 10 pounds) may be beneficial to your health.

Surgery
If surgery has been suggested as a possible treatment option, discuss the advantages and disadvantages with your doctor. It's also a good idea to seek a second opinion.

Various surgical procedures may be available, including:

bone fusion
rebuilding a joint
replacing a joint
correcting deformities of a joint through cutting and resetting
removing a bone or part of a bone
removing the diseased synovial membrane
Surgery usually offers pain relief and may improve the movement and function of your joints. You may also enjoy cosmetic benefits such as improved appearance of deformed joints, especially in the hands. Joint replacement surgery is considered the most significant advance in osteoarthritis treatment for those who've had limited success with other types of medical treatment.

There are risks, however. Surgery may compromise your health and lead to complications if you have other health conditions, such as being overweight. Also, the younger you are, the more likely you are to need another surgery in the future because artificial joints tend to loosen and wear over time.

Self-care measures
How well your treatment plan works largely depends on how well you follow it. It's essential to understand the nature of your disease and its treatment. Here are some specific suggestions:

Modify your environment as much as possible to decrease joint strain. Get enough rest and take breaks during periods of activity before your pain becomes difficult to manage.

Use assistance devices as needed to help with daily activities, such as dressing, eating and bathing.

Eat healthfully, avoid alcohol, and maintain a normal weight for your age and height.

Keep a diary of your responses to treatment and self-care measures to see what works best for you.

Consider relaxation techniques or massage to help relieve pain.

Develop a support network. Counseling or support groups can help you cope with chronic pain. If you become depressed, seek professional help.

Consult your doctor for regular follow-up care or changes in treatment. Contact your doctor if you have a flare-up, medication no longer controls your pain, you develop side effects to the medication, or you have new, unexplained symptoms.

Research
Research on osteoarthritis treatment is ongoing. Here are some recent findings:
The nutritional supplements glucosamine and chondroitin may be useful in reducing joint pain.

The compound S-adenosylmethionine (SAMe) may be useful in reducing joint pain and stiffness.

The antibiotic doxycycline may stop certain enzymes from damaging cartilage.

Acupuncture may reduce pain and improve knee movement.

Pulsed electromagnetic field therapy may reduce the symptoms of osteoarthritis in the knee.

Vitamins C and D may slow the progression of osteoarthritis.
Further research is needed, however. Discuss any treatments with your doctor ahead of time.


Complications
Complications of osteoarthritis may include:
poor joint mobility
muscle wasting or crippling
nerve compression
side effects from drugs used to treat osteoarthritis

Pregnancy-specific information
Gaining weight during pregnancy may temporarily increase stress on your weight-bearing joints. Using medication to treat osteoarthritis, including aspirin and other anti-inflammatory agents, may be harmful to your developing baby. Only take medication approved by your doctor.

Senior-specific information
The risk of developing osteoarthritis increases with age. In fact, osteoarthritis is one of the most common diseases among elderly adults. Sex and previous occupational history are also important factors. Older men, for example, are more likely to develop osteoarthritis in the hip. Older women tend to develop the condition in the fingers and toes. Sometimes, clinical symptoms aren't obvious for those older than age 65.
Treatment options are often the same for older adults. Side effects of medications -- such as prolonged use of NSAIDs -- may be more severe, however. The ideal candidate for joint-replacement surgery is age 60 or older. For older adults, there's less risk of the joint eventually loosening.


Prevention
To help prevent or minimize osteoarthritis:
Maintain an appropriate weight for your age and height.

Protect your joints by eliminating or avoiding repetitive activities.

Maintain strength and flexibility and relieve pain and stiffness with a general fitness program or physical therapy. Daily stretching can also help.

Seek treatment for any underlying conditions.