Arthritis is a disease that comes in many shapes and forms. Although there are more than 100 types of arthritis, the kind most people refer to is osteoarthritis – the “wear and tear” kind -- which affects more than 27 million Americans.
Osteoarthritis (also known as degenerative joint disease or degenerative arthritis) refers to the breakdown of cartilage in a joint. Cartilage is a crucial part of the joint – it provides a rubbery cushion at the ends of the bones in the joint and allows the joint to move smoothly and without pain.
When cartilage breaks down, the cushion in your joint goes away, and your bones begin to rub against each other. When this happens, you start to feel pain and stiffness, which can interfere with your normal, everyday movements.
Osteoarthritis can develop in your 20s and 30s, and it becomes increasingly common with age. In fact, most people over the age of 60 have some degree of osteoarthritis. It can affect you regardless of your race or your gender, although, overall, more women than men are living with this disease.
What causes osteoarthritis?
No one knows exactly what causes osteoarthritis, but it is influenced by several factors:
- Your age – The older you are, the more likely you are to have osteoarthritis.
- Your weight – Excess weight puts pressure on your joints, especially your knees, and this can lead to the development of osteoarthritis.
- Your family history (genetics) – Certain conditions such as inherited bone or joint abnormalities, being double-jointed and having certain arthritis-related genes can increase your risk of osteoarthritis.
- Injuries to the joint – Injuries such as bone fractures can increase your risk of osteoarthritis.
- Overuse of the joint – Jobs that result in joint overuse, such as gardening, can increase your risk of osteoarthritis.
- Other conditions – Muscle weakness near the joint and diseases such as rheumatoid arthritis can increase your risk of osteoarthritis.
How does osteoarthritis develop?
When the cartilage in your joint begins to wear out, it leads to changes in the bones surrounding it. The bones thicken, bony growths (bone spurs) can appear at the joint, and bits of bone can break off and float in the joint space. The lining of the joint (synovium) also can become inflamed due to cartilage breakdown.
All of these changes can result in pain, stiffness and limitations in movement of the joints.
How do I know if I have osteoarthritis?
Osteoarthritis most commonly occurs in the weight-bearing joints of the hips, knees and lower back. It can also affect the neck, small finger joints, the base of the thumb and the big toe. It typically does not affect any other joints in the body unless injury or stress is involved.
Osteoarthritis generally begins as soreness or stiffness in your joints. Initially, you may find it to be just inconvenient, but not so painful that you need to see your doctor. If you’re lucky, your osteoarthritis remains at this stage and you learn to manage it on your own.
In other cases, osteoarthritis worsens – and eventually progresses to a point where you have trouble with everyday activities such as walking, climbing stairs or sleeping.
In rare cases of osteoarthritis, you may also experience signs of inflammation such as swelling, pain and redness.
If you think you may have osteoarthritis, ask yourself these key questions:
- Is your joint sore after periods of overuse (too much exercise) or inactivity (sitting or resting)?
- Are you stiff after resting a while but okay again once you start moving?
- Are you stiff for about 30 minutes when you first wake up in the morning?
- Do you often feel pain in one of your joints? Is it worse at the end of the day?
- Do you have trouble with coordination, posture and walking due to pain and stiffness in your joints?
How is osteoarthritis diagnosed?
If you have the signs and symptoms of osteoarthritis, you should see your physician right away for an accurate diagnosis. Early, aggressive treatment can slow the progression of the disease.
A primary care physician typically performs the initial assessment and diagnosis; from there, you will be referred to a specialist. In making a diagnosis, your doctor will take your medical history and perform a physical exam. Tests such as X-rays and joint aspiration (taking a sample of fluid from your joint) will help confirm the diagnosis.
How is osteoarthritis treated?
When looking at treatment options, your physician will discuss with you your overall treatment goals and concerns. Treatments generally will be aimed at controlling your pain, improving your ability to function and slowing your osteoarthritis from progressing.
At El Camino Hospital, our arthritis specialists usually take a conservative initial approach to treatment, taking into consideration your level of pain, which joints are affected and the damage involved, along with personal factors such as your lifestyle and level of activity.
Most treatment plans include a combination of exercise, weight control, joint protection, physical and occupational therapy, and medications. If initial treatments do not succeed, surgery may be considered.
Treatment is divided into these categories:
2. Physical therapy and occupational therapy
4. Non-medical treatments (exercise and weight control)
5. Alternative treatments
For many, medications can be very effective in treating osteoarthritis, and there are many options available on the market today. Medications generally fall into these five categories:
Oral analgesics – Oral analgesics (such as acetaminophen, propoxyphene hydrochloride and tramadol) can successfully relieve pain and are recommended for people with mild osteoarthritis. They, however, do not relieve inflammation or swelling.
Topical analgesics – These are over-the-counter creams or rubs, which can be applied directly over a painful joint. Active ingredients include counterirritants (such as wintergreen oil, camphor and eucalyptus), salicylates and capsaicin.
Non-steroidal anti-inflammatory drugs (NSAIDs) - NSAIDs (such as aspirin, ibuprofen, ketoprofen, naproxen, naproxen sodium and meloxicam) reduce pain as well as inflammation and swelling. NSAIDs work best in people who have moderate-to-severe pain with inflammation. Cox-2 drugs (such as celecoxib and valdecoxib) are targeted NSAIDs that do not irritate the stomach like other NSAIDs.
Corticosteroids (knee injections) - These are steroid medications injected into the knee joint for quick pain relief. They are used for moderate-to-severe knee pain and inflammation, but cannot be used in the same joint more than a few times a year.
Hylauronic acid (knee injections) - Hylauronic acid is a substance found in the body that gives joint fluid its viscosity. This treatment is used only for knee osteoarthritis and the injections must be administered by an orthopedic surgeon.
Physical Therapy and Occupational Therapy
If osteoarthritis affects your ability to do everyday tasks such as bathing, dressing and walking, your doctor may prescribe physical or occupational therapy to help you with these activities.
Physical therapy can help you strengthen your muscles and boost your flexibility and mobility. Your physical therapist will work with you on an exercise program and teach you various pain management techniques. An occupational therapist can also help you learn how to perform your everyday tasks without putting more stress on your joints. They can also recommend certain equipment to assist you with these tasks.
If you have severe joint damage, significant pain and/or extremely impaired mobility, surgery may be the best option for you.
Surgical options available at El Camino Hospital include:
Arthroscopic surgery – Using tiny instruments connected to a closed-circuit TV, your surgeon can see inside your joint, take tissue samples, remove loose cartilage, repair tears, smooth a rough surface or remove diseased synovial tissue. Surgeons use this technique most often in knee and shoulder surgery.
Osteotomy - To increase stability by redistributing the weight on the joint, your surgeon may perform an osteotomy. Those with hip or knee osteoarthritis in only one joint and those who are too young for a joint replacement may benefit most from this procedure.
Joint fusion - Joint fusion removes the damaged joint and fuses the two bones on each side of the joint. This is done more often in areas where joint replacement is not effective.
Joint replacement surgery (arthroplasty) – For those with severely limited mobility, the replacement of a joint may be necessary. Although there are many variations on joint replacement, it typically involves the removal of the damaged joint, resurfacing and relining of the ends of bones and replacing the old joint with a new artificial one. Knees and hips are the two joints most often replaced, although artificial joints are also available to replace shoulders, fingers, elbows, ankles and back joints.
Exercise and weight control are two of the best options available today to help relieve the symptoms of osteoarthritis.
Exercise - Exercise can reduce your pain and improve joint movement. Research has shown that exercise is not only safe for those with osteoarthritis, it can actually help decrease your fatigue, strengthen your muscles and bones and increase your overall flexibility. Recommended exercises include swimming and walking on flat surfaces. Exercises to avoid, because they can increase joint pain, include jogging and high-impact aerobics.
Weight control – Staying at your recommended weight is particularly important if you have osteoarthritis. Excess weight puts more stress on the joints, especially your knees. Patients with osteoarthritis who have successfully lost weight have seen their symptoms improve dramatically.
Some people have had success with alternative or complementary therapies; however, results of recent studies are mixed. These therapies include:
- Glucosamine and chondroitin sulfate (dietary supplements)
- Chiropractic care
If you are interested in alternative treatments for osteoarthritis, be sure to have a conversation with your physician about the most appropriate option for you. Not all of these treatments have been proven to be effective, and some, such as chiropractic care, can actually be harmful depending on your condition.