CONDITIONS

What Is Osteoarthritis

Osteoarthritis or OA, is also called degenerative joint disease or degenerative arthritis, and is the most common form of arthritis, affecting nearly 27 million Americans. In osteoarthritis, deterioration of joint cartilage – the cushioning for bone ends in joints – causes bones to rub against each other, creating friction that can result in pain, inflammation, stiffness, and damage to the ligaments or bone.

    There are two forms of osteoarthritis: primary and secondary:

  • In primary osteoarthritis, cartilage breakdown is caused by the natural wear and tear of aging.
  • In secondary osteoarthritis, cartilage breakdown is caused by another disease or condition such as obesity, gout, diabetes, or repeated trauma.

The risk of osteoarthritis increases with age, affecting only 13.95% of the 25 and older population, and 33.6% of the 65 and older population.

What Causes Osteoarthritis

Healthy cartilage is composed of a balance of water and protein matrix that includes collagens and proteoglycans. The balance of water and protein matrix allows the bones that cartilage covers to glide over each other, reducing friction and allowing for normal joint function. As the body ages, the water content of the cartilage increases, lessening the protective effects of the compounds found in the protein matrix. This causes the bones to rub against each other, creating friction that leads to inflammation, pain, and joint damage.

 

Researchers are unsure of what causes the increase in cartilage water content; however, they have found several osteoarthritis risk factors including age, obesity, and gender.

Risk Factors For Osteoarthritis

Researchers have identified the following factors as influential in the development of osteoarthritis:

Age. This is by far the strongest risk factor. The Centers for Disease Control report that the incidence of OA increases with age, typically leveling off at around age 75, but that nearly 1 in 2 people may develop symptomatic knee OA by age 85 years.

Obesity. Extra pounds add significant stress to the joints. The knee is particularly affected. A 2008 article published in Arthritis and Rheumatism reported that two in three people who are obese may develop symptomatic knee OA in their lifetime; 66% of adults with doctor-diagnosed arthritis are overweight or obese (compared with 53% of adults without doctor-diagnosed arthritis)

Gender. Although OA affects both men and women, before age 45 it occurs more frequently in men; after age 45 it’s more common in women. The Centers for Disease Control reports that women have higher rates than men, especially after age 50. Men have 45% lower risk of incident knee OA and 36% reduced risk of hip OA than women.

Joint injury. Any traumatic injury to a joint whether by accident, physical labor or sports, increases the risk of developing OA. A 2005 article in Current Opinion in Rheumatology reported that knee osteoarthritis in young adults is common after knee injury. In women who sustained an anterior cruciate ligament injury in soccer, 51% (mean age 31) had radiographic changes after 12 years. Men, 41% (mean age 36) had osteoarthritis after 14 years. An injury to the menisci during middle age resulting in a horizontal tear is more likely the first signal of an already ongoing osteoarthritis process of the knee. Known risk factors seem to contribute to osteoarthritis through pathways related to mechanical aspects of the joint and the musculoskeletal system

Repeated Micro-Trauma (Repetitive Stress Injury). According to the Arthritis Foundation, athletes and people whose jobs require repetitive motion (including landscaping, typing, and operating machinery) are at risk for developing osteoarthritis. An article published inOccupational and Environmental Medicine reported that compared to office workers, male farmers had an increased risk of developing hip OA of hip OA following one to five years of work and a threefold increased risk after 10 years. The risk of developing knee OA was twofold in female construction workers who had worked for six to 10 and over 10 years. Also, an article published in 1995 in Arthritis and Rheumatism reported that a study of male former elite athletes ranging in age from 45-68 years found that the prevalence of osteoarthritis was 29% in soccer players, 31% in weight lifters, and 14% in runners.

Alignment of joints. If joints don’t move correctly (bowlegs, dislocated hips, or double-jointedness) they are more likely to develop OA. A 2002 article in Arthritis and Rheumatism report that varus (bow-legged) and valgus (knock-kneed) malalignment increase the risk of osteoarthritis. The researchers found that in knees with mild OA, the odds of progression of the diseases were significantly increased 4-fold by varus alignment. The odds of progression were increased 2-fold by valgus alignment, approaching significance. In knees with moderate OA, the risk of progression was comparably increased by 10-fold with either varus or valgus alignment.

Genetics. An inherited defect in one of the genes responsible for manufacturing cartilage may be a contributing factor. The Centers for Disease Control reports that about 20%–35% of knee OA and over 50% of hip and hand OA may be genetically determined.

Diagnosing Osteoarthritis

According to the Hospital for Special Surgery in New York City and the Arthritis Foundation, the process for diagnosing osteoarthritis starts with a physical examination and progresses as follows:


Physical Examination

During the evaluation, your doctor will look at your joints and touch those you’ve described as painful. He or she will be looking for areas that are tender, painful or swollen.

To ascertain how arthritis is affecting your body, your doctor will check for:

  • Passive range of motion The doctor will hold onto your affected limb and attempt to move it through what should be its full capability. The doctor will stop at any point if you say you’re experiencing too much pain.
  • Active range of motion The doctor will ask you to move the affected joint or joints yourself through as much of the range of motion as you can.
  • Gait The doctor will ask you to walk so that he or she can observe whether or not hip and/or knee pain is causing you to favor the joints or to limp.
  • Pain level. The doctor will ask you to rank the severity of your pain on a scale of zero to ten with zero representing no pain and each subsequent number representing your opinion about how much the pain is causing problems with your activities of daily living such as sitting, walking, standing, and finding a comfortable sleeping position. Ten represents pain so severe that it is disabling.

Radiological Examinations

  • X-rays of the affected joints will show the following sings that are characteristic of osteoarthritis:
    • Bones that are closer to each other than they should be. This occurs as cartilage wears away and the joint space narrows.
    • Cysts in bones. In response to cartilage destruction, the body attempts to stabilize the joint and this can result in the formation of cysts or fluid-filled cavities in bones.
    • Increased bone density or uneven joints. Without a sufficient cushion of cartilage, bones rub against each other. In response to the resulting friction, the body creates extra layers of bone. The results are increased density and uneven joint surfaces, often with protrusions called osteophytes or bone spurs.
  • MRI (magnetic resonance imaging) This diagnostic tool can show soft tissue swelling and small cartilage or bone fragments in the joint that are indicative of OA.
  • CT (computed tomography) examinations demonstrate the degree of osteophyte (bone spur) formation and its relationship to the adjacent soft tissues.
  • Ultrasound is can identify synovial cysts that may form in patients with OA.
  • Radionuclide Nuclear Medicine Bone Scans can image the entire skeleton, which is helpful if OA is suspected in multiple areas

Laboratory Tests

The physician will order standard blood tests and urinalysis to rule out other possible causes of OA symptoms. In addition, the following tests may be performed:

  • Antinuclear antibody (ANA) – The results of this test are typically normal in people with osteoarthritis. It is used to rule other conditions including rheumatoid arthritis, polymyositis, scleroderma, Sjogren’s syndrome, and mixed connective tissue disease. The experts at the Hospital for Special Surgery note that as we age, a low level positive test for rheumatoid arthritis (rheumatoid factor) or ANA can develop without the presence of illness. The physician will consider this possibility and make the final diagnosis of osteoarthritis based on the entire clinical picture derived from all aspects of the diagnostic procedure.
  • Erythrocyte sedimentation rate – Also called ESR or “sed rate,” this test measures how fast red blood cells settle like sediment in the bottom of a glass tube over the course of about an hour. A high rate indicates inflammation that may be attributed to osteoarthritis. However, as in the case of a positive test for ANA (see above), an elevation of the sedimentation rate can sometimes develop as we age without the presence of illness. Again, the physician will take into consideration the complete diagnostic picture in making a diagnosis of OA.
  • Rheumatoid factor (RF) – This test is done to rule out rheumatoid arthritis by measuring the level of an antibody that acts against the blood component called gamma globulin. The test is often positive in people with rheumatoid arthritis but not in those with osteoarthritis.
  • Uric acid – This test is done to rule out gout by measuring the level of uric acid in the blood. The levels will be in the normal range if gout is not present. This will contribute to a diagnosis of OA rather than gout.
  • Synovial fluid test –Synovial fluid is a lubricating liquid found in the joints. According to a study done by the Osteoarthritis Research Society in 2003, crystals develop in the fluid of people with OA. To test for this, the doctor will draw some fluid, a procedure similar to drawing blood, and send it to a lab for analysis. The presence of the crystals can help to confirm the diagnosis of OA.

Symptoms of Osteoarthritis

Symptoms of osteoarthritis vary from patient to patient and develop gradually, but typically involve:

  • Pain. Some sufferers describe discomfort in the affected joints as an ache while others report sharp stabs of pain or a burning sensation. Pain may be constant or periodic. Increasing levels of pain that become chronic and disturb your sleep often indicate that the condition is becoming more severe.
  • Tenderness. When you press on the affected joints, even with a light touch, the joints may feel tender.
  • Stiffness. Most people with OA report joint stiffness in the morning when they wake up or after sitting for a long time. Moving around usually alleviates the stiffness to some degree.
  • Weak muscles. Muscles surrounding the affected joint typically lose strength.
  • Slight swelling. Some people notice a little swelling at the site of the affected joint, especially if the OA is in the knee.
  • Misshapen joints. The affected joints may change in appearance. For example, knuckles may enlarge and fingers may become crooked if the OA is affecting the hand.
  • Limited range of motion. You may not be able to fully bend your knee or make a fist or walk with a normal gait.
  • Cracking. You may experience a cracking or popping sound when you try to straighten your knee or move your leg.
  • Bone spurs. You may be able to fell hard bumps when you touch the affected joints. These protrusions called osteophytes or bone spurs.

Prognosis

The prognosis of osteoarthritis depends on which joints are involved and the rate at which the disease progresses. OA is typically a progressive disease, meaning that symptoms get worse as time goes on at a pace that varies from person to person. Some people experience periods of mild symptoms in alternation with periods of severe symptoms, and others report no disease progression at all. Rarely are there reports of OA reversals.

OA can affect high-usage joints such as the knees, hips, fingers and lower back, making symptoms especially disruptive when they arrive. Osteoarthritis in different joints can result in different experiences. For example, those with OA in their hands may be more mobile than those who have it in their hips or lower back, but might have a harder time doing detail-oriented tasks that involve the hands.
If untreated, OA can cause long-term pain and can significantly limit activity. Mobility is especially limited if the osteoarthritis involves the knees, hips, or cervical spine. Fortunately, there are treatment options available to lessen the severity of OA symptoms and help you live comfortably with Osteoporosis.

Living With Osteoarthritis

Following these few tips can help you live more comfortably with OA:

  • Exercise. Moderate exercise will help to lubricate joints and strengthen muscles. Gentle, low-impact exercises like swimming, yoga, and walking are best. Excessive exercise can damage your joints. A 2001 article in Archives of Internal Medicine reported that among older adults with knee osteoarthritis, engaging in moderate physical activity at least 3 times per week can reduce the risk of arthritis-related disability by 47%.
  • Lose extra weight. By maintaining a healthy weight, you’ll put less stress on joints. Just 10 extra pounds puts stress on your knee joints that is the equivalent of 30 to 60 pounds.
  • Make adjustments. People in occupations with repetitive and stressful movement should find ways to reduce trauma by adjusting the work area or substituting tasks that produce less stress on joints.
  • Mechanical aids. Splints, braces, shoe inserts, orthopedic shoes, and knee braces are available to limit stress on the joint.
  • OTC pain creams. Creams and gels may provide temporary relief from pain. They work best on joints that are close to the surface of the skin, such as knees and fingers.
  • Rest. If there’s pain or inflammation in your joint, rest it for 12 to 24 hours.

Screening

Osteoarthritis is not a disease that is regularly screened for. Typically, the disease is diagnosed quickly after a patient notices symptoms and brings them to the attention of his or her doctor. Researchers have found that a screening questionnaire for osteoarthritis might help understand overall prevalence of the disease, but would not significantly change the number of people who are ultimately affected.

Prevention

The Arthritis Foundation (AF) makes the following recommendations to protect joints and prevent OA:

  • Maintain your ideal body weight. A 2006 article in American Journal of Preventive Medicine reported that weight loss of as little as 11 pounds reduces the risk of developing knee osteoarthritis among women by 50%
  • Engage in regular low-impact exercise. People at risk for osteoarthritis may be able to delay the onset of the disease or even prevent by participating in lower-impact sports such as walking, swimming or using an elliptical trainer. That was the finding of a study done at the University of California, San Francisco and presented on November 29th 2010 at the annual meeting of the Radiological Society of North America (RSNA) in Chicago. MRI exams of the participants revealed that light exercisers had the healthiest knee cartilage among all exercise levels, and that patients with minimal strength training had healthier cartilage than patients with either no strength training or frequent strength training.
  • Maintain good posture. According to a 2003 publication by the Arthritis Foundation entitled “Protect Your Joints”, one way to stop joint pain before it starts is to practice good posture when you are standing, sitting or even lying down. Keeping your back straight and your shoulders back will help you put your body in a pose that won’t strain your joints.
  • Do a variety of physical activities to avoid repetitive stress injuries. An article in Arthritis Today, the magazine of the Arthritis Foundation, reports that the key staving off exercise injuries that could lead to OA is to establish and stick with a year-round fitness program. The article suggests bicycling or swimming as ideal low-impact exercises that can help maintain fitness, strength, and range of motion as well as cardiovascular health.
  • Pay attention to pain; don’t push through it. In an article published in Arthritis Today, author Camille Noe Pagan quotes Richard Kassler, supervisor at the Orthopaedic and Sports Therapy Center at New York University Hospital for Joint Disease, as saying “Most people with arthritis can work through mild pain safely. But if you’re experiencing a lot of pain while you exercise, even if you’re not doing a particularly joint-taxing workout, it may be a sign that you have inflammation in the joint, or even joint damage that requires treatment.” In that case, Kessler recommends stopping immediately.
  • Include omega-3 fatty acids in your diet. A study done at Duke University and published on July 11th 2104 in the Annals of the Rheumatic Diseases found that mice consuming a supplement of omega 3 fatty acids had healthier joints than those fed diets high in saturated fats and omega 6 fatty acids. Foods that contain omega-3 fatty acids include fish and most seafood, flaxseed, green, vegetables, eggs, and olive oil, among others.

Medication And Treatment

There’s no cure for OA, but the following treatments options can relive pain and improve the quality of like of patients with the condition:


Medications to relieve pain and inflammation

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs may reduce inflammation and relieve pain. They are:
    • ibuprofen (Advil, Motrin, Nuprin, Mediprin) These are available over-the-counter without a prescription. Typical dosage is two oral tablets of gel capsules every four hours.
    • naproxen (Aleve, Naprelan, Naprosyn, Anaprox). These available over-the-counter without a prescription. Some are taken only every 12 hours.
    • prescription NSAIDs. If your physician feels you need stronger pain relief and that you are a good candidate for prescription versions, he or she may call in a scrip to your pharmacy. However, side effects can be an upset stomach, ringing in your ears, and the risk of damage to your heart, kidney, and liver. The older you are, the more likely you will be to experience these problems. Older people have the highest risk of complications.
  • Acetaminophen. Acetaminophen (Tylenol, Panadol, Mapap, Tempra, Ofirmev) These products relieve pain but do not act as anti-inflammatories. Large does can cause liver damage.
  • Narcotics, also called opioid pain relievers, can be abused and addictive, and have been associated with accidental overdose deaths. Always take narcotics as precisely as prescribed and typically for no longer than three or four months:
    • Codeine
    • Fentanyl (Duragesic) — available as a transdermal patch
    • Hydrocodone (Vicodin)
    • Hydromorphone (Dilaudid)
    • Meperidine (Demerol)
    • Morphine (MS Contin)
    • Oxycodone (Oxycontin, Percocet, Percodan)
    • Tramadol (Ultram)

Physical Therapy and Occupational Therapy

  • A physical therapist is trained to create a personalized exercise routine for you with the goal of strengthening the muscles around the affected joint and improving range of motion.
  • An occupational therapist will study your activities of daily living both during you personal time and at work in order to find way you can minimize stress on the affected joints and avoid triggering pain

Injections

  • Corticosteroid shots (Cortisone, Hydrocortisone, Glucocortoid) Corticosteroids includes the natural steroid hormones that are produced in the adrenal cortex of the brain as well synthetic versions. The treatment is controversial and may damage joints over time. Short-term therapy is recommended.
  • Lubrication injections (Hyalgan, Synvisc) Derivatives of the natural hyaluronic acid that lubricates the knee may offer pain relief.

Surgery

  • Osteotomy (Bone realignment) If OA has caused misalignment of the nee, this procedure can rectify the problems
  • Arthroplasty (Total or Partial Joint Replacement) Damaged joints, typically hips and knees, are excised and replaced with internal prostheses made of plastic and metal. Risks include infections, blood clots, and the possibility that the artificial joint may loosen over time so that another surgery is necessary. The failure rate for total hip replacements among women is higher than that among men, according to a study done at Southern California Permanente Medical Group, San Diego and published in JAMA Internal Medicine in February 2013. Women with an average age of 66 made up 57.5% of the participants. After an average of three years following the operation, 2.3% of women and 1.9% of men underwent an additional surgery to correct a problem.

Complementary and Alternative Treatment

According to the National Center for Complementary and Alternative Medicine (NCCAM), researchers have found little conclusive evidence that dietary supplements, including Glucosamine and Chondroitin Sulfate Dimethyl Sulfoxide (DMSO), or Methylsulfonylmethane (MSM) and various herbal remedies, help with OA symptoms or the underlying course of the disease.

However, The Arthritis Foundation offers a “Supplement and Herb Guide” with the pros and cons of each as well as the scientific studies behind the information. Click on the links below:

  • Avocado Soybean Unsaponifiables. A natural vegetable extract made from avocado and soybean oils.
  • Black Currant Oil. Black currant seed oil is obtained from seeds of the black currant.
  • Borage Oil. Oil from the seeds of the borage plant.
  • Boswellia. Also known as Indian Frankincense
  • Bromelain. Group of enzymes found in pineapple that break down protein.
  • Capsaicin. The highly purified, heat-producing component found in chili peppers.
  • Cat’s Claw. Dried root bark of a woody vine that grows in the Amazon rain forests.
  • Chondroitin Sulfate. A component of human connective tissues found in cartilage and bone.
  • Devil’s Claw. A traditional herb used in South Africa.
  • DHEA. An androgen steroid hormone naturally produced by the adrenal glands.
  • DMSO. A colorless, sulfur-containing organic by-product of wood pulp processing.
  • Evening Primrose. The seeds of a wildflower, containing gamma-linolenic acid (GLA).
  • Fish Oil. Oil from cold-water fish such as salmon, tuna, halibut and cod.
  • Flaxseed. Seed of the flax plant, containing omega-3 and omega-6 fatty acids.
  • Ginger. The dried or fresh root of the ginger plant.
  • Ginkgo. Leaf of the ginkgo biloba tree, native to East Asia.
  • GLA. Omega-6 fatty acid in evening primrose, black currant and borage oils.
  • Glucosamine. Major component of joint cartilage; derived from the shells of shellfish.
  • Green-lipped Mussel. The New Zealand mussels are rich in omega-3 fatty acids.
  • Indian Frankincense. Gum resin from the bark of the Boswellia tree found in India.
  • Melatonin. A hormone produced by the pineal gland.
  • MSM. Organic sulfur compound found naturally in fruits, vegetables, grains, etc.
  • Pine Bark. The extract made from the bark of the French maritime pine tree.
  • Rose Hips. Made from the seed pods of roses.
  • Sam-e. A naturally occurring chemical in the body.
  • St. John’s Wort. The St. John’s wort plant is native to Europe and grows wild in the U.S.
  • Stinging Nettle. A stalk-like plant found in the U.S., Canada and Europe.
  • Thunder God Vine. Root of a vine-like plant from Asia.
  • Turmeric. A yellow powder ground from the roots of the lily-like turmeric plant.
  • Valerian. The dried root of the perennial herb valerian.

If you are taking any supplements, tell your doctor.


There are a few complementary treatment options have been shown to be effective for relieving OA symptoms. These are:

Acupuncture A trial of a large number of patients with chronic pain due to OA of the knee or hip, done at the University Medical Center in Berlin and published in the November 2006 issue of Arthritis & Rheumatism, found that for patients who were receiving routine primary care, the addition of acupuncture to the treatment regimen resulted in a “clinically relevant and persistent benefit”. Each patient was followed for a total of six months and the control group received acupuncture during the last three months of their study period. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and a health-related quality of life survey (Short Form 36) were used to measure outcomes when the study began and at three and six months. “Patients with chronic pain due to OA of the knee or the hip who were treated with acupuncture in addition to routine care showed significant improvements in symptoms and quality of life compared with patients who received routine care alone,” the authors state.

Swedish Massage According to the National Center for Complimentary and Alternative Medicine, a multi-university study published in February 2012 in PLoS One found that a 60-minute “dose” of Swedish massage therapy delivered once a week for pain due to osteoarthritis of the knee was both optimal and practical. The team randomly assigned 125 participants with osteoarthritis of the knee to receive one of four 8-week doses of Swedish massage (30 or 60 minutes weekly or twice weekly) or usual care. At 8 weeks, participants in the 60-minute massage group had significant improvements in pain, function, and global response compared with participants in the 30-minute group and the usual care group.

Tai Chi Researchers from Tufts University School of Medicine determined that patients over 65 years of age with knee osteoarthritis who engage in regular Tai Chi exercise improve physical function and experience less pain. This traditional style of Chinese martial arts features slow, rhythmic movements to induce mental relaxation and enhance balance, strength, flexibility, and self-efficacy. The findings were published in the November 2009 issue of Arthritis Care & Research, a journal of the American College of Rheumatology. At the end of the 12-week period, patients practicing Tai Chi exhibited a significant decrease in knee pain compared with those in the control group. Using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale, researchers noted a –118.80 reduction in pain from baseline between the Tai Chi and control group. Researchers also observed improved physical function, self-efficacy, depression, and health status for knee OA in subjects in the Tai Chi group.

Hydrotherapy The Arthritis Foundation reports that a research team in Australia recruited 152 sedentary people with painful hip and/or knee OA to participate in a trial that would determine whether water exercise would alleviate their pain and improve their function. Marlene Fransen, MPH, PhD, the study’s lead investigator, concludes “This study demonstrated that access to 12 weeks of intensive water exercise classes . . . for fairly sedentary older individuals over 59 years of age with chronic symptomatic knee or hip OA resulted in clinical benefits that were sustained a further 12 weeks.”

When To Contact A Doctor

Contact your doctor or healthcare provider if you are exhibiting symptoms of osteoarthritis, including mild joint symptoms that last more than 6 weeks and don’t get better with home treatments.

If you have already been diagnosed with osteoarthritis, call your doctor immediately if you have:

  • Sudden swelling, warmth, or pain in any joint. These symptoms may mean that you have inflammation or an infection.
  • Joint pain with a fever or rash. This is not typical for osteoarthritis so you may have another condition such as rheumatoid arthritis. If a child has these symptoms, the cause may be Still’s Disease (Systemic Juvenile-Onset Idiopathic Arthritis).
  • Pain so bad that you can’t use your joint.  This may indicate that your cartilage is deteriorating more rapidly than before and you need to discuss surgical options with your physician.
  • Side effects from pain medicine.

Questions For A Doctor

If your doctor has diagnosed your condition as osteoarthritis, you might be feeling anxious about your future. Knowledge is power so don’t be afraid to ask questions such as the following:

  • Is it safe for me to exercise? What kind of exercise should I do?
  • What medicines can help relieve my pain?
  • Is it safe for me to take a pain reliever every day?
  • Would I benefit from a weight-loss plan?
  • How much worse will my condition get?
  • Could alternative therapies, such as yoga or acupuncture, help relieve my pain?
  • Will I need surgery?