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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.
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.
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.
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.
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:
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:
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:
Symptoms of osteoarthritis vary from patient to patient and develop gradually, but typically involve:
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.
Following these few tips can help you live more comfortably with OA:
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.
The Arthritis Foundation (AF) makes the following recommendations to protect joints and prevent OA:
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
Physical Therapy and Occupational Therapy
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:
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.”
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:
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:
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