Osteoarthritis

Osteoarthritis is the most common type of arthritis, affecting an estimated 30 million adults in the United States. (Read about "Arthritis and Rheumatic Diseases") According to the National Institutes of Health, the disease is responsible for more trouble walking and stair climbing than any other disease, and it is the most common indication for total joint replacement of the hip and knee. (Read about "Joint Replacement")

In osteoarthritis, the cartilage that normally covers our bones starts to degenerate. Cartilage is the hard but slippery tissue that covers the ends of bones where they meet to form a joint. Healthy cartilage allows bones to glide over one another. It also absorbs energy from the shock of physical movement. In osteoarthritis, the surface layer of cartilage breaks down and wears away. This allows bones under the cartilage to rub together, causing pain, swelling and loss of motion of the joint. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) says that over time, the joint may lose its normal shape. Also, small deposits of bone - called osteophytes or bone spurs - may grow on the edges of the joint. Bits of bone or cartilage can break off and float inside the joint space. This causes more pain and damage.

NIAMS says this type of arthritis is sometimes called degenerative arthritis or degenerative joint disease. This risk of developing this form of arthritis increases with age. The risk also may be increased if someone experiences joint injuries either from sports, accidents or repetitive movements. (Read about "Repetitive Stress")

All told, osteoarthritis affects over twenty million Americans. Most are over the age of 45, and women are more often affected than men, according to the Arthritis Foundation. As the population ages, the number of people with osteoarthritis is expected to grow.

Unlike some other forms of arthritis, such as rheumatoid arthritis, osteoarthritis affects only joint function and does not affect skin tissue, the lungs, the eyes or the blood vessels. Osteoarthritis affects different people differently. Although in some people it progresses quickly, in most individuals joint damage develops gradually over years. In some people, osteoarthritis is relatively mild and interferes little with day-to-day-life; in others, it causes significant pain and disability. Symptoms can include:

• joint pain
• reduced joint motion
• loss of function
• movement limitation
• disability

According to NIAMS, the most commonly affected joints are those at the ends of the fingers (closest to the nail), thumbs, neck, lower back, knees and hips. Disability results most often when the disease affects the spine and the weight-bearing joints (the knees and hips). (Read about "The Spine" "The Knee") In extreme cases, the cartilage may wear away entirely, leaving a bone-on-bone joint. Bony spurs (pointy bulges of bone) may form at the edges of the joint.

Treatment options

Among treatment options, weight control is very important for anyone with arthritis, especially osteoarthritis. Excess weight puts added pressure on your weight-bearing joints. A study by the Arthritis Foundation found that overweight, middle-aged and older women can actually lower their risk of developing osteoarthritis of the knee by losing weight. (Read about "Losing Weight")

The Arthritis Foundation also recommends proper exercise for arthritis treatment. Exercises can develop range of motion, using gentle stretching, for example, to improve joint mobility. (Read about "Rehabilitation") Strengthening exercises for muscles can also help stabilize joints. According to researchers at the National Institutes of Health, weakness of the quadriceps muscle (in front of the thigh) is common in patients with osteoarthritis and strengthening the quadriceps decreases the risk of osteoarthritis. In addition, there are a number of specific classes, such as water exercise or chair exercises, designed for people with arthritis. Always consult your doctor or physical therapist for information on the right type of exercise for your specific problem. (Read about "Stretching and Health")

In addition, NIAMS says there are other therapies that may work for flare-ups of swelling and pain. These include:

• Heat and cold - The decision to use either heat or cold for arthritis pain depends on the type of arthritis and should be discussed with your doctor or physical therapist. Moist heat, such as a warm bath or shower, or dry heat, such as a heating pad, placed on the painful area of the joint for about 15 minutes may relieve the pain. Make sure you take all necessary precautions to avoid burning or otherwise hurting your skin (Read about "Skin"), and if you have poor circulation, do not use cold packs.
• Joint Protection - Using a splint or a brace to allow joints to rest and protect them from injury can be helpful. Your physician or physical therapist can make recommendations.
• Transcutaneous electrical nerve stimulation (TENS) - A small TENS device that directs mild electric pulses to nerve endings that lie beneath the skin in the painful area may relieve some arthritis pain. NIAMS says TENS seems to work by blocking pain messages to the brain and by modifying pain perception. (Read about "The Brain" "Nervous System")

The drugs used for treating osteoarthritis fall into several different categories. They include:

• Non-steroidal anti-inflammatory drugs (NSAIDs) - such as aspirin, ibuprofen, naproxen sodium and ketoprofen. Many arthritis drugs are available over-the-counter; however long-term use of these products should never be undertaken without a doctor's advice. NIAMS says common side effects of NSAIDs, including those available over-the-counter, can include stomach upset, heartburn, diarrhea, and fluid retention. (Read about "Heartburn" "Diarrhea" "Gastritis") Some patients also develop liver and kidney inflammation (Read about "The Liver" "Kidney Disease") while taking NSAIDs, making it especially important to stay in close contact with the doctor while taking these medications. (Read about "Medication and Digestion")
• COX-2 inhibitors - This class of drugs has less risk of gastrointestinal ulceration and bleeding. (Read about "Gastrointestinal Bleeding") However, serious concerns about heart disease risk have made them a less common option. (Read about "Coronary Heart Disease")
• Corticosteroids may also be used. These are hormones that can be given by injection. In osteoarthritis, the doctor may inject a corticosteroid into the affected joint to stop pain. According to NIAMS, because frequent injections may cause damage to the cartilage, they should only be done once or twice a year. Long-term corticosteroid use has also been linked to a condition called osteonecrosis in which a portion of bone loses its blood supply and begins to die. (Read about "Osteonecrosis")
• Hyaluronic acid may be another option for some types of osteoarthritis pain. The American Academy of Family Physicians (AAFP) says that when you have osteoarthritis, there isn't enough hyaluronic acid, a fluid which is normally present to protect the joint. Hyaluronic acid injections may be helpful in some cases. However, you need to discuss this with your doctor.

When taking medication, it's important that you never mix different types of drugs on your own. Even medications such as cold remedies may contain ingredients that can cause problems if taken in combination with other medications, so always read labels and talk with your doctor or pharmacist first. (Read about "Drug Interaction Precautions")

In addition, topical creams can be helpful. Many contain salicylates to reduce inflammation and pain. Other topical treatments may produce feelings of warmth or coolness on the skin to help provide relief. In addition, capsaicin (the substance found in hot peppers) is being used in some topical creams to provide pain relief. As with any medicine, always talk with your doctor before using, make sure you read and follow all package directions carefully and keep all such medications out of children's reach.

Surgery for osteoarthritis

For some cases, surgery is the best option. Surgery can dramatically improve independence and quality of life by reducing pain and improving mobility, according to the Food and Drug Administration. There are different types of surgery:

• Arthroscopy - This procedure inserts a very thin tube with a light at the end (arthroscope) through a small skin incision. The doctor can then see directly into the joint to treat the problem. This procedure is often done on knees and shoulders. (Read about "The Knee" "The Shoulder") Arthroscopy may also be used to help diagnose and treat some forms of arthritis, including osteoarthritis and rheumatoid arthritis. (Read about "Rheumatoid Arthritis" "Arthroscopy")
• Resection - this involves the removal of part or all of a bone. This is often done when the joints are causing severe pain or impairing mobility.
• Osteotomy - this procedure corrects bone deformity by cutting the bone and realigning the joint.
• Joint replacement or arthroplasty - this procedure replaces the damaged joint with an artificial one. Sometimes, the surgeon will not remove the whole joint, but will only replace or fix the damaged parts. The Arthritis Foundation says joint replacement or resurfacing can provide not only dramatic relief from pain, but also improvement in motion for many people with arthritis. They are most often done on the hip, the knee and the elbow. (Read about "Joint Replacement" "Joint Resurfacing")
• Joint fusion - this procedure fuses two bones together so they form one unit. The fused joint loses flexibility, but can be more stable and less painful.

As with any surgical procedure, there are benefits and risks to all of the above. You need to discuss them with your doctor.

Related Information:

    Orthopedics

    Skeletal System

    The Hip