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Osteoarthritis: Understanding the Most Common Form of Arthritis

Osteoarthritis Fast Facts

  • While some joint changes are irreversible, joint replacement surgery is not often required.
  • Symptoms of osteoarthritis (OA) can differ from one person to another.
  • The primary goals of OA treatment include improving function and reducing pain.
  • Exercise is a vital part of osteoarthritis treatment as it can help improve joint function and minimize pain.
  • At present, no known treatment is available to reverse osteoarthritis damage.

What is osteoarthritis?

Sometimes known as degenerative arthritis or degenerative joint arthritis, osteoarthritis is considered the most common form of arthritis in adults.

Also referred to as “wear and tear” of the joints, the condition is associated with the breakdown of the gliding cartilage in the joints.

The cartilage is the firm and rubbery material that covers the ends of the bones. Its primary function is to serve as a “cushioning” and reduce friction in the joints.

Osteoarthritis causes the cartilage found in the joint to lose its elasticity and become stiff—making it more prone to damage by impact.

Continued deterioration of the cartilage especially when eccentrically can cause the ligaments and tendons to stretch, resulting to pain and progressive angulation of a joint.

In severe cases, the cartilage wears away totally and can cause the bones to eventually rub against each other. This can actually be felt by the patient, called crepitus.

While OA can occur in any joint in the body, it often develops in the weight-bearing joints of the knees, ankle, spine, and hips. It can also affect the thumb, neck, fingers, and the large toe.

Who are at risk?

OA is considered a progressive joint disease typical among the middle-aged and the elderly. In the United States alone, the condition affects approximately 27 million people. The probability of getting osteoarthritis increases with age.

Many people over the age of 60 have OA to some degree in some joint or other, although the severity varies. Osteoarthritis can also develop in people who are in their 20s and 30s. This may run in families, too.

However, it is often attributed to some underlying reasons like repetitive joint stress secondary to overuse or joint injury. In individuals over 50 years of age, the condition has been observed to be more common among women than in men.

What are the common symptoms?

Symptoms of the condition often manifest gradually and can include:

  • Joint pain and soreness (especially when moving)
  • Pain after long hours of inactivity
  • Stiffness (especially after resting)
  • Pain after overuse
  • Bony enlargements in the end and middle joints of the fingers
  • Swelling of the joint
  • Angulation like bowed-legs

What are the risk factors?

Several factors can significantly increase an individual’s chance of developing OA.

Some of the factors include:

  • Injury. Injuries have been known to contribute to the development of post-traumatic arthritis. Case in point: athletes who have had knee-related injuries like meniscus tears are considered at a higher risk of developing knee OA. In other instances, individuals who have had severe back injury are more predisposed to developing osteoarthritis of the spine.
  • Heredity. People with joint abnormalities are more prone to developing osteoarthritis. Likewise, those with known spine abnormalities like scoliosis are more susceptible to spine osteoarthritis.
  • Other diseases. Those with rheumatoid arthritis are considered more likely to also develop osteoarthritis. In addition, other rare conditions like excess growth hormone or iron overload has been known to increase one’s likelihood of getting OA.
  • Obesity. Obesity can increase one’s risk of developing osteoarthritis of the hip, spine, and knee. Losing the excess pounds or maintaining the ideal weight can help prevent OA in those areas or decrease the condition’s progression rate for those who are already afflicted.
  • Joint overuse. Overuse of certain joints can increase an individual’s chance of getting OA. For instance, those with jobs that require lifting, repeated knee bending or stair climbing may have a higher risk of developing knee OA.

How is OA diagnosed?

Diagnosis of the condition is carried out based on a combination of the following key factors:

  • Description of the symptoms
  • Pattern and location of the pain
  • Physical examination
  • X-rays

X-rays are often required to help confirm the diagnosis and to ensure patient is not suffering from another kind of arthritis. If X-ray results do not point clearly to arthritis, an MRI might be recommended so the doctor can have a better look at the joint cartilage as well as the tissues surrounding it. If there is fluid accumulation in the joints, the doctor may perform joint aspiration to rule out other conditions.

What are the treatment options available?

Osteoarthritis is often managed using a combination of treatments like medications, physical therapy, use of supportive devices (i.e. canes or crutches), and injection of medications into the joint, among others. Surgery might become an option when all other noninvasive alternatives have proved futile. The treatment type will depend on several factors like occupation, age, activities, condition severity, medical history, and overall health of the patient.

Medications

Over-the-counter (OTC) pain relievers—naproxen (Aleve), ibuprofen (Motrin, Advil), and acetaminophen (Tylenol)—are usually given to help ease OA pain. However, stronger anti-inflammatory drugs like coxibs might be prescribed if the condition does not respond to OTC medications. If pain is persistent despite the use of medications or topical creams, injecting steroids directly into the joint may be considered.

Surgery

In the event of serious joint damage or when other conservative treatment options have failed, surgery might be recommended. Surgery might involve arthroscopy (debriding the joint through keyhole incisions).

If there is still good cartilage but the joint is badly angulated, a corrective osteotomy (bone realignment) can be done to restore normal loading. If joint damage is beyond repair, a joint replacement surgery might be suggested. They can be partial (like unicondylar knee replacements) or total where both sides are replaced by metal bases and plastic liners. Such surgery is major and applied as a last resort, and most have a finite life span, but current designs have already survived beyond 20 years.

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