Osteoarthritis

What is Osteoarthritis?

Arthritis is one of the most common medical problems and the No. 1 cause of disability in America. The word arthritis is a blend of the Greek words arthron, for joint, and itis, for inflammation. In other words, arthritis literally means “joint inflammation.” Although arthritis is often referred to as one disease, it’s not. Arthritis has more than 100 forms.

Osteoarthritis, sometimes called degenerative joint disease or osteoarthrosis, is the most common form of arthritis. Osteoarthritis affects nearly 21 million people in the United States. It’s characterized by the breakdown of joint cartilage and may affect any joint in your body, including those in your fingers, hips, knees, lower back and feet. Initially it may strike only one joint. But if your fingers are affected, multiple hand joints may become arthritic.

There’s no cure for osteoarthritis, but treatments today are far ahead of what was available just a few years ago. In addition, how well you live with arthritis often depends on your actions and attitude. If you actively manage your arthritis, you may be able to gain control over your pain.

Signs and symptoms of Osteoarthritis

Your doctor may use a variety of methods to diagnose osteoarthritis, including a physical examination, blood tests and certain imaging techniques. Doctors use blood tests to diagnose or rule out specific types of arthritis. Fluid may be withdrawn from a joint for analysis (joint aspiration).

Imaging techniques may include X-rays, bone scans, computerized tomography (CT scan) , magnetic resonance imaging (MRI) and arthrography an image taken after dye has been injected into your joint. Imaging techniques can reveal bone spurs, worn-down cartilage and loss of joint space, indicating the presence of osteoarthritis.

Causes of Osteoarthritis

With osteoarthritis the problem lies in the cartilage that cushions the ends of bones in your joints. Over time, the cartilage deteriorates, and its smooth surface roughens. Eventually, if the cartilage wears down completely, you may be left with bone rubbing on bone causing the ends of your bones to become damaged and your joints to become painful.

The exact cause of osteoarthritis isn’t known. Researchers suspect that it’s a combination of factors, including being overweight, the aging process, joint injury or stress, heredity and muscle weakness.

Some scientists believe the cartilage damage may be due to a mechanical stress that results in an imbalance of enzymes released from the cartilage cells or from the lining of the joint. When balanced, these enzymes allow for the natural breakdown and regeneration of cartilage. But too much of the enzymes can cause the joint cartilage to break down faster than it’s rebuilt. The exact cause of this enzyme imbalance is unclear.

Your body goes to work repairing the damage, but the repairs may be inadequate, resulting instead in growth of new bone along the sides of the existing bone, which produces prominent lumps, most noticeable on hands and feet. Each of the steps in this repair process produces pain. The pain and tenderness over the bony lumps may be most marked early in the course of the disease and less evident later on.

Osteoarthritis commonly occurs in the neck or lower back. Hips and knees also are frequently affected because they bear most of your weight. You can have chronic pain or varying amounts of discomfort when you stand and walk. Swelling also may occur, especially in your knees.

Risk factors for Osteoarthritis

The exact causes of osteoarthritis are unclear, but these factors increase your risk:

• Being 45 years old or older
• Being female
• Having certain hereditary conditions, including defective cartilage and malformed joints
• Having joint injuries caused by physical activity or sports
• Being obese
• Having diseases that change the normal structure and function of cartilage, such as rheumatoid arthritis, hemochromatosis, gout or pseudogout
• Having weak thigh (quadriceps) muscles, which may lead you to develop osteoarthritis in your knees

How is Osteoarthritis treated?

There’s no known cure for osteoarthritis, but treatments can help to reduce pain and maintain joint movement. Your doctor may recommend a combination of treatments that may include medication, self-care, physical therapy and occupational therapy. In some cases, surgical procedures may be necessary.

What are the medications for Osteoarthritis?

Medications are used to treat the pain and mild inflammation of osteoarthritis and to improve your joints’ functioning. They include both topical medications and oral medications. Over-the-counter (OTC) medications may be sufficient to treat milder osteoarthritis, but stronger prescription medications also are available.

• Topical pain relievers. Various OTC products are available as creams, gels, ointments and sprays to temporarily relieve arthritis pain. Products containing the pain reliever trolamine salicylate include Aspercreme and Sportscreme. Products containing one or more of the counterirritant medications methyl salicylate, menthol and camphor include Eucalyptamint, Icy Hot and Ben-Gay. Capsaicin (Zostrix, Capzasin-P), a cream made from the seeds of hot chili peppers, may relieve pain in joints close to your skin surface, such as your fingers, knees and elbows.
• Acetaminophen. Acetaminophen (Tylenol, others) can relieve pain, but doesn’t reduce inflammation. It has been shown to be effective for people with osteoarthritis who have mild-to-moderate pain. Taking more than the recommended dosage of acetaminophen can cause liver damage, especially if you consume three or more alcoholic drinks a day. It might be best to limit or abstain from alcohol if you take acetaminophen regularly. Acetaminophen can also affect other medications you may be taking, so be sure to inform your doctor if you’re taking it.
• NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) work in two ways. They relieve pain (such as from osteoarthritis and sore muscles), and they fight inflammation (such as from rheumatoid arthritis). NSAIDs range from OTC aspirin, ibuprofen (Advil, Motrin, others), and naproxen sodium (Aleve)  which are also available at higher dosages by prescription to others that are only available by prescription, such as ketoprofen (Oruvail), diclofenac (Cataflam, Voltaren) and nabumetone (Relafen). NSAIDs have risks of side effects that increase when used at high dosages for long-term treatment. Side effects may include ringing in your ears, gastric ulcers, gastrointestinal bleeding and liver and kidney damage. Consuming alcohol or taking corticosteroids while using NSAIDs also increase your risk of gastrointestinal bleeding.
• COX-2 inhibitors. Considered as effective for managing pain and inflammation as other NSAIDs, COX-2 inhibitors  celecoxib (Celebrex) and valdecoxib (Bextra)  may not have the same stomach-damaging effects but are more expensive than generic, nonselective NSAIDs. Side effects may include fluid retention and causing or exacerbating high blood pressure. Some reports indicate that COX-2 inhibitors may be associated with an increased risk of heart attack.
• Tramadol. Tramadol (Ultram) is a centrally acting analgesic that’s available by prescription. It has no anti-inflammatory effect, but can provide effective pain relief with fewer side effects  such as stomach ulcers and bleeding  than NSAIDs. However, Tramadol may cause nausea and constipation. It’s generally used for short-term treatment of acute flare-ups.
• Antidepressants. Independent of their antidepressant properties, antidepressants, especially tricyclics, can help reduce chronic pain. Some people with arthritis also experience symptoms of depression. Antidepressant medications can treat the sleep disturbance that can accompany arthritis. The most common antidepressants used for arthritis pain and nonrestorative sleep are amitriptyline (Elavil), nortriptyline (Pamelor, Aventyl) and trazodone (Desyrel).
• Intra-articular injections. Occasionally, your doctor may suggest injecting a joint space with a corticosteroid, which can offer some pain relief and reduce inflammation. Injecting hyaluronic acid derivatives into knee joints (viscosupplementation) can relieve pain from osteoarthritis. Hyaluronic acid is a component of joint fluid, and Hylan G-F20 (Synvisc) and hyaluronate (Hyalgan, Supartz) are derivatives made from cockscomb.

Surgical or other procedures for Osteoarthritis

Surgical procedures can help relieve disability and pain caused by osteoarthritis.

• Join replacement. In joint replacement surgery (arthroplasty), your surgeon removes your damaged joint and replaces it with a plastic or metal device called a prosthesis. The hip and knee joints are the most commonly replaced joints. But today implants can replace your shoulder, elbow, finger or ankle joints. Joint replacement is most successful in large joints, such as hips and knees. It can help you resume an active, pain-free lifestyle. In smaller hand joints, it also can improve appearance and comfort and may improve your joint’s mobility.
• Fragment removal. Other surgical techniques are designed to remove loose fragments of bone or cartilage that may cause pain or cause mechanical problems such as “locking.” The procedure is usually done with an arthroscope, a small tube inserted into the joint, through which the surgeon works. A study reported in July 2002 in the New England Journal of Medicine evaluated some types of arthroscopic procedures in people with osteoarthritis of the knees. The study showed no significant difference in pain relief or improved function two years after the surgery among those who underwent arthroscopic surgery and those who underwent a sham placebo procedure. The majority of the people in the study were men. Additional studies, including women, are necessary to better evaluate the results of this study.
• Repositioning bones. Surgeons can also reposition your bones to help correct deformities (osteotomy).
• Fusing bones. Surgeons also can permanently fuse bones in a joint (arthrodesis) to increase stability and reduce pain. The fused joint, such as an ankle, can then bear weight without pain, but has no flexibility.

Coping skills for Osteoarthritis

Osteoarthritis can affect your everyday activities and overall quality of life. As a result, it’s important to adopt coping strategies for dealing with the disease. You might consider the following:

• Keep a positive attitude. Make a plan with your doctor for managing your arthritis. This will help you feel that you’re in charge of your disease, rather than vice versa. Studies show that people who take control of their treatment and actively manage their arthritis experience less pain and function better.
• Use assistive devices. Your painful knee may need a brace for support. You might also opt for a cane to take weight off the joint as you walk. The cane should be used in the hand opposite the affected joint. If your hands are affected, various helpful tools and gadgets are available to help you maintain an active lifestyle. Contact your pharmacy or doctor’s office for information on ordering the items that may help you the most.
• Know your limits. Rest when you’re tired. Arthritis can make you prone to fatigue and muscle weakness  a deep exhaustion that makes everything you do a great effort. A rest or short nap that doesn’t interfere with nighttime sleep may help.
• Avoid grasping actions that strain your finger joints. For example, instead of a clutch-style purse, select one with a shoulder strap. Use hot water to loosen a jar lid and pressure from your palm to open it, or use a jar opener. Don’t twist or use your joints forcefully.
• Spread the weight of an object over several joints. Use both hands, for example, to lift a heavy pan. Try using a walking stick or cane.
• Take a break. Periodically relax and stretch.
• Maintain good posture. Poor posture causes uneven weight distribution and may strain ligaments and muscles. The easiest way to improve your posture is by walking. The faster you walk, the harder your muscles must work to keep you upright. Some people find that swimming also helps improve their posture.
• Use your strongest muscles and favor large joints. Don’t push open a heavy glass door. Lean into it. To pick up an object, bend your knees and squat while keeping your back straight.

Alternative medicine for Osteoarthritis

Because many complementary medicine methods haven’t been studied extensively by researchers using mainstream scientific methods, it’s difficult for the scientific community to evaluate their effectiveness and safety. And with much of today’s research funding coming from the pharmaceutical industry, some “low-tech,” nontraditional approaches to manage diseases such as arthritis may not get as much attention from the research community as they deserve. For these reasons, many Western physicians just don’t know enough about these methods to endorse them. Nonetheless a growing body of evidence indicates that complementary medicine practices could have a role in treating and managing some diseases.

Common forms of complementary and alternative medicine for treatment of osteoarthritis include:

• Acupuncture
• Copper jewelry
• Homeopathy
• Magnets

Some studies have shown positive effects of nutritional supplements such as glucosamine and chondroitin sulfate preparations on osteoarthritis. Studies are ongoing in people who have osteoarthritis to compare results of using glucosamine with those of using chondroitin sulfate and of using a mixture of the two. Don’t use glucosamine if you’re allergic to shellfish. Glucosamine may raise your blood insulin level if you have diabetes. Chondroitin sulfate may affect blood levels of warfarin (Coumadin) if you’re taking that medication.

Be careful when considering alternative therapies. Many are expensive, and some may be harmful. Before taking any complementary medications or dietary supplements, talk with your doctor to learn about potential dangers, particularly if you’re taking other medications.