• Osteoarthritis

    (Degenerative Joint Disease; Arthritis, Osteo-)

    Definition

    Osteoarthritis is the breakdown of cartilage in the joints. This is followed by chronic inflammation of the joint lining. Healthy cartilage is a cushion between the bones in a joint. Osteoarthritis usually affects the hands, feet, spine, hips, and knees. People with osteoarthritis usually have joint pain and limited movement of the affected joint.
    Joints Affected by Osteoarthritis
    IMAGE
    Copyright © Nucleus Medical Media, Inc.

    Causes

    The exact cause is unclear.

    Risk Factors

    Risk factors include:
    • Being overweight or obese
    • Having a family history of osteoarthritis
    • Having an injury to the joint surface
    • Having an occupation or doing physical activities that put stress on joints
    • Having an endocrine disorder (such as diabetes)
    • Being older

    Symptoms

    Symptoms include:
    • Mild-to-severe pain in a joint, especially after overuse or long periods of inactivity, such as sitting for a long time
    • Creaking or grating sound in the joint
    • Swelling, stiffness, limited movement of the joint, especially in the morning
    • Weakness in muscles around the sore joint
    • Deformity of the joint
    Other symptoms include loss of cartilage, bone spurs around the joint, and muscle weakness of the extremity.

    Diagnosis

    Your doctor will ask about your symptoms and medical history. He or she will do a physical exam.
    Tests may include:
    • X-ray—a test that uses radiation to take a picture of structures inside the body, especially bones
    • Blood tests
    • Arthrocentesis—a procedure that involves withdrawing fluid from a joint

    Treatment

    There is no treatment that stops cartilage loss or repairs damaged cartilage. The goal of treatment is to reduce joint pain and inflammation, and to improve joint function.
    Treatments may include:

    Medications

      Over-the-counter pain medicine:
      • Acetaminophen (such as Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs), for example ibuprofen (such as Advil) and naproxen (for example, Aleve)
    • Topical pain medicines (such as creams or patches) that are applied to the skin, for example, capsaicin, methyl salicylate, menthol, diclofenac
    • Prescription pain medicine, such as:
      • Diclofenac and misoprostol (Arthrotec)—NSAID; may reduce the risk for gastrointestinal bleeding
      • Opiates and opiate-like medicines
    • Antidepressants, such as duloxetine (Cymbalta)—may be prescribed to treat chronic pain from osteoarthritis
    • Viscosupplementation—injection of a substance called hyaluronan into the joint, which helps lubricate the joint

    Dietary Supplements

    Glucosamine and chondroitin are two commonly used supplements. But, research has shown that these are not beneficial for most people with osteoarthritis. Talk with your doctor before taking any herbs or supplements.

    Alternative Treatments

    Some doctors report that acupuncture has been successful in reducing the pain of osteoarthritis. However, the evidence is not consistent.
    While more studies are needed, balneotherapy (hot water therapy), relaxation therapy, exercise, yoga, and tai chi may be helpful.

    Mechanical Aids

    Shoes with shock-absorbing soles may provide some relief while you are doing daily activities or exercising. Splints or braces help to properly align joints and distribute weight. Knee and wrist joints may benefit from elastic supports. A neck brace or corset may relieve back pain. Also, a firm mattress may help chronic back pain. Canes, crutches, walkers, and orthopedic shoes can help with advanced osteoarthritis in the lower body.

    Weight Reduction

    Losing weight can lessen the stress on joints affected by osteoarthritis. Losing five pounds can eliminate at least 15 pounds of stressful impact for each step taken. The more weight lost, the greater the benefit.

    Exercise and Physical Therapy

    Strengthening the muscles supporting an arthritic joint (particularly the knee, lower back, and neck) may decrease pain and absorb energy around the joint. For example, if you have arthritis in the knee, exercise, including strength training, can also help improve knee function.
    Swimming and water aerobics are good options. They do not put stress on the joint.
    Another option is transcutaneous electrical nerve stimulation (TENS). With TENS, you are connected to a machine. The machine sends electrical signals through the skin to nerves. This type of therapy may decrease pain in some people.

    Assistive Devices

    If you are having difficulty getting around due to arthritis pain, your doctor might recommend that you install handrails and grips throughout your home. These are useful in the bathroom and shower. You may need elevated seats (including toilet seats) if you're having difficulty rising after sitting.

    Heat and Ice

    Applying heat (with hot water bottles or heating pads) helps joints and muscles move more easily. It can also lessen pain. Using ice packs after activity can also help.

    Manual Therapy

    If you have knee osteoarthritis, manual therapy (including massage therapy and manipulation) may be helpful.

    Steroids

    Corticosteroid injections to the inflamed joint may be given if other pain medicines do not work. However, repeated cortisone injections can be harmful to the cartilage. They are reserved for those with severe symptoms.

    Surgery

    Surgery can:
    • Reposition bones to redistribute stress on the joint
    • Replace joints
    • Remove loose pieces of bone or cartilage from joints

    Prevention

    To reduce your chance of getting osteoarthritis:
    • Maintain a healthy weight.
    • Do regular, gentle exercise (for example, walking, stretching, swimming, yoga).
    • Avoid repetitive motions and risky activities that may contribute to joint injury, especially after age 40.
    • With advancing age, certain activities may have to be stopped or modified. But, continue to be active.

    RESOURCES

    American College of Rheumatology http://www.rheumatology.org

    The Arthritis Foundation http://www.arthritis.org

    CANADIAN RESOURCES

    The Arthritis Society http://www.arthritis.ca

    Seniors Canada http://www.seniors.gc.ca

    References

    American College of Rheumatology Subcommittee on Osteoarthritis. Recommendations for the medical management of osteoarthritis of the hip and knee. 2000 update. Arthritis Rheum. 2000;43:1905-1915.

    Arthritis. National Institute of Arthritis and Musculoskeletal and Skin Disorders website. Available at: http://www.niams.nih.gov/Health%5FInfo/Osteoarthritis/default.asp. Published July 2002. Updated May 2006. Accessed June 9, 2008.

    Jordan K, Arden N, et al. EULAR recommendations 2003: an evidence based approach to the management of knee osteoarthritis: report of a task force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis. 2003;62:1145-1155.

    Osteoarthritis. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com. Updated April 3, 2012. Accessed April 19, 2012.

    Osteoarthritis. EBSCO Natural and Alternative Treatment website. Available at: http://www.ebscohost.com/healthLibrary. Accessed March 4, 2008.

    van den Berg WB. Pathophysiology of osteoarthritis. Joint Bone Spine. 2000;67:555-556.

    10/21/2008 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Fransen M, McConnell S. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2008;CD004376.

    12/11/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Rutjes WJ, Nuesch E, Sterchi R, et al. Transcutaneous electrostimulation for osteoarthritis of the knee. Cochrane Database Syst Rev. 2009;(4):CD002823.

    10/15/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Wandel S, Jüni P, Tendal B, et al. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis. BMJ. 2010;341:c4675.

    10/26/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Massey T, Derry S, Moore R, McQuay H. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.

    11/15/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: US Food and Drug Administration. FDA clears Cymbalta to treat chronic musculoskeletal pain. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm232708.htm. Published November 4, 2010. Accessed November 12, 2010.

    11/29/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: French HP, Brennan A, White B, Cusack T. Manual therapy for osteoarthritis of the hip or knee: a systematic review. Man Ther. 2011;16(2):109-117.

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