Osteoarthritis (Degenerative Joint Disease)
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Osteoarthritis is a chronic, degenerative disorder and defined as the gradual deterioration (degeneration) of the cartilage in a joint. This noninflammatory disorder may follow a trauma or be a complication of malformations at birth. Osteoarthritis affects the cartilages on the ends of the bones between joints. Healthy cartilages are smooth and prevent friction when the joint surfaces rub each other. It has a cushioning effect in the joint and acts as a shock absorber when there is physical movement. In osteoarthritis—called wear and tear arthritis—the cartilage wears off and the surfaces of the bones become rough. Rubbing together then causes pain, swelling, and loss of motion of the joint. Pieces of bones or cartilage can also break off and float in the joint space. There is also the possibility of bone spurs or osteophyte formation. Learn more about knee anatomy.
Healthy Joint Anatomy
In a healthy joint, the point where bone surfaces come in contact with each other is protected by a soft, smooth covering of articular cartilage. The joint capsule, which is a tough sac-like membrane, covers the joint and the cartilage. This capsule has a thin membrane lining its inner surface, called the synovium. This membrane secretes synovial fluid. The capsule and the synovial fluid protects the adjoining muscles and connective tissues. The fluid lubricates the joint and cartilage reducing friction and helps the joint to move easily and without pain. When the cartilage deteriorates, it allows the bones to rub together causing pain and limited movement.
What Happens in Osteoarthritis?
Osteoarthritis is most common in weight-bearing joints—feet, ankles, knees, hips. It also affects fingers, wrists, shoulders and spine. In an osteoarthritic joint, the articular cartilage is worn where the bones meet. Deposits of bone or bony growth, called osteophytes or bone spurs, appear on the edge of the joint. The synovial fluid increases. Together, these can make the joint stiff and painful to move. The more damage there is to the joint, the more painful movement becomes.
Osteoarthritis mainly affects the elderly, although there is a possibility that younger people may also be affected after an injury or genetic defect in the cartilage. Osteoarthritis affects more women than men over age 45, but for ages below 45, it affects men more than women. It also affects people who are overweight or those whose job causes day-to-day stress on a particular joint. Your risks of osteoarthritis increases with activities that stress joints—dancing, football, tennis, weightlifting—or an injury to the joint or a family history of osteoarthritis.
- as the smooth, spongy cartilage of the joint wears down or wears away
- as the bones underneath the cartilage stiffen and bony spurs develop around the joint causing the space between the joints to become narrow
- with movement of the joint, the bones rub together causing pain and loss of function in the joint.
Primary osteoarthritis affects the joints of the hip, knee, spine and thumb and seems to be related to aging or may be hereditary. Secondary arthritis results from other factors such as:
- traumatic injury
- developmental disorders
- calcium deposits
- endocrine disorders (like diabetes)
Effects of Osteoarthritis
The effects of osteoarthritis are limited to the joints that starts with gradual stiffening. Soreness leads to joint pain which worsens with activity and is relieved with rest.
Osteoarthritis can be local or general. Generalized arthritis means you have arthritis in three or more joints. It affects various joints of the body; hence the affects are specific to that particular joint.
Fingers and thumb: When affected, the fingers and thumbs become enlarged and twisted and are accompanied with pain, numbness, and stiffness.
Knee : This is one of the commonly affected joint with symptoms of stiffness, pain, and swelling. When osteoarthritis affects the knee, it becomes difficult to walk, climb, sit on the chair or get up after sitting for some time. This eventually leads to knee replacement or disability.
Hips: This is another commonly affected joint which has symptoms of stiffness and pain. The pain can radiate to the groin region, the inner thighs, buttocks, or even to the knees. People affected with hip osteoarthritis often find it difficult to bend or move around. This eventually leads to hip replacement or disability.
Spine: The symptoms are stiffness and pain in the neck and lower back. With the severity of the arthritis, the pressure builds up on the adjoining nerves, which ultimately exits the spinal column. This results in numbness and weakness of the arms or legs, depending on the particular nerve that is being affected.
Apart from the basic symptoms of joint pain and stiffness, the effects of osteoarthritis differ from person to person depending on the severity of the degeneration. The basic effect on the lifestyle of the affected person could include:
- limitations in continuing his or her job
- limitations in activities of daily living
- inability to take part in various responsibilities or fun activities at home
- depression and anxiety caused due to the disability
Osteoarthritis cannot be diagnosed with one single test. Your doctor will first do a history—where you describe your symptoms, that is “tell him where it hurts.” Your doctor will also need to know if you have any other medical conditions and any medicines you are taking.
You doctor will check your joint reflexes and mobility of your problem areas.
Depending on what your doctor finds, he may order x-rays to asses the extent of your arthritis. The xrays can show cartilage or bone damage and bony growths or bone spurs. However, early stages of osteoarthritis may not be seen on xrays since not much cartilage is lost in the early stages.
An MRI (magnetic resonance imaging), which is high-resolution computerized images of the tissues, can show any damage to the adjoining joint ligaments, tissues, or meniscus.
A joint aspiration is a process of drawing synovial fluid from the joint with a needle and then examining it under the microscope to find any infection.
Certain blood tests may be ordered to rule out other physical ailments which can cause symptoms like osteoarthritis.
The treatment of osteoarthritis involves four goals:
- controlling pain
- improving joint mobility and function
- reducing weight or maintaining normal body weight
- having a healthy lifestyle
To achieve these goals, one or more of the following methods can be used:
Exercising is the best treatment for osteoarthritis. Exercise helps reduce pain, increases mobility of the joint, helps maintain weight, and improves blood flow to the body, which in turn improves general physical fitness. Walking, swimming, and water aerobics are good exercises for people with osteoarthritis. A physical therapist can help you find the most appropriate form of exercise to suit your physical condition. He will also teach you how much exercise you can do. Exercising is an inexpensive treatment option. The side effects are almost zero if the exercises are done correctly.
Osteoarthritis mostly affects people who are overweight or obese. So, to improve your arthritic condition, weight reduction should be a top priority. Weight loss reduces the stress on the affected joints, increases flexibility, and reduces the pain in the joint. A registered dietician or nutritionist can help you with the right weight loss diet to reduce weight and keep up a healthy weight.
Rest and Sleep
Another important treatment is to rest the affected joint. When the joint is getting tired—get rest right away. Don;t over exert the affected joint. Splints or braces can provide support for the joint. Using a cane can also relieve pressure on the joint. An occupational therapist can help you find and get fitted for the correct cane or brace. Getting plenty of sleep provides rest and helps manage pain.
Pain Relief Without Medicine
There are various methods that you can use to relieve pain without medication. These include:
- hot and cold packs – either individually or in combination. Hot packs help increase blood flow and decrease pain and stiffness; cold packs help in reduce inflammation and soreness.
- TENS or transcutaneous electrical nerve stimulation – mild electric pulses are applied to which relieves pain.
- massage – increases blood flow and relaxes stressed muscles.
All these methods should be used after talking with your doctor or physical therapist to choose the right treatment for you and get the most out of treatment.
Most often doctors prescribe pain medications to relieve pain and help patients carry on the activities of daily living. The doctor analyzes factors like unwanted side effects, previous medical history, and other medications the patient is already taking along with the intensity of pain to prescribe medicine. The doctor can prescribe any of the following medications: acetaminophen, NSAIDs (nonsteroidal anti-inflammatory drugs), tramadol, corticosteroids, viscosupplements, mild narcotic painkillers, and topical pain-relieving creams or sprays. Most medications have side effects, so before taking any medicine, learn as much as you can about that particular medicine as well as signs and symptoms of allergic reaction.
Treatment of osteoarthritis with surgery is required:
- if loose pieces of bone or cartilage need to be removed
- if bones need to be repositioned
- if bones need to be resurfaced or smoothened.
- In very severe cases, hip, knee and shoulder joints may also be replaced with artificial joints made of plastic and/or metal.
See: Hip bones, knee bones, and shoulder bones to better understand how osteoarthritis affects joints.
Many factors like the intensity of pain, level of disability, patient’s age and occupation are considered before having surgery. Usually after surgery and rehabilitation, the patient’s pain and swelling lessen and the joint mobility increases.
If you have surgery, your physical therapist can help with getting you back to “normal” and recovery time for shoulder replacement surgery, knee replacement and hip replacement.
When the usual treatment options fail to provide pain relief, some people try alternative therapies like acupuncture, nutritional supplements (glucosamine, chondroitin sulfate, etc.), as well as home remedies (drinking herbal tea, wearing copper bracelets, etc.) These methods do not have any side effects; however, their benefits have yet to be proved.
What Kind of Doctor Treats Osteoarthritis?
Osteoarthritis requires a variety of health care professionals to treat it and it’s symptoms. These include:
- Primary care physician: does the initial diagnosis and refers to other specialists based on findings.
- Rheumatologist: the doctor who cares for patients with arthritis or conditions which affect the bones, joints, and muscles.
- Orthopedist: the doctor or surgeon who specializes in the treatment and surgery of bone or joint diseases.
- Physical therapist: provides therapy to improve joint functions.
- Occupational therapist: teaches the patient to protect the joints, reduce the pain, and continue day-to-day activities.
- Dietician: advises on diets depending on body weight and its effect on the osteoarthritic joint.
- Nurse educator: helps the patient better understand osteoarthritis, your condition, and your treatment plan.
- Acupuncture therapist: helps reduce pain and immobility of joints by piercing fine needles at particular points on the skin.
- Physiatrist: takes care of the rehabilitation process and helps patients use their total physical abilities.
- Psychologist: helps patients overcome the psychological effects of physical disability at home and at work.
- Social workers: help patients cope with unemployment, financial crisis, home health care, and other social challenges, which come up due to the disability of osteoarthritis.
What You Can Do To Treat Osteoarthritis
Your doctor or other health care providers can give you a variety of treatment options or methods to care for your osteoarthritis, but you have to do what is necessary to have as normal a life as possible. The following tips can help you control your symptoms and enjoy better health.
- Learn as much about the osteoarthritis as you can. A good understanding of osteoarthritis will help you deal with it better. Enroll in an arthritis support group, patient education program, or self-management program.
- Have an active lifestyle. Exercise regularly. Include strengthening exercises, aerobics, and range-of-motion exercises to reduce stiffness and maintain your overall strength and fitness. Always talk with your doctor before doing any form of exercise. Your doctor can tell you which exercises will be the best for your situation.
- Eating a balanced diet can help you keep fit. Avoid foods that make you gain weight. Try to eat a diet that will help you lose or maintain a healthy weight. Added weight puts pressure on your affected joint and cause more discomfort and pain.
- Getting plenty of sleep every night is important for resting your joints. Rest helps reduce pain and thereby help you do daily activities with less pain and stiffness. If you have problems getting enough sleep because of pain, talk with your doctor who can prescribe pain medicine. Your doctor can advise you on proper bedding or sleeping positions and even the timing of medicines to help you sleep. Also, avoid caffeine or alcohol at night, make your room dark, quiet and comfortable while going to sleep, or taking a warm bath before going to bed.
- Most importantly, keeping a positive attitude can affect your physical health. Participate in fun activities like sports or other hobbies. If the pain keeps you from being active, talk with your physical or occupational therapist for ways to overcome problems. When you occupy your mind with things you enjoy you will feel better!
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