What are the Symptoms of Osteoarthritis?
How
is Osteoarthritis Diagnosed?
What is the Treatment for Osteoarthritis?
Osteoarthritis is a joint
inflammation resulting from cartilage degeneration. Osteoarthritis is also known as degenerative arthritis. It can be caused by aging, heredity, and
injury from trauma or disease. The most
common symptom of osteoarthritis is pain in the affected joint(s) after
repetitive use. There is no blood test
for the diagnosis of osteoarthritis.
The aim of treatment in is to reduce joint pain and inflammation, and
improve and maintain joint function.
Osteoarthritis is a type of arthritis that is caused by inflammation,
breakdown, and eventual loss of joint cartilage of the joints. Cartilage is a protein substance that acts
as a ‘cushion’ between the bones of the joints. Osteoarthritis is the most common of the more than 100 different
types of arthritis conditions. Before
age 45, osteoarthritis occurs more frequently in males. After age 55 years, it occurs more
frequently in females. There is a
higher incidence of osteoarthritis in the Japanese population, and a lower
incidence in South African blacks, East Indians and southern Chinese.
Osteoarthritis usually affects the
hands, feet, spine, and large weight-bearing joints, such as the hips and
knees. Most cases of the disease have
no known cause, and are referred to as primary osteoarthritis. Cases in which the cause is known are
referred to as secondary osteoarthritis.
Primary osteoarthritis is mostly
related to aging. With aging, the water
content of the cartilage increases and its protein composition
degenerates. Repetitive use of the
joints over the years irritates and inflames the cartilage, causing joint pain
and swelling. Eventually, cartilage
begins to degenerate by chipping or forming tiny cracks. In advanced cases, there is a total loss of
the cartilage cushion between the bones of the joints, which causes friction
between the bones, leading to pain and restriction of joint mobility. Inflammation of the cartilage can also
stimulate new bone outgrowths (spurs) to form around the joints. Osteoarthritis is sometimes found in several
members of the same family, implying a heredity (genetic) basis for the
disease.
Secondary osteoarthritis is caused
by another disease or condition.
Conditions that can cause secondary osteoarthritis include abnormal
joints at birth (congenital abnormalities), diabetes and other hormone
disorders, gout, obesity, repeated trauma or surgery to the joint structures.
Some people are born with
abnormally formed joints (congenital abnormalities) that are susceptible to
mechanical wear, which causes early degeneration and loss of joint
cartilage. Osteoarthritis of the hip
joints is frequently related to congenital abnormalities of these joints.
Hormone imbalances, such as
diabetes and growth hormone disorders, are also associated with early cartilage
wear and secondary osteoarthritis.
Crystal deposits in the cartilage
can cause cartilage degeneration, and osteoarthritis.
Arthritis in gout is caused by
uric acid crystals; arthritis in pseudogout is caused by calcium pyrophosphate
crystals.
Obesity causes osteoarthritis by
increasing the mechanical stress on the cartilage.
Repeated trauma to joint tissues
(ligaments, bones and cartilage) is thought to lead to early osteoarthritis of
knees in soccer players.
What are the Symptoms of Osteoarthritis?
Unlike many other forms of
arthritis that are systemic diseases, such as rheumatoid arthritis and systemic
lupus, osteoarthritis does not affect other organs of the body, only the
joints. The most common symptom of
osteoarthritis is pain in the affected joint(s) following repetitive use;
hence, joint pain is usually worse later in the day. Swelling, warmth, and creaking of the affected joints may
occur. Pain and stiffness of the joints
can also occur after long periods of inactivity. In severe osteoarthritis, there may be pain when resting or with
limited motion, through the complete loss of cartilage cushion causing friction
between bones.
Symptoms of osteoarthritis vary
greatly from person to person. Some
sufferers are debilitated by their symptoms.
Others may have remarkably few symptoms in spite of dramatic degeneration
of the joints shown on x-rays. Symptoms
also can be intermittent.
Osteoarthritis of the knees is
often associated with obesity or a history of repeated injury and/or joint
surgery. Progressive cartilage
degeneration of the knee joints can cause deformity and outward curvature of
the knees. People suffering from
osteoarthritis of the weight bearing joints, such as the knees, can develop a
limp. In some patients, the pain, limping,
and joint dysfunction may not respond to medication, and joint replacement is
undertaken. Osteoarthritis of the spine
causes pain in the neck or low back.
Bony spurs forming along the arthritic spine can irritate spinal nerves,
causing severe pain, numbness, and tingling of the affected parts of the
body. Osteoarthritis can cause the
formation of hard bony enlargements of the small joints of the fingers. Osteoarthritis of the joint at the base of
the big toe causes the formation of a bunion.
How is Osteoarthritis Diagnosed?
There is no blood test for the
diagnosis of osteoarthritis. Blood
tests are carried out to exclude diseases that can cause secondary
osteoarthritis, and other arthritis conditions that can mimic osteoarthritis.
X-rays of the affected joints can
indicate osteoarthritis. Such
indications include loss of joint cartilage, narrowing of the joint space
between adjacent bones, and bone spur formation.
Arthrocentesis is a method by
which a sterile needle is used to remove joint fluid for analysis. Joint fluid analysis is useful in excluding
gout, infection, and other causes of arthritis. During arthrocentesis, removal of joint fluid and injection of
corticosteroids into the joints can help relieve pain, swelling, and
inflammation.
Arthroscopy is a surgical
technique whereby a physician inserts a viewing tube into the joint space. Cartilage and ligament abnormalities and
damage can be detected and sometimes repaired through the arthroscope. If successful, this method of surgery has a
much quicker recovery period than open joint surgery.
A careful analysis of the
location, duration, and nature of the joint symptoms and the appearance of the
joints will help the physician in the diagnosis of osteoarthritis
What is the Treatment for Osteoarthritis?
There is no specific treatment to
stop cartilage degeneration or repair damaged cartilage in osteoarthritis,
apart from weight reduction and avoiding activities that put excessive stress
on the joint cartilage. The aim of
treatment in osteoarthritis is to reduce joint pain and inflammation, and to
improve and maintain function. Some
patients with osteoarthritis have little or no pain, and may not need
treatment. Others may benefit from
moderate measures such as exercise, rest, weight reduction, physical and
occupational therapy, and mechanical support devices. Medication can be taken orally or injected into the joints to
decrease joint inflammation and pain.
Surgery can be considered if moderate measures fail to control pain and
improve joint function.
Exercise does not usually
aggravate osteoarthritis when performed at levels that do not cause joint pain,
and is helpful in several ways. First,
it strengthens the muscular support around the joints. It also improves and maintains joint
mobility. Finally, it promotes weight
reduction and endurance. Applying local
heat before and cold packs after exercise can help relieve pain and
inflammation. Swimming is particularly
beneficial to osteoarthritis sufferers because it allows patients to exercise
with minimal impact stress to the joints.
Other popular exercises are walking, stationary cycling, and moderate
weight training.
Resting sore joints reduces stress
on the joints, and relieves pain and swelling.
Sufferers are usually advised to decrease the intensity and/or frequency
of the activities that consistently cause joint pain.
Physical therapists can provide
support devices that can be helpful in reducing stress on the joints, such as
splints, canes, walkers, and braces.
Occupational therapists can assess the need for additional devices that
may help patients at work or home, such as finger splints, paraffin wax dips,
warm water soaks, and nighttimes cotton gloves to ease hand symptoms. Spine symptoms can be helped with a neck
collar, lumbar corset, or a firm mattress, depending on what areas are
involved.
Mild pain relievers such as
aspirin and acetaminophen (TYLENOL) creams applied to the skin over the joints
may be adequate treatment for many osteoarthritis sufferers. Recent studies have shown that acetaminophen
given in sufficient doses can be as effective in pain relief in osteoarthritis
of the knees as prescription anti-inflammatory medications.
Nonsteroidal anti-inflammatory
drugs (NSAIDs) are medications that are used to reduce pain and inflammation in
the joints. Examples of NSAIDs include
aspirin, ibuprofen, nabumetone, and naproxen.
It is important to note that side effects of NSAIDs may involve
gastrointestinal distress, such as stomach upset, cramping diarrhoea, ulcer and
even bleeding. Oral cortisone is generally
not used in treating osteoarthritis, but when injected directly into the
inflamed joints, it can rapidly decrease pain and restore function. However, repeated cortisone injections can
be harmful to the tissue and bones, and are administered to sufferers with more
pronounced symptoms.
Surgery is usually reserved for
those patients with osteoarthritis that is particularly severe and unresponsive
to the moderate treatments. Arthroscopy
is helpful when cartilage tears are suspected.
Osteotomy is a bone removal procedure that can help realign some of the
deformity, particularly in knee disease.
Severely degenerated joints may be treated by fusion (arthrodesis) or
replacement with an artificial joint (arthroplasty). Total hip and total knee replacements are now common, and can
bring dramatic pain relief and improved function.
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