Osteoarthritis

OA is the most common chronic condition of the joints. It can affect any joint but occurs most often in knees, hips, lower back and neck, small joints of the fingers and the bases of the thumb and big toe.

Although Osteoarthritis can damage any joint in your body, it most commonly affects joints in the hands, feet, and spine as well as the large weight-bearing joints, such as the hips and knees.

Specifically, OA may affect different parts of the body in different ways:

• Hip: pain felt in the groin area or buttocks and sometimes on the inside of the knee or thigh.
• Knees: A “grating” or “scraping” sensation occurs when moving the knee.
• Fingers: Bony growths (spurs) at the edge of joints can cause fingers to become swollen, tender and red. There may be pain at the base of the thumb.
• Feet: Pain and tenderness are felt in the large joint at the base of the big toe. There may be swelling in ankles or toes. It can be a factor causing the formation of bunions, rendering them red or swollen.

Many people believe that the effects of Osteoarthritis are inevitable, so they don’t do anything to manage it. But OA symptoms can hinder work, social life, and family life if steps are not taken to prevent joint damage, manage pain and increase flexibility.

In normal joints, cartilage (a firm, rubbery material that covers the end of each bone) provides a smooth, gliding surface for joint motion and acts as a protective cushion between the bones.

In people with OA, this protective cartilage breaks down and diminishes the protective cushioning, thus causing pain, swelling and problems moving the joint.

In many cases OA worsens over time and further damages the cartilage in several ways:

• Bones may break down and develop growths called spurs
• Bits of bone or cartilage may chip off and float around in the joint causing irritation
• Inflammation may cause proteins and enzymes to develop

In the final stages of OA, the cartilage completely wears away and bone rubs against bone leading to joint damage and more pain.

OA occurs in people of all ages, but it is most common in people older than 65. Common risk factors include increasing age, obesity, previous joint injury, overuse of the joint, weak thigh muscles, and genes.

According to historical records, one in two adults will develop symptoms of knee OA during their lives, and one in four adults will develop symptoms of hip OA by age 85. It also appears to be genetic.

Osteoarthritis symptoms can usually be effectively managed, although the underlying process cannot be reversed. Staying active, maintaining a healthy weight and other treatments may slow the progression of the disease and help improve pain and joint function.

The most common symptoms of OA are joint pain and stiffness. These vary depending on which joints are affected and how severely they are affected.

These symptoms, which tend to build slowly rather than show up suddenly, include:

• Pain: Hurting or aching feeling during or after movement especially after activity or at the end of the day
• Tenderness: Sensitivity when pressure is applied to the hurt area
• Joint stiffness: Most noticeable after waking up in the morning or after a period of inactivity
• Loss of flexibility or range of motion: Unable to move your joint through its full range of motion
• Grating sensation: You may hear or feel a grating sensation when you use the joint
• Bone spurs: Extra bits of bone, which feel like hard lumps, may form around the affected joint
• Numbness/Weakness: The arms and legs may become numb or weak when the back or spine is affected
• Crepitus: A clicking and cracking noise that occurs when the affected joint is moved, especially the shoulder or knee joints
• Swelling: In and around the affected joint and may be accompanied by tenderness
• Joint locking or joint instability: Similar to stiffness, it affects daily activity

Initially, symptoms may occur only following exercise but may become more constant with time. The pain typically worsens with prolonged activity and is relieved by rest.

OA pain, swelling or stiffness may make it difficult to perform ordinary tasks at work or at home. Simple acts like opening a box of cereal, grasping a computer mouse or holding a pencil can become painful or nearly impossible. In the lower body, activities such as walking, climbing stairs, and lifting objects may become difficult.

It is important to note the risk factors for OA to help prevent or properly manage it.

• Obesity: Research has shown that being overweight puts additional pressure on the hips and knees. Many years of carrying extra pounds can cause the cartilage that cushions joints to break down faster. In addition, fat tissue produces proteins that may cause harmful inflammation in and around your joints.
• Older age: The risk of Osteoarthritis increases with age.
• Post-menopause: Changes in hormone levels may play a role in the development of Osteoarthritis as it is more prevalent among post-menopausal women than among men of the same age.
• Occupation: Increased risk of developing knee and hip Osteoarthritis was found among those who have physically demanding work, specifically manual lifting and handling, kneeling or squatting, walking and climbing tasks as well as constant standing while at work. The risk for hip Osteoarthritis increases over time among those who repeat bent or twisted positions at work.
• Diabetes: Diabetes increases the risk of having Osteoarthritis and people with diabetes have joint replacements at a younger age than those without diabetes.
• Joint injuries: Injuries from an accident or playing sports may increase the risk of Osteoarthritis. Even those that occurred many years ago and seemingly healed can increase the risk of Osteoarthritis.
• Genetics: Some people inherit a tendency to develop Osteoarthritis as it tends to run within families.
• Bone deformities: People born with malformed joints or defective cartilage are at an increased risk of Osteoarthritis.

To diagnose Osteoarthritis, the physicians at Semmes Murphey Clinic will collect detailed information on personal and family medical history, perform a physical examination and order diagnostic tests.

In preparation for an appointment, it’s important to note the following information needed to help diagnose Osteoarthritis:

• Description of the symptoms
• Details about when and how the pain or other symptoms began
• Details about other existing medical problems
• Location of the pain, stiffness or other symptoms
• How the symptoms affect daily activities
• List of current medications

During the exam, the doctor will examine the joints and test their range of motion. He or she will be looking for areas that are tender, painful or swollen as well as signs of joint damage. If appropriate, the doctor will also examine the position and alignment of the neck and spine.

If Osteoarthritis is suspected after a medical history and physical examination are completed, the next step to confirm OA is diagnostic tests such as:

• Joint fluid analysis: Examining and testing the fluid from the affected joint(s) can determine if there's inflammation and if your pain is caused by gout or an infection.
• X-ray: X-rays can show damage, bone spurs and other changes related to Osteoarthritis. It will also reveal cartilage loss by a narrowing of the space between the bones in your joint.
• Magnetic resonance imaging (MRI): This test provides a better view of cartilage and other structures to detect early abnormalities typical of Osteoarthritis. MRIs are used to provide more information in complex cases.
• Blood tests: Although there is no blood test for Osteoarthritis, certain tests may help rule out other causes of joint pain, such as rheumatoid arthritis.

Osteoarthritis is a chronic (long-term) disease. There is no cure, but treatments are available to help manage symptoms and improve joint mobility and flexibility.

While it may be hard to think of exercise when the joints hurt, moving is considered an important part of the treatment plan. Talk to a doctor before starting an exercise program.

OA treatment plans often include these options to help get patients moving:

• Simple activities like walking around the neighborhood or swimming can help reduce or maintain a healthy weight which, in turn, reduces joint pain.
• Strengthening exercises to build muscles around OA-affected joints and help ease the burden on those joints and reduce pain.
• Range-of-motion exercise is important in maintaining and improving joint flexibility while also reducing stiffness.
• Aerobic exercise helps improve stamina and increase energy levels while also helping to reduce excess weight.

The U.S. Department of Health and Human Services recommends that everyone, including those with arthritis, get 150 minutes of moderate exercise per week. This can be broken down into shorter segments, for example, 30 minutes of exercise done five times a week.

Weight Management is an important factor in preventing OA and relieving pain in weight-bearing joints, such as the hips, knees, feet, and back. Even being a little overweight can negatively affect the body. The basic rule for losing weight is to eat fewer calories and increase physical activity.

Stretching—slowly and gently—helps improve flexibility, lessens stiffness and reduces pain. Exercises such as yoga and tai chi are great ways to manage stiffness and gain flexibility. When led by a knowledgeable instructor, these therapies are safe. Alert the instructor of your issues and they should offer alternative moves that will not cause pain, if necessary.

Oral and injectable medications (over-the-counter and prescription) may help relieve the pain and inflammation of OA. Discuss these with your physician to decide which may be right for you.

Physical and occupational therapists can provide a range of treatment options for pain management including heat and cold therapies. They also can work with you to create an individualized exercise program that will strengthen the muscles around your joint, increase your range of motion and reduce pain.

An occupational therapist can show you ways to do everyday tasks or your job without putting extra stress on an already painful joint.

Assistive devices (scooters, canes, walkers, splints, shoe orthotics or helpful tools) can help with function and mobility. Some are available over-the-counter. But those that require proper and perfect fit (such as custom knee braces and shoe wedges) need to be prescribed by a doctor and fitted by a physical or occupational therapist.

Natural or alternative therapies are used by many people to address symptoms and improve their overall well-being. These may include nutritional supplements, acupuncture or acupressure, massage, relaxation techniques, and hydrotherapy, among others. While a prescription is not required, you will need to alert your physician of these therapies to make sure they do not cause any negative effects.

Joint replacement surgery or resurfacing may be recommended if the impact of symptoms of Osteoarthritis on quality of life is significant and more conservative management is ineffective.

Joint surgery can repair or replace severely damaged joints, especially hips or knees. Many people have found relief with successful surgery. Discuss your options with your physician to be sure you’re a good candidate as well as the details to make a wise choice about your personal health.

Currently, the process underlying Osteoarthritis cannot be reversed, but symptoms can usually be effectively managed with lifestyle changes, physical and other therapies, medications, and surgery. Exercising and achieving a healthy weight are generally the most important ways to treat Osteoarthritis.

This information was provided by the specialists at Semmes Murphey Clinic. Readers are encouraged to research trustworthy organizations for information. Please talk with your physician for websites and sources that will enhance your knowledge and understanding of this issue and its treatments.