Osteoarthritis, the most common form of arthritis in the United States, affects roughly 12 percent of Americans between the ages of 25-74. An often painful and debilitating condition, the good news for patients is that there are treatment options available that can reduce their symptoms and improve their quality-of-life.
Osteoarthritis: Commonly Asked Questions
What is osteoarthritis?
Osteoarthritis is a degenerative form of arthritis. The joints in the body are composed of bone, which are covered with a smooth layer of cartilage. Over time, the cartilage can get worn away. In some cases, this wearing away is so severe that the joints lose range-of-motion and can cause pain. Joints that are weight-bearing, meaning that they hold the weight of the body, are particularly vulnerable. The hips and the knees are the joints most commonly affected by osteoarthritis. There is another type of osteoarthritis, erosive osteoarthritis of the hands, which affects the finger joints. This form of arthritis is hereditary and is especially common in women after the age of 50.
What is the difference between osteoporosis and osteoarthritis?
Osteoporosis means bone thinning. This thinning can result in brittle bones that are more prone to fracture (break). We all reach our peak bone mass around age 35. From that time, our bones start getting thinner. Estrogen helps to maintain bone thickness. During menopause, when the estrogen level starts to drop, the bone loss can increase. Calcium, Vitamin D, exercise, and hormone replacement therapy can all help slow bone loss. Medications that slow down or prevent bone loss can also be used. Osteoporosis predisposes a person to fractures.
Osteoarthritis is the wearing down of the cartilage in the joint. The body responds by putting down new bone, not necessarily in the correct position. This laying down of bone may make some joints appear larger and misshapen. The bony growth and the loss of cartilage can make the space between the bones smaller leading to the bones rubbing against one another. This can interfere with the joint’s normal function.
What are the risk factors involved in getting osteoarthritis?
Osteoarthritis occurs because the cartilage gets worn away. There are some risk factors that are thought to be involved in this process. Some of these are age, sex, and genetics. Local factors include prior injury to the joint, deformity in the joint, obesity and muscle weakness. Other modifiable factors include nutrition and possibly hormones.
What are the symptoms of osteoarthritis?
Symptoms of osteoarthritis are generally limited to the joint involved. Patients usually experience pain when they use the joint and the symptoms go away with rest. Patients may have some stiffness, when they first use a joint. If the arthritis is severe, patients may lose functional capacity in the joint that has osteoarthritis. For example, in severe osteoarthritis of the knee, a patient may experience such severe pain that they stop walking or going up and down stairs.
What does the health care provider look for during a physical exam?
The joint can have bony enlargement and bumpiness. Patients with osteoarthritis of the hands can get knobs on the finger joints. There is usually minimal swelling of the involved joint. The joints can have decreased range-of-motion. Often the health care provider will take radiographs (X-rays) of the joint. These radiographs can show a decrease in the cartilage space, new bone formation and incorrect alignment.
Areas of Osteoarthritis — Where does osteoarthritis occur?
Where does osteoarthritis occur?
Although osteoarthritis could potentially occur in any joint of the body, it most commonly is found in the major weight bearing joints of the body. Some of the most common joints involved include:
The hip: The hip is one of the major weight bearing joints of the body. In younger patients, hip osteoarthritis occurs because the individual has an imperfect ball and socket joint- something that occurred when the hips were developing. In older patients, it is the result of wear and tear over time. Hip arthritis causes groin pain and knee pain. Activities that can become difficult include walking, tying one’s shoes, and crossing one’s legs.
The knee: The knee is the other most common place to develop osteoarthritis. Patients will often complain of pain with walking and, over time, limit their walking distance. The knees can develop a bony prominence and a crunching sound with movement.
The hand: Hand osteoarthritis is very common, especially in women. Most women will experience this type of arthritis at some point in their life. Bony overgrowth occurs at the joints of the fingers. These growths, which are called Hebernon’s and Bouchard’s nodes, occur in the sets of joints closest to the fingertips. Pain, swelling and redness occur during the bony deposition, which lasts anywhere from six months to three years. After that, most patients are just left with bony deposits on their joints but no pain and no loss of function. Individuals can also get arthritis at the base of the thumb.
The spine: The cervical (neck) and lumbar (lower back) spine is composed of vertebral bodies that are connected by joints and have cushioning discs between levels. Over time, these joints are subject to wear and tear, which can cause osteoarthritis and disc degeneration. This can lead to pain in the neck, and the upper and lower back.
Other joints such as the ankle, elbow and shoulder are less susceptible to osteoarthritis.
Treatment
What is the treatment for osteoarthritis?
There are many types of accepted treatment for osteoarthritis. These therapies can be divided into two major groups: non-surgical and surgical. Some of the non-surgical therapies include medications, nutritional supplementation, physical therapy, occupational therapy, exercise, self-management, and weight loss.
Medications: The most common types of medications used to reduce pain in osteoarthritis include acetaminophen (Tylenol®), Non-steroidal antiinflammatory drugs NSAIDS (e.g. Motrin®, Advil®, Aleve®), and painkillers.
Acetaminophen (Tylenol): has been shown to be as effective as nonsteroidal medication in treating the pain of knee osteoarthritis. Individuals should keep their dose of acetaminophen to under 2000 mg a day as higher doses could cause kidney disease.
NSAIDS: Nonsteroidal anti-inflammatory drugs such as Motrin®, Advil®, Aleve®, and other prescription medications are very effective in treating the pain of osteoarthritis. However, their use is somewhat limited as they have many side effects including ulcer formation, heartburn, confusion, kidney and liver problems. Moreover, they can interfere with anti-clotting medications (warfarin) and some medications used to treat high blood pressure.
Pain medications: Other pain medications, non-narcotic and narcotic, can be used for pain control. Narcotic medications can be addicting over time.
Nutritional supplements: There has been much interest in the field of nutritional supplements that are the building blocks of cartilage. These products such as glucosamine and hyaluronic acid, are non- prescription, and have been shown in a limited number of studies to possibly slow the progression of osteoarthritis.
Physical therapy: Physical therapy is aimed at restoring muscle strength, protecting the joint and maximizing the amount of function that a joint has. Physical therapy can be especially beneficial to the patient who wants to delay surgical intervention.
Occupational therapy: Occupational therapy is aimed at providing direction in performing the activities of daily living and recommending appropriate devices such as canes and bathroom equipment to maintain independence.
Exercise: Some studies have shown that generalized conditioning and aerobic exercise can decrease pain and increase function in patients with osteoarthritis.
Self-management: Small groups, patient education, and contact with a provider are all beneficial in dealing with osteoarthritis.
Weight loss: Although weight loss can not reverse the damage that has been done to a joint, it can decrease pain, enhance rehabilitation and improve surgical outcome.
Surgical Intervention: There are several different types of surgical interventions.
Arthroscopy: The surgeon makes a small incision in the skin and places a small tube through which he/she can examine a joint and perform procedures such as scraping cartilage or bone and repairing ligaments.
Osteotomy: In an osteotomy the surgeon will remove part of the bone in a joint to realign the joint as a temporary treatment for osteoarthritis.
Arthroplasty: In arthroplasty, the surgeon removes part of the bone and replaces the joint with a man-made joint. These man-made joints are ever improving and can last many years. Surgical interventions include arthroscopy, osteotomy, and joint replacement therapy.
PREVENTION
What can I do to prevent osteoarthritis?
The prevention of osteoarthritis is founded on maintaining a healthy lifestyle. Keeping a healthy weight from early adulthood on is probably the best step. Exercising regularly to maintain muscle tone helps protect the joint.
Are there complementary or alternative therapies I can utilize?
Although there is little evidence to support the benefit of chiropractic manipulation, acupuncture and herbal remedies for osteoarthritis, these modalities may provide pain relief of an affected joint. It is important to communicate your use of complementary therapies with your health care provider to insure that these treatments do not interfere with your other medical conditions or therapies.
What is new in the field of osteoarthritis?
There is very exciting research being performed on osteoarthritis. Some studies are trying to ascertain which genetic factors predispose individuals to osteoarthritis. Other researchers are trying to establish what chemical mediators are contributing to joint destruction in osteoarthritis. Another exciting development includes experimental therapy in which one’s own cartilage is grown outside of the body in a lab and then reintroduced to the joint that is destroyed.
ADDITIONAL INFORMATION
For more information, to make an appointment, or to learn more about the services and locations of Brigham and Women’s Hospital’s Orthopedics and Arthritis Center, call 1-800-BWH-9999.
Where can I get more information?
