Osteoarthritis for Patients and Families

Osteoarthritis is the most common form of arthritis in the United States, affecting roughly 12 percent of Americans aged 25 - 74. It's a chronic joint disease that breaks down cartilage and bones in the neck, lower back, knees, hips, shoulders and/or fingers. Common symptoms are pain, stiffness and limited joint movement.

Both rheumatoid arthritis and osteoarthritis cause joint pain, stiffness and limited range of motion, but the two diseases are distinct in their root cause and treatment.

Rheumatoid arthritis is an autoimmune condition where a person's own immune system attacks their joints, causing inflammation. Rheumatoid arthritis typically affects many joints simultaneously, especially in the hands, wrists, and feet, and is treated with medications to suppress the immune response.

Osteoarthritis, in contrast, is not an autoimmune disease and although the exact causes are not known, multiple potential risk factors have been identified and are outlined below. In a healthy joint, cartilage provides cushioning and a smooth joint surface for motion; in an osteoarthritic joint, as cartilage is irreversibly destroyed and bone abnormalities develop, movement becomes painful and more difficult.

Osteoarthritis is classified as either primary or secondary. Primary osteoarthritis is the most common form. Although there is no known cause, numerous risk factors have been identified. Secondary osteoarthritis is caused by another disease that sets off the joint degeneration, such as an infection, severe injury or congenital deformity.

The following are some of the most common risk factors for primary osteoarthritis:

• Heredity – Slight joint defects or increased joint mobility (“double-jointedness”) may contribute to the development of osteoarthritis.
• Obesity – Excessive weight can put stress on joints and promote cartilage damage.
• Injury – Significant injury, such as ligament damage, can eventually lead to osteoarthritis.
• Age – Osteoarthritis is more common among the elderly, but even young adults can develop osteoarthritis.
• Gender – Women are more likely to develop osteoarthritis.
• Muscle weakness.
• Poor nutrition.

The following are some common risk factors for secondary osteoarthritis:

• Traumatic injuries.
• Repetitive stress injuries.
• Scoliosis or other curvatures of the spine.
• Birth defects that affect the hip joint, such as congenital hip dysplasia or congenital dislocation.

Patients with osteoarthritis usually first tell their primary care physicians about their joint symptoms. When the primary care physician or patient feels that more advanced diagnostic measures or therapies are needed, the patient will then see either a rheumatologist or an orthopedic surgeon. Rheumatologists offer a full evaluation of the patient’s osteoarthritis to confirm the diagnosis and make sure the patient does not have another type of joint problem, such as gout or rheumatoid arthritis. The rheumatologist will then optimize non-surgical treatments (see “How is Osteoarthritis Treated?”). Orthopedic surgeons also can advise patients on non-surgical treatments and can provide a number of surgical options (see “How is Osteoarthritis Treated?”).

The physician will begin with a complete medical history and a physical examination. During the exam, the doctor will look for an enlarged or bumpy joint, signs of swelling or decreased range of motion. Your health care provider may then order x-rays, which can show a decrease in the cartilage space, new bone formation or incorrect alignment. In some cases, your doctor may perform an aspiration – the removal of fluid from a swollen joint or bursa – to exclude infection, gout or rheumatoid arthritis as possible causes of your joint pain.

There are many types of treatments for osteoarthritis that are designed to reduce your joint pain, increase flexibility and improve how your joints are functioning. Treatments for osteoarthritis can be divided into two major groups – non-surgical and surgical.

Non-surgical Interventions:

• Optimization of anti-inflammatory and pain medication, such as acetaminophen, non-steroidal anti-inflammatory drugs and other pain medications.
• Topical analgesics.
• Injections of cortisone and viscosupplements (gel-like substances that act like natural joint fluids).
• Physical therapy.
• Occupational therapy.
• Guidance on weight loss and exercise.
• Bracing and orthotics.
• Self-management strategies.
• Guidance on the use of nutritional supplements.

Surgical Interventions:

• Arthroscopy is a minimally-invasive procedure to diagnose and treat conditions affecting the joints. The surgeon first examines the internal structure of the joint through a small video camera inserted through the skin. Additional steps to improve joint function then can be taken, such as the removal of loose cartilage or meniscal repair.
• Arthroplasty is a surgical procedure to replace or restore a severely osteoarthritic joint to ease pain and improve mobility, thereby improving the patient’s quality of life.
• An osteotomy involves the removal of a portion of bone to realign the joint as a temporary treatment for osteoarthritis.
• Cartilage repair and regeneration – This technique can replace damaged cartilage and may be useful for patients with certain types of cartilage defects.

Although the evidence to support the benefit of chiropractic manipulation, acupuncture or herbal remedies for the treatment of osteoarthritis is limited, these interventions may provide pain relief for an affected joint. It is important to communicate your use of complementary therapies to your health care provider to insure that these treatments do not interfere with your other medical conditions or therapies.

Maintaining a healthy lifestyle may help prevent osteoarthritis. Eating nutritious foods, maintaining a healthy weight throughout your life and exercising regularly to strengthen muscles that protect the joints are three very important methods that may reduce your risk of developing osteoarthritis.

Osteoporosis refers to bone thinning, which leads to brittle bones and a greater risk of breaks. Everyone’s peak bone mass is reached at around the age of 35, and from then on, our bones start getting thinner. Osteoarthritis is the wearing down of cartilage in the joint. The body responds by developing new bone, but not necessarily in the correct position. This new 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 and interfering with the joint's normal function.