Osteoarthritis, also known as degenerative joint disease, is the most common form of arthritis in the United States. It affects more than 20 million Americans. Osteoarthritis has been generally thought of as a “wear and tear” condition on joints that only affects elderly individuals. In reality, osteoarthritis can occur in younger men and women, especially if prior joint damage occurred through trauma.
Symptoms may start with occasional pains in weight bearing joints, the hip, knee, low back and neck. But can also affect joints that are overused, like the finger and base of the thumb. The first stage of osteoarthritis is characterized by the loss of cartilage. This in turn leads to decreased cushioning of the joint and eventual bone-on-bone rubbing.
In the process of trying to heal the damage, the cartilage cells, known as chondrocytes, attempt to repair the cartilage loss. This repair is done haphazardly and does not compare in strength or elasticity with the original cartilage. If untreated, there can be ongoing thinning of cartilage and overgrowth of bone, called bone spurs. Eventually, the cartilage that cushions the ends of the bones can be completely gone. This late stage of osteoarthritis usually causes pain with mobility and the joint may develop deformities.
Osteoarthritis can produce the following symptoms:
• Mild to severe pain in a joint, especially after overuse or long periods of inactivity, such as sitting or sleeping
• A grinding or grating sensation in the joint
• Swelling, stiffness, limited movement of the joint, especially in the mornings
• Weakness in muscles around the joint caused by lack of use
• Deformity of the joint
Because osteoarthritis is so common and leads to widespread pain and disability, rheumatologists try to prevent worsening damage from occurring. Today, multiple treatments can slow down the destructive processes of osteoarthritis.
Early intervention is key in starting a comprehensive program. The major goal is to keep patients functioning. With early treatment and awareness, surgery may be avoided.
Warning signs to alert a patient of possible degenerative joint disease include:
• Relatives with osteoarthritis
• History of injury to a joint
• History of surgery on a weight bearing joint
• Pain, stiffness or swelling, especially after inactivity
There is a strong genetic influence in developing osteoarthritis, especially among females. Trauma or surgery to the joint cartilage may be an early focus of osteoarthritis. For example, surgical treatments, like complete menisectomy, or removal of the meniscus from the knee, can lead to early osteoarthritis. Also, obesity can predispose an individual to early development of osteoarthritis in the knees and hips.
Signs of osteoarthritis include asymmetry, or different joints affecting different sides of the body. Osteoarthritis may involve one knee or a finger joint. Typical joints affected include the hips, knees, fingers, bases of the thumb, low back and neck. Less common joints are the wrists, elbows, shoulders and ankles. If these joints are affected it may be indicative of other problems occurring.
Sometimes joints can “flare” with increased swelling and pain. This may be a sign that the condition is worsening or another arthritic condition is occurring concomitantly, like gout, pseudogout or a superimposed joint infection. Regardless of the cause, a severity in symptoms requires prompt attention by a physician experienced in treating arthritis.
If you are referred to a rheumatologist for evaluation and treatment of possible osteoarthritis, a history and complete physical exam will be performed to determine the cause of the problem. X-rays will usually be needed to confirm the type of arthritis and its severity. Fluid may be withdrawn from joints with excessive swelling to help establish a diagnosis. Sometimes more sophisticated tests, like an MRI, may be needed.
Treatment is multifaceted to decrease pain, improve joint mobility and prevent future progression of osteoarthritis. The following interventions may be used:
• Weight reduction
• Physical therapy evaluation and treatment
• An ongoing exercise program to conserve joint mobility and improve muscle strength
• Nutritional supplementation
• Pain and anti-inflammatory medications
• Joint injections to control pain
By instituting treatment with multiple different modalities, the ability to continue an active lifestyle with the lowest level of discomfort is possible.
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