Osteoarthritis

Description

Osteoarthritis results from inflammation and injury to joints with age, causing the cartilage to break down in joints. It also involves deterioration of tendons and ligaments surrounding the joints. Bones that form the joints lose the protection of cartilaginous layers and rub and grind against each other causing pain and the formation of bone spurs. Commonly afflicted joints are the knees, hips, the lower back and the hands. Osteoarthritis can be severe enough to significantly limit day to day activities.

Causes

In addition to age-related changes, osteoarthritis has other modifiable and non-modifiable causes. Inflammatory and metabolic processes in the presence of disease states such as diabetes and high cholesterol levels can contribute to its development. Genetic factors can be involved as well. Sports related injuries and repetitive motion injuries can contribute to the development of osteoarthritis.

Presumably, joint inflammation and defective repair mechanisms in response to injury erode the cartilaginous lining of joints. They lose mobility and function and become painful with activity.

Symptoms

  • Slow and progressive onset over years.

  • Pain that becomes worse as the day progresses. Improves with rest.

  • Stiffness after inactivity.

  • Swelling especially after activity.

  • Bone spurs that can cause physical deformities.

  • Reduced range of motion and lack of flexibility.

  • Crackling and clicking sounds with joint motion resulting from bones grinding against each other.

Diagnosis

A medical history is the first step in diagnosing osteoarthritis. The physician will inquire about family history and symptoms.

On the physical exam, the physician will look for swelling and tenderness in the joints, limitations of motion and visible deformities.

Laboratory tests include joint aspiration. During this study, a small amount of fluid is aspirated from the joint for examination.

X-ray findings do not always correlate with symptoms in osteoarthritis. Most patients over the age of sixty have X-ray changes indicative of osteoarthritis, however only about a third will report symptoms.

An MRI can provide details regarding the damage to the joint, especially the involved cartilage.

Management

Management of osteoarthritis is directed toward reducing pain, mitigating additional joint damage if possible, and trying to improve the quality of life of the patient.

  • Medications include acetaminophen, NSAIDS, COX-2 inhibitors, steroids, topical pain relievers

  • Non-drug therapies include physical therapy, cold and heat therapy, and aquatic therapy

  • Splints or other physical aids such as walkers and canes can be beneficial

  • Interventional pain procedures include hyaluronic acid substitute injections for the knee

  • Weight loss

  • Surgery can be performed as a last resort