Osteoarthritis

Osteoarthritis (OA) is the most common joint disorder, which happens due to aging and wear and tear of a joint.

CAUSES AND RISK FACTORS

• Osteoarthritis is a normal result of aging. It is also caused by 'wear and tear' of a joint.
• Cartilage is the firm, rubbery tissue that cushions your bones at the joints, and allows bones to glide over one another.
• If the cartilage breaks down and wears away, the bones rub together. This causes pain, swelling, and stiffness.
• Bony spurs or extra bone may form around the joint. The ligaments and muscles around the joint become weaker and stiffer.
• OA tends to run in families.
• Being overweight increases the risk of OA in the hip, knee, ankle, and foot joints because extra weight causes more wear and tear.
• Fractures or other joint injuries can lead to OA later in life. This includes injuries to the cartilage and ligaments in your joints.
• Jobs that involve kneeling or squatting for more than an hour a day puts you at a high risk. Jobs that involve lifting, climbing stairs or walking also put you at risk.
• Playing sports that involve direct impact on the joint (such as football), twisting (such as basketball or soccer), or throwing also increases the risk of arthritis.
• Bleeding disorders that cause bleeding in the joint, such as hemophilia
• Disorders that block the blood supply near a joint and leads to avascular necrosis
• Other types of arthritis, include chronic gout, pseudogout or rheumatoid arthritis

SYMPTOMS

Pain and stiffness in the joints are the most common symptoms. The pain is often worse after exercise when you put weight or pressure on the joint. If you have osteoarthritis, your joints probably become stiff and harder to move over time. You may notice a rubbing, grating or crackling sound when you move the joint. The phrase "morning stiffness" refers to the pain and stiffness you may feel when you first wake up. Stiffness usually lasts for 30 minutes or less. It is improved by mild activity that "warms up" the joint. During the day, the pain may get worse when you are active and feel better when you are resting. After a while, the pain may be present when you are resting. It may even wake you up at night. Some people might not have symptoms, even though X-rays show the changes of OA.

SIGNS AND TESTS

A physical examination reveals

• Joint movement may cause a cracking (grating) sound, called crepitation
• Joint swelling (bones around the joints may feel larger than normal)
• Limited range of motion
• Tenderness when the joint is pressed
• Normal movement is often painful
• No blood tests are helpful in diagnosing OA. An X-ray of affected joints will show a loss of the joint space. In advanced cases, there will be a wearing down of the ends of the bone and bone spurs.

TREATMENT

OA cannot be cured. It will most likely get worse over time. However, your OA symptoms can be controlled. You can have surgery, but other treatments can improve your pain and make your life much better. Although these treatments cannot make the arthritis go away, they can often delay surgery.

MEDICATIONS

Over-the-counter pain relievers, which you can buy without a prescription, can help with OA symptoms. Most doctors recommend acetaminophen (Tylenol) first, because it has less side effects than other drugs. If your pain continues, your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs). Types of NSAIDs include aspirin, ibuprofen, and naproxen.

Other medications or supplements include:

• Corticosteroids injected right into the joint to reduce swelling and pain
• Over-the-counter remedies such as glucosamine and chondroitin sulfate
• Capsaicin (Zostrix) skin cream to relieve pain
• Artificial joint fluid (Synvisc, Hyalgan) can be injected into the knee to relieve pain for 3 - 6 months

LIFESTYLE CHANGES

Staying active and getting exercise helps maintain joint and overall movement. Ask your health care provider to recommend an appropriate home exercise routine. Water exercises such as swimming, are especially helpful. Other lifestyle recommendations include

• Applying heat and cold
• Maintaining a healthy balanced diet
• Getting adequate rest
• Reducing weight if you are overweight
• Protecting the joints

As the pain from your OA becomes worse, keeping up with everyday activities may become more difficult or painful. Sometimes making changes around the home will take some stress off your joints and relieve some of the pain. If your work is causing stress in certain joints, you may need to adjust your work area or change work habits.

PHYSICAL THERAPY

Physical therapy can help improve muscle strength and motion of stiff joints, as well as your sense of balance. Therapists have many techniques to treat OA. If therapy does not make you feel better after 6-8 weeks, then it most likely will not work at all.

Massage therapy may also help provide short-term pain relief. Make sure you work with an experienced massage therapist who understands how to work with sensitive joint areas.

BRACES

Splints and braces can sometimes support weakened joints. Some prevent the joint from moving; others allow some movement. You should use a brace only when your doctor or therapist recommends one. Using a brace the wrong way can cause joint damage, stiffness and pain.

ALTERNATIVE TREATMENT

Acupuncture is a treatment based on Chinese medicine. How it works is not entirely clear. Some studies have found that acupuncture may provide short-term pain relief for people with OA.

SURGERY

• Severe cases of OA might need surgery to replace or repair damaged joints. Surgical options include
• Arthroscopic surgery to trim, torn and damaged cartilage
• Changing the alignment of a bone to relieve stress on the bone or joint (osteotomy)
• Surgical fusion of bones, usually in the spine (arthrodesis)
• Total or partial replacement of the damaged joint with an artificial joint (knee replacement, hip replacement, shoulder replacement, ankle replacement, elbow replacement)

COMPLICATIONS

• Reaction to drugs used for treatment
• Diminished ability to perform everyday activities, such as personal hygiene, household chores or cooking
• Decreased ability to walk

Authored By : DR. DAVID V RAJAN