Orthopedics

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Bone and Joint Health

Know About Arthritis

Osteoarthritis, sometimes called degenerative joint disease or osteoarthrosis, is the most common form of arthritis. Osteoarthritis occurs when cartilage in your joints wears down over time. Osteoarthritis can affect any joint in your body, though it most commonly affects joints in the hands, hips, knees and spine. Osteoarthritis typically affects just one joint, though in some cases, such as with finger arthritis, several joints can be affected.

Causes

Osteoarthritis occurs when the cartilage that cushions the ends of bones in the joints deteriorates over time. The smooth surface of the cartilage becomes rough, causing irritation. Eventually, if the cartilage wears down completely, what remains is bone rubbing on bone causing the ends of your bones to become damaged and the joints to become painful.

It isn't clear what causes osteoarthritis in most cases. Researchers suspect that it's a combination of factors, including being overweight, the aging process, joint injury or stress, heredity, and muscle weakness.

Signs and symptoms

Osteoarthritis symptoms often develop slowly and worsen over time. Signs and symptoms of osteoarthritis include:

  • Pain in a joint during or after use, or after a period of inactivity
  • Tenderness in the joint when you apply light pressure
  • Stiffness in a joint, that may be most noticeable when you wake up in the morning or after a period of inactivity
  • Loss of flexibility may make it difficult to use the joint
  • Grating sensation when you use the joint
  • Bone spurs, which appear as hard lumps, may form around the affected joint
  • Swelling in some cases

Osteoarthritis symptoms most commonly affect the hands, hips, knees and spine.

Treatment

There's no known cure for osteoarthritis, but treatments can help to reduce pain and maintain joint movement so that you can go about your daily tasks. While medications and joint replacement surgery are key components of treatment for osteoarthritis, your doctor will likely recommend you try all other possible solutions before you consider those options. Eventually medications and surgery may be necessary.

Initial treatment options for mild osteoarthritis

For mild osteoarthritis pain that is bothersome, but not enough to have a great impact on your daily activities, your doctor may recommend that you:

  • Rest. If you're experiencing pain or inflammation in your joint, rest it for 12 to 24 hours. Find activities that don't require you to use your joint repetitively. Try taking a 10-minute break every hour.
  • Exercise. With your doctor's approval, get regular exercise when you feel up to it. Stick to gentle exercises, such as walking, biking or swimming. Exercise can increase your endurance and strengthen the muscles around your joint, making your joint more stable. Avoid exercising tender, injured or swollen joints. If you feel new joint pain, stop. New pain that lasts more than two hours after you exercise probably means you've overdone it.
  • Lose weight. Being overweight or obese increases the stress on your weight-bearing joints, such as your knees and your hips. Even a small amount of weight loss can relieve some pressure and reduce your pain. Aim to lose 1 or 2 pounds a week, at most. Talk to your doctor about healthy ways to lose weight. Most people combine changes in their diet with increased exercise.
  • Use heat and cold to manage pain. Both heat and cold can relieve pain in your joint. Heat also relieves stiffness and cold can relieve muscle spasms. Soothe your painful joint with heat using a heating pad, hot water bottle or warm bath. Heat should be warm, not hot. Apply heat for 20 minutes several times a day. Cool the pain in your joint with cold treatments, such as with ice packs. You can use cold treatments several times a day, but don't use cold treatments if you have poor circulation or numbness.
  • Work with a physical therapist. Ask your doctor for a referral to a physical therapist. The physical therapist can work with you to create an individualized exercise plan that will strengthen the muscles around your joint, increase your range of motion in your joint and reduce your pain.
  • Find ways to avoid stressing your joints. Find ways to go about your day without stressing your joints. An occupational therapist can help you discover ways to do everyday tasks or do your job without putting extra stress on your already painful joint. For instance, a toothbrush with a large grip could make brushing your teeth easier if you have finger osteoarthritis. A special seat in your shower could help relieve the pain of standing if you have knee osteoarthritis.

Treatment options for moderate osteoarthritis

Osteoarthritis pain that persists despite initial treatment may require medications in addition to initial treatment options. Don't assume that taking a medication is all you need. In order to get the most from your treatment, continue exercising when possible and resting when you need to. If you're overweight, continue working to lose weight.

Medications that may be useful for moderate arthritis include: Acetaminophen, NSAIDs etc

Treatment options for severe osteoarthritis

If you've tried other treatments but are still experiencing severe pain and disability, you and your doctor can discuss other treatments including:

  • Stronger painkillers.
  • Cortisone shots. Injections of corticosteroid medications may relieve pain in your joint. During this procedure your doctor numbs the area around your joint and then inserts a needle into the space within your joint and injects medication. It isn't clear how or why corticosteroid injections work in people with osteoarthritis. Your doctor may limit the number of injections you can have each year, since too many corticosteroid injections may cause joint damage.
  • Visco-supplementation. Injections of hyaluronic acid derivatives (Hyalgan, Synvisc) may offer pain relief by providing some cushioning in your knee. These treatments are made of rooster combs and are similar to a component normally found in your joint fluid. Visco-supplementation is only approved for knee osteoarthritis, though researchers are studying its use in other joints. Injections are typically given weekly over several weeks. Pain relief may last for a few months. Possible risks include infection, swelling and joint pain. People who are sensitive to birds, feathers or eggs shouldn't undergo visco-supplementation treatments.

Surgery for osteoarthritis

Surgery is generally reserved for severe osteoarthritis that isn't relieved by other treatments. You may consider surgery if your osteoarthritis makes it very difficult to go about your daily tasks. Surgical treatments include:

  • Joint replacement. In joint replacement surgery (arthroplasty), your surgeon removes your damaged joint surfaces and replaces them with plastic and metal devices called prostheses. The hip and knee joints are the most commonly replaced joints. But today implants can replace your shoulder, elbow, finger or ankle joints. How long your new joint will last depends on how you use it. Some knee and hip joints can last 20 years. Joint replacement surgery can help you resume an active, pain-free lifestyle. In smaller hand joints, it can also improve appearance and comfort and may improve your joint's mobility. Joint replacement surgery carries a small risk of infection and bleeding. Artificial joints can wear or come loose, and may need to eventually be replaced.
  • Cleaning up the area around the joint (debridement). Your surgeon may recommend removing loose pieces of cartilage and bone from around your joint to relieve your pain. Debridement is most useful if you're experiencing a locking sensation from a torn cartilage or loose debris in your knee joint. Debridement is typically done arthroscopically, meaning only small incisions are made in your body. A tiny video camera is inserted through the incision to allow your surgeon to see inside your joint. The surgeon uses special surgical tools to clean out any debris pieces from your joint.
  • Realigning bones. Surgery to realign bones may relieve pain. These types of procedures are typically used when joint replacement surgery isn't an option, such as in younger people with osteoarthritis. During a procedure called an osteotomy, the surgeon cuts across the bone either above or below the knee to realign the leg. Osteotomy can reduce knee pain by transferring the force of the joint away from the worn-out part of the knee.
  • Fusing bones. Surgeons also can permanently fuse bones in a joint (arthrodesis) to increase stability and reduce pain. The fused joint, such as an ankle, can then bear weight without pain, but has no flexibility. Arthrodesis may be an option if you experience severe pain in your joint, but can't undergo joint replacement

 

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