Conditions in Rheumatology: Osteoarthritis

Conditions in Rheumatology: Osteoarthritis

Osteoarthritis affects millions of people worldwide and is the most common form of arthritis as well as the most common and chronic joint condition. It occurs when the protective cartilage cushions at the end of your bones wear down over time. This most commonly affects joints in your hands, fingertips, knees, hips, and spine. Osteoarthritis is also known as wear-and-tear arthritis, degenerative joint disease, and degenerative arthritis. 

Cartilage is a firm but slippery tissue that allows nearly frictionless movement of joints. If cartilage wears down completely, bone will rub against bone instead, causing pain as the bone surfaces become pitted and rough. The damaged cartilage cannot repair itself because cartilage has no blood vessels. 

Osteoarthritis affects not only the cartilage, but the entire joint, causing changes in the bone as well as deterioration of the joint’s connective tissues. It also causes inflammation of the joint lining.

While damage to the joints can’t be reversed, the pain can be managed. Some ways to help combat the condition include staying a healthy weight, staying active, and various treatments to improve pain and joint function.

Symptoms of Osteoarthritis

Osteoarthritis symptoms usually start slowly and get worse over time. These symptoms include: 

  • Increased pain
  • Stiffness, especially after awakening or after activity
  • Tenderness
  • Loss of flexibility and decreased range of motion
  • Grating sensation
  • Bone spurs
  • Swelling and inflammation

There are four stages of osteoarthritis: minor, mild, moderate and severe. 

  • Stage 1: Minor: While there is some small amount of wear-and-tear in the joints, there is typically little or no pain in the affected area. 
  • Stage 2: Mild: X-Rays show bone spur growths (bone spurs can happen when bones meet each other in the joint). The area becomes stiff and uncomfortable after long sedentary periods. 
  • Stage 3: Moderate: Cartilage starts to erode and narrow the gap between joint and bone. The inflamed joint causes discomfort during daily activity. 
  • Stage 4: Severe: The cartilage is almost completely gone in the joint, causing an inflammatory response. The bone spurs have often multiplied, causing excruciatin pain. 

Risk Factors for Osteoarthritis

Osteoarthritis is not a disease that arrives out of the blue. There are several risk factors for osteoarthritis, including: 

  • Older age
  • Sex, as women are more likely to develop osteoarthritis
  • Obesity, as extra body weight causes more stress to weight-bearing joints
  • Joint injuries
  • Repeated stress on the joint
  • Genetics
  • Bone deformities. 
  • Certain metabolic diseases. 

Treatment for Osteoarthritis

Treatment for osteoarthritis is wide and varied. Medication, non-invasive interventions and surgical treatments are available. These treatments include: 

  • Acetaminophen
  • NSAIDs (non-steroidal anti-inflammatory drugs)
  • Duloxetine (Cymbalta, also used as an antidepressant, but approved for use with chronic pain, including osteoarthritis pain)
  • Physical therapy
  • Occupational therapy
  • Cortisone injections, which may relieve the pain but can worsen the damage in the joint over time
  • Lubrication injections, which may provide some extra cushioning in the affected joint
  • Realigning bones, in a surgery called an osteotomy which helps shift your body weight away from the affected part of the joint
  • Joint replacement

Lifestyle changes and home remedies can also make a major impact on your quality of life while living with osteoarthritis. These changes include:

  • Losing weight
  • Low-impact exercise, such as swimming
  • Movement therapies, such as tai chi or yoga
  • Heat and cold therapies, to relieve the pain and swelling in the joint
  • Capsaicin, a chili pepper extract applied over an arthritic joint that provides relief for some people
  • Braces or shoe inserts that support your foot and help take some pressure off the affected joint
  • Assistive devices such as a cane
  • TENS, or transcutaneous electrical nerve stimulation, which uses a low-voltage electrical current to relieve pain

On top of lifestyle and home remedies, there are several alternative therapies that may be useful. These include:

  • Acupuncture
  • Glucosamine and chondroitin
  • Avocado-soybean unsaponifiables
  • Omega-3 fatty acids

While osteoarthritis may cause chronic pain, it’s by no means an unmanageable condition. Make sure you speak to your doctor if you worry that you are exhibiting the signs and symptoms of this condition and discuss your treatment plans with a medical professional first. 

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