(ĐTĐ) - Osteoarthritis, or degenerative joint disease, is the most common type of arthritis. It is associated with the breakdown of a joint's cartilage. Cartilage is a firm, rubbery material that covers and cushions the ends of bones in normal joints. Its main function is to reduce friction in the joints and serve as a "shock absorber."
Osteoarthritis causes the cartilage in a joint to become stiff and lose its elasticity, making it more susceptible to damage. Over time, the cartilage may wear away in some areas, greatly decreasing its ability to act as a shock absorber. As the cartilage wears away, tendons and ligaments stretch, causing pain. If the condition worsens, the bones could rub against each other, causing even more pain and loss of movement.
OA is most common in middle-aged and older people, and its symptoms can range from very mild to very severe. The disorder most often affects hands and weight-bearing joints such as knees, hips, feet and the back, but can affect almost any joint in the body. Women are more commonly affected than men.
Symptoms of Osteoarthritis
Symptoms of osteoarthritis include:
Joint aching and soreness, especially with movement
Pain after overuse or after long periods of inactivity
Bony enlargements in the middle and end joints of the fingers. These enlargements may or may not be painful.
What Causes Osteoarthritis?
There are many factors that can increase a persons chance of developing OA, including:
Obesity. Maintaining an ideal weight or losing excess weight may help prevent osteoarthritis of the knees and hips. Weight loss or maintenance also can decrease OAs rate of progression once the disease is established.
Injury. People with joint injuries due to sports, work-related activity, or accidents may be at increased risk of developing OA. For example, athletes with knee-related injuries may be at higher risk of developing osteoarthritis of the knee. In addition, people who have had a severe back injury may be predisposed to develop osteoarthritis of the spine. People who have had a broken bone near a joint are prone to develop osteoarthritis in that joint.
Heredity. Some people have an inherited defect in one of the genes responsible for making cartilage. This causes defective cartilage, which leads to more rapid deterioration of joints. People born with joint abnormalities are more likely to develop osteoarthritis, and those born with an abnormality of the spine (such as scoliosis, a curvature of the spine) are more likely to develop osteoarthritis of the spine.
Joint Overuse. Overuse of certain joints increases the risk of developing OA. For example, people in jobs requiring repeated bending of the knee are at increased risk for developing OA of the knee.
Age. Although age is a risk factor, research has shown that OA is not an inevitable part of aging.
Doctors make a diagnosis of OA based on a physical exam and history of symptoms. The diagnosis of osteoarthritis is based on a combination of the following factors:
A description of symptoms
The location and pattern of pain
Certain findings in a physical examination
X-rays may be used to confirm a diagnosis and to make sure that no other type of arthritis is present. Most people over age 60 reflect the disease on X-ray; about a third of patients have actual symptoms.
Sometimes blood tests are administered. While blood tests cannot point to anything in particular that can help a doctor confirm the presence of OA, the tests can help the doctor determine the presence of a different type of arthritis.
If fluid has accumulated in the body's joints, the doctor may remove some of the fluid with a process called joint aspiration and may examine the fluid under a microscope to rule out other diseases.
The treatment of OA focuses on decreasing pain and improving joint movement. The following treatments are available.
Over the counter pain-relieving medications: These including acetaminophen (Tylenol, for example) and painkillers (often called NSAIDs), such as aspirin, ibuprofen, or naproxen. Some medications in the form of creams, rubs, or sprays may be applied over the skin of affected areas to relieve pain.
Synvisc, Supartz and Hyalgan: These medications can be given as a series of three to five weekly injections to relieve pain in some people with osteoarthritis.
Narcotics: Stronger pain pills, such as narcotics, may be prescribed when osteoarthritis pain is severe and other treatments are not working.
Joint protection devices: These can prevent strain or stress on painful joints.
Hot or cold compresses: These treatments may be given in the form of a hot shower or bath, or by applying heating pads or cold compresses.
Surgery: When other treatment options have failed, some people may need surgery to relieve chronic pain in damaged joints.
Weight control: Losing weight can prevent extra stress on weight-bearing joints.
Exercise: Physical activity can improve joint movement and strengthen the muscles that surround the joints. Gentle exercises, such as swimming or walking on flat surfaces, are recommended because they create less stress on joints. Activities that increase joint pain (jogging, high-impact aerobics, etc.) should be avoided.
Alternative Therapy: Acupuncture and bioelectric therapy may be able to provide some pain relief. Some medical research has shown that the supplements glucosamine and chondroitin can relieve pain in some people with osteoarthritis, especially in the knee. In addition, there is evidence that these supplements can help rebuild some cartilage. Some people also use methylsulfonylmethane (MSM) for arthritis, but there is less medical evidence showing its benefits. MSM is a naturally occurring sulfur that is taken as a dietary supplement.
How Does Weight and Exercise Impact Osteoarthritis?
Staying at your recommended weight helps prevent osteoarthritis of the knees, reduces the stress on weight-bearing joints and reduces pain in affected joints. Once you have osteoarthritis, losing weight also can relieve the stress and pain in your knees.
Exercise is important to improve joint movement and to strengthen the muscles that surround the joints. Gentle exercises, such as swimming or walking on flat surfaces, are recommended because they are less stressful on your joints. Avoid activities that increase joint pain, such as jogging or high impact aerobics. Exercises that strengthen the quadriceps muscle reduce knee pain in patients with osteoarthritis.
Are There Alternative Treatments for Osteoarthritis?
Some medical research has shown that the supplements glucosamine and chondroitin may relieve pain in some people with osteoarthritis -- especially in the knee. There is no evidence that glucosamine can help rebuild cartilage.
Some people also use methylsulfonylmethane (MSM) and S-adenosylmethionine (SAM-e) for arthritis but there is questionable medical evidence showing their benefits. MSM is a naturally occurring compound that is taken as a dietary supplement.
Acupuncture and bioelectric therapy also may be useful at relieving pain.
What Supportive Devices Are Available to Help With Osteoarthritis?
Supportive or assistive devices may be helpful to decrease pressure on the joints with osteoarthritis. Knee supports may be helpful for some people to stabilize the ligaments and tendons and decrease pain. Canes or crutches may be helpful to take pressure off certain joints.
In addition to pain relief, assistive devices improve function and prevent falls. A licensed physical therapist or other health care professional is needed to recommend what devices are best for you.
Is There a Surgery for Osteoarthritis?
When osteoarthritis pain is not controlled with medications and the other mentioned treatments, or when the pain prevents you from participating in your normal activities, you may want to consider surgery.
There are several types of surgery for osteoarthritis. They include:
Arthroscopy to clean out the damaged cartilage has not been proven in recent studies to be effective for osteoarthritis.
Joint replacement surgery to replace the damaged joint with an artificial one. Joint replacement surgery should be considered when the severity of the joint pain significantly interferes with a person’s function and quality of life. Even under the best of circumstances, surgery cannot return the joint to its normal state (artificial joints do not have all of the motion of a normal joint). However, an artificial joint will diminish pain. The two joints most often replaced are the hip joint and the knee joint. Artificial joints are now also available to replace shoulders, fingers, elbows, ankles, and back joints to treat severe pain that has not responded to other treatments.
Joint fusion removes the damaged joint and fuses the two bones on each side of the joint. This is done more often in areas in which joint replacement is not effective.
Talk to your doctor to determine if any of these treatment options are right for you.