Osteoarthritis

Answer 1

Definition

Osteoarthritis (OA) is the most common joint disorder.

Alternative Names

Hypertrophic osteoarthritis; Osteoarthrosis; Degenerative joint disease; DJD; OA; Arthritis - osteoarthritis

Causes, incidence, and risk factors

In osteoarthritis, the cushioning (cartilage) between the bones wears away in the joints. As osteoarthritis gets worse, the cartilage disappears and bone rubs on bone. Bony spurs or growths usually form around the joint. The ligaments and muscles around the joint loosen and become weaker.

Often, the cause of OA is unknown. It is mainly related to aging, but other factors can also lead to OA.

• Osteoarthritis tends to run in families
• Being overweight increases the risk
• Fractures or other joint injuries can lead to osteoarthritis later in life
• Long-term overuse at work or in sports can lead to osteoarthritis

Medical conditions that can lead to osteoarthritis include:

• Bleeding disorders that cause bleeding in the joint, such as hemophilia
• Disorders that block the blood supply near a joint, such as avascular necrosis
• Other types of arthritis, such as chronic gout, pseudogout, or rheumatoid arthritis

The symptoms of osteoarthritis usually appear in middle age and almost everyone has them by age 70. Before age 55, the condition occurs equally in men and women. After age 55, it is more common in women.

Symptoms

The symptoms of osteoarthritis include:

• Deep aching joint pain that gets worse after exercise or putting weight on it, and is relieved by rest
• Pain that is worse when you start activities after a period of no activity
• Over time, pain is present even when you are at rest
• Grating of the joint with motion
• Increase in pain during humid or moist weather
• Joint swelling
• Limited movement
• Muscle weakness around arthritic joints

Some people might not have symptoms.

Signs and tests

A physical exam can show:

• Joint movement may cause a cracking (grating) sound
• 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 osteoarthritis.

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

The goals of treatment are to:

• Increase the strength of the joints
• Maintain or improve joint movement
• Reduce the disabling effects of the disease
• Relieve pain

The treatment depends on which joints are involved.

MEDICATIONS

Over-the-counter pain relievers can help with symptoms. Most doctors recommend acetaminophen (Tylenol) first, because it has fewer side effects than other drugs.

If your pain continues, your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs help relieve pain and swelling. Types of NSAIDs include aspirin, ibuprofen, and naproxen.

However, long-term use of NSAIDs can cause stomach problems, such as ulcers and bleeding. These drugs may also increase the risk for heart attacks and strokes.

The prescription drug, Celebrex (a COX-2 inhibitor) may work as well as other NSAIDs. Because of a risk for heart attacks and stroke, it is given only at the lowest possible dose for the shortest possible period of time.

Corticosteroids injected right into the joint can also be used to reduce swelling and pain. However, relief only lasts for a short time.

Many people use over-the-counter remedies such as glucosamine and chondroitin sulfate. There is some evidence that these supplements can help control pain, although they do not seem to grow new cartilage. Some doctors recommend a trial period of 3 months to see whether glucosamine and chondroitin work.

Capsaicin (Zostrix) skin cream may help relieve pain. You may feel a warm, stinging sensation when you first apply the cream. This sensation goes away after a few days of use. Pain relief usually begins within 1 - 2 weeks.

Artificial joint fluid (Synvisc, Hyalgan) can be injected into the knee. It may relieve pain for 3 - 6 months.

LIFESTYLE CHANGES

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
• Eating a healthy, balanced diet
• Getting rest
• Losing weight if you are overweight
• Protecting the joints

People whose work is causing stress in certain joints should find ways to reduce trauma. You may need to adjust the work area or change work tasks.

PHYSICAL THERAPY

Physical therapy can help improve muscle strength and the motion at stiff joints. Therapists have many techniques for treating osteoarthritis. If therapy does not make you feel better after 3 - 6 weeks, then it likely will not work at all.

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.

SURGERY

Severe cases of osteoarthritis might need surgery to replace or repair damaged joints. Surgical options include:

• Arthroscopicsurgery 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 arthroplasty, hip arthroplasty)

Support Groups

For more information and support, see arthritis resources.

Expectations (prognosis)

Your movement may become very limited. Treatment generally improves function.

Complications

• Adverse reactions to drugs used for treatment
• Decreased ability to perform everyday activities, such as personal hygiene, household chores, or cooking
• Decreased ability to walk
• Surgical complications

Calling your health care provider

Call your health care provider if you have symptoms of osteoarthritis.

Prevention

Weight loss can reduce the risk of knee osteoarthritis in overweight women.

References

Gregory PJ, Sperry M, Wilson AF. Dietary supplements for osteoarthritis. Am Fam Physician. 2008;77:177-184.

Hunter DJ. In the clinic: Osteoarthritis. Ann Intern Med. 2007;147(3):ITC8-1-ITC8-16.

Answer 2

Osteoarthritis is the most common form of arthritis and is associated with the aging process. Osteoarthritis is a chronic disease causing the deterioration of the cartilage within a joint.

For most people, the cause of osteoarthritis is unknown, but metabolic, genetic, chemical, and mechanical factors play a role in its development. Symptoms of osteoarthritis include loss of flexibility, limited movement, and pain and swelling within the joint. The condition results from injury to the cartilage, which normally absorbs stress and covers the bones, so they can move smoothly.

The cartilage of the affected joint is roughened and becomes worn down. As the disease progresses, the cartilage becomes completely worn down and the bone rubs on bone. Bony spurs usually develop around the margins of the joint.

Part of the pain results from these bone spurs, which can restrict the joint's movement as well.

Reviewed By

Review Date: 09/26/2011

Ariel D. Teitel, MD, MBA, Clinical Associate Professor of Medicine, NYU Langone Medical Center. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Answer 3

Definition

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

Alternative Names

Hypertrophic osteoarthritis; Osteoarthrosis; Degenerative joint disease; DJD; OA; Arthritis - osteoarthritis

Causes, incidence, and risk factors

Osteoarthritis is a normal result of aging. It is also caused by 'wear and tear' on 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.

Often, the cause of OA is unknown. It is mainly related to aging.

The symptoms of OA usually appear in middle age. Almost everyone has some symptoms by age 70. However, these symptoms may be minor.

Before age 55, OA occurs equally in men and women. After age 55, it is more common in women.

Other factors can also lead to OA.

• 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 put you at the highest 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 increase the risk of arthritis.

Medical conditions that can lead to OA include:

• Bleeding disorders that cause bleeding in the joint, such as hemophilia
• Disorders that block the blood supply near a joint and lead to avascular necrosis
• Other types of arthritis, such as 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 and when you put weight or pressure on the joint.

If you have osteoarthritis, your joints probably become stiffer 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 in the morning. 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're 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 exam can show:

• 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 fewer 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 that you may use 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
• Eating a healthy, balanced diet
• Getting rest
• Losing 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 tasks.

PHYSICAL THERAPY

Physical therapy can help improve muscle strength and the motion of stiff joints, as well as your sense of balance. Therapists have many techniques for treating OA. If therapy does not make you feel better after 6 - 8 weeks, then it 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 TREATMENTS

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.

S-adenosylmethionine (SAMe, pronounced "Sammy") is a man-made form of a natural byproduct of the amino acid methionine. It has been marketed as a remedy for arthritis, but scientific evidence to support these claims is lacking.

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)

Support Groups

For more information and support, see arthritis resources.

Expectations (prognosis)

Every person with OA is different. Pain and stiffness may prevent one person from performing simple daily activities, while others are able to maintain an active lifestyle that includes sports and other activities.

Your movement may become very limited over time. Doing everyday activities, such as personal hygiene, household chores, or cooking may become a challenge. Treatment usually improves function.

Complications

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

Calling your health care provider

Call your health care provider if you have symptoms of OA that get worse.

Prevention

Try not to overuse a painful joint at work or during activities.

References

Gregory PJ, Sperry M, Wilson AF. Dietary supplements for osteoarthritis. Am Fam Physician. 2008;77:177-184.

Hunter DJ. In the clinic: Osteoarthritis. Ann Intern Med. 2007;147(3):ITC8-1-ITC8-16.

Hunter DJ, Lo GH. The management of osteoarthritis: an overview and call to appropriate conservative treatment. Med Clin North Am. 2009;93:127-43, xi.

Richmond J, Hunter D, Irrgang J, et al. Treatment of osteoarthritis of the knee (nonarthroplasty). J Am Acad Orthop Surg. 2009;17:591-6000.

Bijlsma JW, Berenbaum F, Lafeber FP. Osteoarthritis: an update with relevance for clinical practice. Lancet. 2011;377:2115-2126.

Reviewed By

Review Date: 09/26/2011

Ariel D. Teitel, MD, MBA, Clinical Associate Professor of Medicine, NYU Langone Medical Center. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Answer 4

Hello, I see you are asking " What are the symptoms for osteoarthritis?"The main symptoms of osteoarthritis are pain and stiffness in your joints, which can make it difficult to move the affected joints and do certain activities.

joint tenderness.

increased pain and stiffness when you have not moved your joints for a while.

joints appearing slightly larger or more "knobbly" than usual.

orthopedicshealth. com/condition/osteoarthritis/c/31204