Osteoarthritis

General Illness Information

Common Name: Osteoarthritis

Medical Term: (Degenerative Arthritis)

Description: Osteoarthritis is a type of arthritis caused by inflammation, breakdown and eventual loss of joint cartilage. Cartilage is a protein substance that serves as a cushion between the bones of the joint.

It is the commonest of all the different types of arthritis and affects over 15 million people in the United States.

Before age 45, osteoarthritis occurs more frequently in males. After age 55, it occurs more frequently in females. It is the leading cause of disability in people over age 65.

It usually affects the hands, feet, spine, and large weight bearing joints such as the hips and knees.

Causes:

  • Primary osteoarthritis is mostly related to aging.
  • Secondary osteoarthritis is caused by another disease or conditions as listed below:
  • Childhood anatomic abnormalities (e.g., congenital hip dysplasia, slipped femoral epiphyses);
  • Obesity- excess weight increases the mechanical stress on the cartilage e.g. as seen in weight lifters;
  • Repeated trauma e.g. osteoarthritis in soccer players;
  • Surgery to joint structures;
  • Hormonal disorders such as diabetes, hyperparathyroidism, gout and Inheritable metabolic disorders (e.g., alkaptonuria, Wilson’s disease, hemochromatosis);
  • Neuropathic arthropathy (Charcot’s joints);
  • Hemophilic arthropathy;
  • Paget’s disease;
  • Noninfectious inflammatory arthritis (e.g., rheumatoid arthritis, spondyloarthropathies);
  • Septic or tuberculous arthritis.

Prevention: For primary osteoarthritis- not known.

For secondary osteoarthritis: Follow up of secondary causes.

Signs & Symptoms

  • Slowly developing joint pain.
  • Pain in the affected joints after repetitive use- pain is usually worse at the end of the day. In severe osteoarthritis ,pain is present even at rest.
  • Stiffness and pain after long periods of rest or  inactivity e.g. sitting in a car for a prolonged period or on awakening in the morning (lasting less than 15 minutes).
  • Decreased range of motion
  • Tenderness usually absent; may be associated with synovitis, with tenderness along joint margin
  • Swelling ,warmth and creaking of the joints (crepitus).
  • Joint deformities e.g. in the knee joints with progressive loss of cartilage – leads to bow legs ( outward curvature of the knees).
  • Arthritis of the spine causes pain in the neck and low back pain. Bony spurs that develop along the arthritic spine can irritate spinal nerves and causes severe pain, numbness and tingling of the affected part of the body.
  • Osteoarthritis of the small joints of the fingers causes bony enlargements at the ends of the fingers and these are called Heberden’s nodes. Bony enlargements  of the middle joint of the finger is called a Bouchard’s node. These may not be painful but are characteristic of osteoarthritis.
  • Osteoarthritis of the joint at the base of the big toe leads to the formation of a bunion.Osteoarthritis of toes and fingers may have a genetic basis and can be found in numerous female members of some families.

Risk Factors

  • Family history.
  • Age over 50.
  • Obesity (weight bearing joints)
  • Prolonged overuse of a joint or group of joints as in certain occupations such as foundry work, coal mining, and bus driving.
  • Injury to a joint and repeated trauma as in certain sports e.g. soccer, and ballet.

Diagnosis & Treatment

Diagnostic tests may include:

  • X-rays-to confirm diagnosis of osteoarthritis. The usual x-ray findings in osteoarthritis are reduced joint space, loss of cartilage, and bone spur formation.
  • blood tests to rule out other forms of arthritis, as there are no blood tests for diagnosing osteoarthritis.
  • arthrocentesis- this involves withdrawing fluid with a sterile needle from the involved joint and sent to the laboratory for analysis. It is useful in excluding gout, infection and other causes of arthritis. Sometimes corticosteroids  may be injected into the joint space during this procedure- and this often helps in reducing inflammation and therefore relieve pain.
  • arthroscopy- This procedure involves an incision through which an arthroscope is inserted into the joint space to check out and repair if necessary any abnormalities and damage to the cartilage and ligaments. Recovery time from arthroscopic surgery is much shorter than from open joint surgery.

General Measures:

  • The goal of treatment in osteoarthritis is to reduce joint pain and inflammation and maintain joint function and mobility. Physiotherapy and occupational therapy are of paramount importance.
  • During an acute flare up , ice compresses and rest will help reduce pain and inflammation. Use of devices such as canes, walkers and splints will help reduce stress on the damaged joint.
  • Weight reduction if obese
  • Heat (local, tub baths, wax baths etc.)
  • Assessment of daily activities by an occupational therapist, and recommendation of additional devices to help patient cope at home and work with reduced stress on the affected joints.

Medications:

  • Acetaminophen for relief of pain. If not effective, non-acetylated salicylates or low dose ibuprofen £ 1600 mg/d.
  • Other NSAIDs can be used and have similar efficacy. Their prolonged use is associated with significant side effects, especially in the elderly. Since pain in osteoarthritis varies from day to day brief courses of a short acting NSAID are preferable.
  • A new class of NSAIDs referred to as cyclo-oxygenase-2 ( COX-2) specific inhibitors have recently become available. They are less likely to cause stomach ulcers and they work as well as the nonspecific NSAIDs in reducing arthritis inflammation and pain. They are currently much more expensive than the conventional NSAIDs.
  • All the above medications are for symptom relief but do not alter or modify course of the disease. More recent studies have shown that Glucosamine sulphate ( classified as a a dietary supplement) is the only product on the market that actually restores the damaged cartilage in osteoarthritis and helps reduce inflammation and pain and increases joint mobility. Glucosamine sulphate ,combined with additional enhancing  herbs, namely, Devil’s claw, Circuma Longa and Chondroitin sulphate (Osteonutrix), not only relieves the discomfort of osteoarthritis, but has also been shown to modify the disease process.

Intra-articular Injections:

Cortisone– Cortisone injection given into an inflamed joint can rapidly decrease pain and increase mobility. Repetitive injections of cortisone can be harmful and therefore this treatment is reserved for patients with pronounced symptoms.

Hyaluronic Acid preparation (e.g. Synvisc)–When injected into a joint acts like a lubricant and may help relieve symptoms and increase function in some patients. Benefit from this injection may last 6 to 9 months.

Surgery: reserved for people with severe symptoms and not responding to conservative management. Various surgical procedures are listed below: Arthroscopy:- for cartilage repair and debridement and removal of loose bodies in the joint space. Osteotomy:- excision of bone to realign the deformity  e.g. correction of “bow legs” in patients with osteoarthritis of the knees. Arthrodesis- fusion of a joint that is severely degenerated and is therefore very painful. Arthroplasty:- Replacement with an artificial joint (e.g. total hip and knee replacement).

Activity: As active as tolerated

Diet: No special diet

Possible Complications:

  • Gastrointestinal bleeding, decreased renal function on NSAIDs or acetyl salicylic acid;
  • Infection or accelerated cartilage loss with intra-articular corticosteroids.

Prognosis

  • Osteoarthritis tends to be progressive:
  • Early in course, pain relieved by rest; later, pain may occur at rest and at night;
  • Joint effusions may occur, especially in knees;
  • Joint enlargement occurs later in course due to bony enlargement;
  • Osteophyte (spur) formation, especially at joint margins, as disease progresses;
  • Advanced stage with full thickness loss of cartilage down to bone.

Other

Nothing specified.

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