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Osteoarthritis (OA), also known as arthrosis or
degenerative joint disease, is a disease featuring pain and impaired function of
the joints. It is the most common form of
arthritis. While inflammation
contributes to osteoarthritis process, the main cause is "wear and tear" to the synovium (joint lining). Treatment
for osteoarthritis is with non-steroidal anti-inflammatory drugs
(NSAIDs), local injections with glucocorticoids and with joint replacement
surgery. There is no cure for osteoarthritis.
Osteoarthritis Signs and Symptoms
The main symptoms of Osteoarthritis are pain and
restricted movement. The pain is chronic pain or gives varying amounts of
discomfort when standing and walking. Pain is generally described as aching,
sharp, or a burning sensation in the associated muscles and tendons, and
includes loss of mobility and often stiffness. Humid weather increases the pain
in many osteoarthritis patients. Osteoarthritis patients can experience muscle spasm and contractions in the
tendons. Osteoarthritis can cause a crackling noise (called crepitus) when moved
or palpated. Occasionally, affected joints may fill with fluid. Some develop
Heberden's nodes in the fingers when these are affected.
Osteoarthritis Diagnosis
The joints mainly affected by osteoarthritis are
the hip joints and the knee joints, although in theory any joint in the body can
be affected. Osteoarthritis can affect the fingers, the spine, and the shoulder.
The diagnosis is made on the basis of the
history, physical examination (restricted movement, crepitations) and X-rays of
the joints. Occasionally, MRI (magnetic resonance imaging) may be required to
examine the extent of the damage, especially in the spine. Imaging techniques
can reveal damaged cartilage, loss of joint space, or bone spurs indicating the
presence of osteoarthritis.
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Pathophysiology of
Osteoarthritis
The crucial factor in the development of
osteoarthritis is the disappearance of synovium and later all cartilage of
affected joints. An inflammatory reaction, local resorption of bone and
formation of osteophytes (bone processes) play a role. The patient experiences
joint pain upon weight bearing, like walking and standing, as the bone surfaces are
now unprotected by cartilage. Due to decreased movement (because of the
joint pain),
regional muscles may atrophy and ligaments may become more lax.
Osteoarthritis results from a combination of
genetic predisposition and joint injuries. Contributing factors include
congenital hip luxation (which is genetically determined), obesity,
osteoporosis, and inflammatory diseases such as Perthes' disease and all chronic
forms of arthritis (e.g. rheumatoid arthritis and gout).
As it progresses, joints appear larger, are stiff
and painful and usually feel worse the more they are used throughout the day,
which distinguishes it from rheumatoid arthritis.
Mild cases are treated with nonsteroidal
anti-inflammatory drugs (NSAIDs). These include acetaminophen (paracetamol) -
which mainly reduces the joint pain - and agents such as diclofenac, ibuprofen and
naproxen. High doses are often required. All NSAIDs act by inhibiting the
formation of prostaglandins, which play a central role in inflammation and pain.
Unfortunately, there is an increased risk of peptic ulceration with earlier NSAIDs. COX-2 selective inhibitors (such as valdecoxib, celecoxib, and the
withdrawn rofecoxib) reduce this risk substantially.
Topical osteoarthritis treatments are effective in treating pain
associated with arthritis. Creams and lotions containing capsaicin are effective
in relieving arthritic pain. They are especially useful for patients in whom NSAIDs are contraindicated, or where these cause intolerable side-effects.
Severe pain in specific joints can be treated
with local injections with lidocaine (or similar local anaesthetics) and
glucocorticoids (such as hydrocortisone). If the above management is
ineffective, surgery (joint replacement) may be required. Individuals with very
painful osteoarthritic joints may require surgery such as fragment removal,
repositioning bones, or fusing bone to increase stability and reduce pain. For
severe pain, narcotic pain relievers such as tramadol and eventually opioids (hydrocodone,
oxycodone or morphine) may be necessary; this is reserved for very severe cases
and is rarely necessary.
The substances glucosamine and chondroitin
sulphate have recently been shown to improve symptoms of osteoarthritis.
However, recent evidence shows that glucosamine is not effective in treating
osteoarthritis of the knee (McAlindon et al 2004). Another nutritional
supplement showing promise is S-adenosyl-methionine. Small scale studies have
shown it to be as effective as NSAIDs in reducing pain although it takes about
four weeks for the effect to take place.
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Coping with Osteoarthritis
Assistive devices may be useful in maintaining
mobility. In the case of osteoarthritis of the knees, knee braces, a cane, or a
walker can be a helpful aid for walking and support. Regularly exercise, if
possible, in the form of walking or swimming, is encouraged.
Weight loss can
delay progression. Cold or heat therapy benefits some patients, as do relaxation
techniques.
Dealing with chronic pain can be difficult and
result in depression.
Communicating with others with osteoarthritis is
helpful, as is maintaining a positive attitude. People who take control of their
treatment, communicate with their doctor, and actively manage their arthritis
experience less pain and function better. Epidemiology of Osteoarthritis |
