Diseases

Osteoarthritis

Osteoarthritis (OA) is the most common type of arthritis. It is caused by the breakdown of cartilage in the joints.

When the cartilage in a joint begins to break down, it results in swelling and pain in the joint. As cartilage continues to wear away, bones begin to rub against each other. This bone-on-bone contact causes stiffness, swelling, and pain in the joint.

Osteoarthritis is a degenerative form of arthritis and is a chronic (long-term) disease. Because this disease is caused by wearing away of the cartilage, more people develop it as they age.

Who Gets Osteoarthritis

Osteoarthritis usually occurs in people aged 50 years or older and is more common in women than in men.

This type of arthritis can sometimes run in families, especially when it affects the small joints in the hands.

Other risk factors for the disease include age, being overweight, excessive use of a joint, and suffering a serious injury to a joint.

People who are overweight are at higher risk of getting osteoarthritis in their weight-bearing joints such as the knees, hips, and the joints in their feet.

Understanding Osteoarthritis

Symptoms

The most common symptom of Osteoarthritis is joint pain and stiffness. It usually starts slowly and gets worse with time. Many patients don’t notice it at first.

Different people tend to show different symptoms. They can experience varying levels of discomfort and reduced joint mobility. In some people, joint pain and stiffness caused by the disease can reduce the quality of sleep and lead to fatigue.

Joints that are commonly affected by osteoarthritis include the knees and the hips. Other joints can also be affected. These frequently include the:

  • End joints or middle joints of fingers
  • Base of the thumb
  • Base of the big toe (this can form a bunion)
  • Neck
  • Low back (this is also known as degenerative disc disease)

In people with osteoarthritis, affected joints can feel stiff after a period of rest or when they wake up in the morning. The morning stiffness usually lasts only 20 to 30 minutes, until the joints get “worked out”.

Joint pain is usually worse after people with osteoarthritis use their affected joints, and it gets better after the joints are rested for a period of time. When the disease is more severe, the pain can continue throughout the day, even after periods of rest.

Osteoarthritis can also cause swelling of the joints. This can reduce the joints’ flexibility, and can cause a loss of strength.

Diagnosis

Osteoarthritis is diagnosed by a thorough assessment and physical examination by a physician familiar with the disease. Many family physicians are very comfortable making this diagnosis.

Following an initial assessment, patients may also be sent for x-rays and blood tests to confirm the diagnosis.

Common Tests to Diagnose Osteoarthritis

Scans

X-Rays are one of the best tests to diagnose osteoarthritis because the changes in joints caused by osteoarthritis can often be easily identified in x-ray images.

The tell-tale signs of osteoarthritis are very well described, and are easily recognizable by trained physicians.

Blood Tests

Blood tests to rule out other conditions: It is sometimes difficult to distinguish osteoarthritis from other forms of arthritis because there are about 100 different types of the disease. Blood tests help rule out other diagnoses.

Causes

Osteoarthritis occurs when the cartilage at the ends of the bones wear down. Cartilage helps protect the ends of the bones by working as a shock absorber for joints. It also helps them move smoothly. The reason that cartilage wears down is not well understood.

When cartilage starts to wear away, the ends of the bones in a joint may come into contact with one another (“bone on bone”). This can cause inflammation of the affected joints.

The word inflammation comes from the Latin word inflammare which means to light on fire. In people with osteoarthritis, inflammation causes the joints to become warm, swollen, and painful. Affected joints can feel like they’re on fire.

When joints are inflamed, the body tries to repair itself by growing new bone. It is thought that this is the body’s attempt to strengthen the damaged joint. Unfortunately, this part of the body’s healing process doesn’t work well for osteoarthritis. It can result in the formation of nodes, or bumps of new bone growth around the joint. This occurs most commonly when joints in the hands are affected by the disease. The inflammation and nodes can cause joint stiffness and pain.

Age is a significant risk factor for osteoarthritis. Although it can occur at any age, people aged 50 and over have experienced more wear and tear on the cartilage in their joints and are more likely to get the disease. Women are more likely to get the disease than men, but it is not understood why.

People who are overweight also have a higher chance of developing osteoarthritis, especially in weight-bearing joints like the knees, hips, and feet. Even a little bit of weight loss (as few as 10 lbs or 4.5 kg) can make a big difference for people with osteoarthritis in these joints.

People who have had a serious injury to a joint have a higher chance of eventually getting osteoarthritis in that joint. This is thought to be the result of damage to the cartilage itself or to the way the joint moves. This explains why osteoarthritis is common among former professional athletes and people who may have injured their joints in their line of work.

Osteoarthritis can sometimes run in families, especially when it affects joints in the hands. The reason for this is not well understood. Experts think it may have something to do with the shape of bones and how they fit together, or it may be related to the body’s ability to repair damage to joints.

Treatments

Most medications for osteoarthritis are geared towards pain control. They can help make living with the disease much more comfortable and help to improve function and mobility. A mixed or multimodalapproach that combines different treatments is common for patients with osteoarthritis.

Possible medications include analgesics and opioids (pain killers), Non-Steroidal Anti-Inflammatory Drugs to reduce inflammation, and corticosteroid injections for pain and swelling. Unfortunately, no medications exist that have been shown to alter the progression of osteoarthritis. Once a joint is damaged, there is nothing patients can take to undo or repair it.

The goal of these treatments is to keep the joints as healthy as possible for as long as possible. It is important to help keep the joints moving smoothly to help decrease joint pain and reduce limitations in mobility and functioning.

Medications for Osteoarthritis

Analgesics

Non-prescription analgesic medications such as acetaminophen or paracetamol can be effective in controlling pain in some people with osteoarthritis. It has been shown to be safe when used for long periods of time. This type of medication can only control pain. It does nothing to control the disease or to prevent further joint damage.

Non-Steroidal Anti-Inflammatory Drugs

Non-Steroidal Anti-Inflammatory Drugs or NSAIDs are medications that reduce the inflammation in joints caused by osteoarthritis. They also help to reduce symptoms such as pain. There are about 20 different anti-inflammatory medications available. If one doesn’t work for a particular patient, there are lots of other options for them to try.

Corticosteroid Injections

Some patients benefit from cortisone injections directly into a joint. This type of treatment can reduce the pain and swelling in joints affected by osteoarthritis. It can take up to 24 or 48 hours to feel the effects of a corticosteroid injection. Once the effects set in, they can last for a few days up to a few months; it depends on the individual person and the joint. Corticosteroid injections are usually limited to 3 or 4 in a single joint per year.

Opioids

When non-prescription analgesics and Non-Steroidal Anti-Inflammatory Drugs are not enough to control joint pain caused by osteoarthritis, stronger medicines called opioids may be used. While opioids can be very effective at controlling pain, they should be used with caution because they can cause dependence and have been associated with drug abuse. Examples of opioids include codeine, morphine, and oxycodone.

Physiotherapy

A trained arthritis physiotherapist can design a program of exercise and stretching that can help improve joint pain and stiffness. They can also provide education about joint protection to prevent further damage.

Weight Loss Therapy

Losing weight, even as few as 10 pounds (4.5kg), is another treatment option that can improve osteoarthritis in weight-bearing joints.

Surgery (Joint Replacement)

Surgery is an option in severe, advanced cases where a patient’s joints lose their ability to function and it is necessary to improve mobility, restore functioning, and enhance quality of life.

It is arguably the most effective form of treatment for osteoarthritis. Surgery usually involves replacing a damaged joint with an artificial joint, most commonly the hip or knee.

While surgery has revolutionized the treatment of osteoarthritis, it is also associated with potential risks. Patients should talk to their doctor to find out if surgery is right for them.