Osteoarthritis

Osteoarthritis (OA)

By Lori Montgomery, MD, CCFP

Introduction

Arthritis (say: ar-THRIE-tis) means "pain in the joints". It is a very general description that applies to more than 100 specific disorders. Osteoarthritis (or OA for short) is one of the most common of these. It affects about one in ten people. This disease affects the cartilage. Cartilage is the smooth, tough, elastic material that normally acts as a shock absorber between the bones in a joint. The cartilage becomes thin and rough, and does not protect the bones as well. To protect themselves, the ends of the bones then become thicker, and can develop bumps, or bone spurs.

Signs and symptoms

  • slow development of joint pain: often in weight-bearing joints such as hips, knees, and feet
  • pain that may affect the hands and fingers as well. Other joints are most often not affected unless they have been injured before.
  • heat and swelling around the joint
  • stiffness or a decreased range of motion in the joint
  • weakness of the muscles around the joint
  • grating or crackling noise (or sensation) in the joint as the bone moves over the rough cartilage

Causes

The cause of OA is not known for certain. There is a genetic component. This means you are more likely to get arthritis if your parents had it. However, there are other factors as well. If you are overweight, there is more stress placed on your weight-bearing joints, which adds to OA. Also, if you injured the joint before, or have another medical condition that places unusual strain on the joint, OA can develop quicker.

Diagnostic tests

The diagnosis of OA is most often made based on how you describe your symptoms and a physical exam, sometimes also with X-rays. Blood tests may be needed to rule out other kinds of arthritis. In some cases, fluid from inside the joint will be tested.

Treatment approach

Medicines

  • For mild to moderate pain, acetaminophen (Tylenol) is often the first step.
  • Anti-inflammatory medicines may be prescribed for more lasting or more severe pain.
  • Topical creams or gels are available over-the-counter and may be useful when used with other treatments.
  • Stronger opioid medicines can sometimes be used for severe pain.
  • Cortisone is a hormone that naturally exists in the body. Corticosteroids are based on this hormone, and can be injected into the joint to relieve pain. However, this should not be done too often, because it can cause further damage to the joint
  • Viscosupplementation is a specific therapy for OA of the knee. A gel is injected into the knee joint, which helps cut down on friction and reduce pain.
  • Some authorities recommend glucosamine, chondroitin, and methylsulfonylmethane (MSM) for osteoarthritis. There is less research evidence for these agents than for some other medicines. The current evidence seems to suggest that over the long term (several months), many people experience some relief by taking them.

Exercise

The muscles around an affected joint become weak very quickly when they are not used. A good exercise program of light weight-bearing activity (like swimming, walking, or using an elliptical machine) can help to strengthen these muscles, reduce pain, and slow down the damage to the joint. A number of different health care providers have expertise to create an activity program without flaring pain.

Weight loss

Losing weight -- even as little as 10 pounds (4.5 kilograms) - can reduce strain on the joint and decrease pain as well. Using a cane or a brace for the joint is another way to redistribute the weight that a joint has to carry, which can also help.

Ice or heat

Many people find ice or heat applied to the joint to be helpful.

Non-drug therapies

Studies have shown that non-drug therapies can help to reduce pain levels and enhance pain coping. These include:

  • relaxation
  • meditation
  • activity pacing
  • cognitive behavioural therapy

These self-management strategies can help you to improve your function so you can do more and enjoy life more.

Surgery

In time, surgery may be required for advanced arthritis. Sometimes, a surgeon can simply clean torn pieces of cartilage out of the joint, which can improve function. If needed, joint reconstructions or replacements can work very well to improve mobility and decrease pain. Still, the new joint lasts a certain amount of time (perhaps 10 to 20 years, depending on how active you are). Then it needs to be replaced again. This is why this surgery should be delayed as long as possible.

For more information

Web sites

Arthritis Foundation
www.arthritis.org

The Arthritis Society
www.arthritis.ca

American College of Rheumatology
www.rheumatology.org

Public Health Agency of Canada (Arthritis)
www.phac-aspc.gc.ca/ccdpc-cpcmc/topics/musc-arthritis_e.html

National Institutes of Health (Osteoarthritis)
www.health.nih.gov/topic/osteoarthritis

References

Brady OH, Masri BA, Garbuz DS, Duncan CP. Rheumatology: 10. Joint replacement of the hip and knee - when to refer and what to expect. Canadian Medical Association Journal. 2000;163:1285-1291.

Conaghan PG, Dickson J, Grant RL. Care and management of osteoarthritis in adults: Summary of NICE guidance. British Medical Journal. 2008;336:502-503.

Rashiq S, Schopflocher D, Taenzer P, Jonsson E, (eds). Chronic pain: A health policy perspective. Wiley Blackwell, 2008.