Osteoarthritis: an Overview

What is Arthritis?

Arthritis is a common affliction. Half of all adults will develop it in at least one knee during their lifetimes, it’s the leading cause of disability in adults, and research indicates that degenerative arthritis is becoming increasingly prevalent in all age groups. But even those who suffer from the condition may not understand exactly what it is.

Essentially, arthritis is inflammation of a joint. Any of the components that go to make up the joint can be affected. These include cartilage, bones, joint lining, and supportive tissues. The inflammation can produce stiffness, joint pain, and swelling among other symptoms and affect only one joint or several. Arthritis symptoms can vary considerably from one person to the next, but it’s a good idea to be on the lookout for the following:

Arthritis Symptoms

• Pain that gets worse with activity and better with rest.
• Reflective pain (AKA referred pain.) This is soreness that shows up in a place that isn’t the actual locus of the arthritis but is related to it. For example, arthritis of the hip can produce soreness in the knee and anterior thigh.
• Stiffness after inactivity or upon waking up that goes away after an hour or so.
• Joint swelling. This results from a build-up of fluid.
• Bone cracking or popping (AKA crepitus.) This happens because the individual has developed bone spurs.

What is Osteoarthritis?

Osteoarthritis (AKA OA or degenerative arthritis) is a common type of arthritis. It is a consequence of a breakdown of cartilage, the cushioning tissue found at the end of bones. Cartilage provides a low-friction surface that facilitates joint movement and keeps one bone from rubbing directly on another.

It’s natural for cartilage to get thinner with age, and in and of itself, this won’t necessarily lead to osteoarthritis. But overuse, trauma, improper alignment, genetics, and impaired biochemical and cellular processes can all contribute to the condition.

Doctors classify osteoarthritis based on whether the cause is unknown or known. In primary osteoarthritis, it’s unknown, and arthritis symptoms progress slowly over a number of years. In secondary osteoarthritis, doctors can identify a specific triggering incident (like injury), and the condition is likely to progress more rapidly.

In either case, hands, spines, hips, and knees are the joints most commonly affected, and OA progresses through four stages.

Stages of Osteoarthritis

In Stage One, there’s minor bone spur growth, but the patient generally isn’t experiencing any pain as yet.

In Stage Two, X-rays reveal the bone spurs have grown larger, but in all likelihood, the cartilage is still of a healthy thickness, and so the spacing of bones remains normal. The patient also retains sufficient synovial fluid to facilitate normal joint motion. Still, the individual may begin experiencing symptoms like pain after a long day of exertion, stiffness in a joint that’s gone unused for several hours, or tenderness when bending, kneeling, or climbing stairs.

In Stage Three, there’s obvious cartilage damage, and the spacing between bones is becoming narrower. Patients are likely to experience frequent joint pain and possibly even swelling when using the joint and stiffness after sitting for an extended period of time or upon waking up.

In Stage Four, patients experience severe pain when attempting to use the joint because the cartilage is nearly all destroyed. This leaves the joint stiff and possibly altogether immobile. The level of synovial fluid has diminished to such a degree that it no longer lubricates the joint. Patients who reach Stage Four may find their doctors recommending total joint replacement.

Risk Factors for Osteoarthritis

Sadly, anyone can develop osteoarthritis, but scientists have identified a number of risk factors

• In a nutshell, the older a person is, the more likely he or she is to develop osteoarthritis
• Women are more likely to develop osteoarthritis after menopause. Unfortunately, when they do develop it, they are more likely than their male counterparts to suffer rapid structural deterioration.
• A number of specific genes have been connected to osteoarthritis. One that is of particular interest is the VDR gene. It helps the body process Vitamin D. Vitamin D is necessary for bone formation, and thus if the VDR gene is defective and Vitamin D levels are low, the risk of osteoarthritis goes up.
• A job that puts stress on a joint increases the risk of OA. Naturally, different jobs stress different parts of the body, but shipyard workers, dockworkers, cotton workers, and carpenters have all shown this effect.
• Strenuous activity. Certain sports lead to increased risk of osteoarthritis in particular joints. Baseball pitchers, wrestlers, boxers, skydivers, cyclists, gymnasts, cricket players, ballet dancers, football players, and soccer players are all vulnerable to one degree to another.
• Previous injury. People with ligamentous or meniscal injury to the knee are more likely to develop osteoarthritis.
• The heavier people are, the more stress than puts on their joints, and the more likely they are to develop osteoarthritis, particularly knee osteoarthritis. The good side of this is that losing weight relieves the stress and accordingly reduces joint pain and other symptoms.

Osteoarthritis Interventions

Given the severe potential consequences of OA, it’s important to prevent the disease if possible or slow its progression as much as possible. The methods for doing these things fall into two general categories, joint preservation and osteoarthritis treatment.

Joint Preservation

As the name suggests, joint preservation is a system for preventing the progression of osteoarthritis using a combination of health management, medical, and sometimes even surgical techniques. Seen from a certain perspective, the ultimate goal is to prevent the need for total joint replacement.

Patients learn to move their joints in a way that causes the least stress and therefore the least cartilage damage. They also learn proper nutrition and the importance of exercise. They’re fighting the lack of mobility that often results from osteoarthritis and can lead to further medical issues like obesity, cardiovascular problems including heart attack, and diabetes.

Osteoarthritis Treatments

Osteoarthritis treatments aim at controlling joint pain and reducing inflammation.

Some over-the-counter medications may accomplish this. These include NSAIDs, acetaminophen, oral glucosamine, oral hyaluronan, oral chondroitin sulfate, oral diacerein, and avocado-soybean unsaponifiables.

Alternative treatments like tai chi, yoga, acupuncture, and mindfulness (a particular type of meditation) may also help some patients.

So may wraps, icing, bracing, and the proper shoes, and for patients in need of greater assistance, there are canes, crutches, walkers, wheelchairs, and scooters.

Ergonomics provides information on how patients can reduce stress on their joints by adjusting their postures.

Physical therapy offers specific exercises that relieve symptoms and strengthen muscles around the osteoarthritic joint, another way of reducing stress on it.

When a combination of the above measures proves insufficient, doctors can prescribe medication. Prescription medicines for the treatment of arthritis include Cox-2 inhibitor, hyaluronic acid injection, platelet-rich plasma injection, stem cells, cortisone injections, and narcotics.

When all else fails, the patient’s doctor may recommend a surgical intervention. There are a number of these that can be undertaken depending on the case. Osteotomy realigns a misaligned joint. Joint resurfacing creates a smooth metal surface. Partial joint arthroplasty replaces one portion of the joint while leaving the rest intact. Total joint arthroplasty replaces the entire joint, and revision arthroplasty addresses problems that have arisen with a prosthetic implant, possibly because it’s past its useful lifespan of 15-30 years.