WHAT IS OSTEOARTHRITIS?

Osteoarthritis (OA), also called degenerative (breaking down) joint disease, is one of the most common types of arthritis, affecting more than 20 million people in the United States. The disease causes cartilage, the cushioning on the ends of joints, to break down, allowing bones to rub against each other. This causes pain, swelling and loss of motion. Over time, the joint may lose its normal shape. OA usually affects the hands, knees, hips, feet, neck and back. It is one of the most common causes of physical disability among adults.

WHAT CAUSES IT?

Many factors can cause OA. One may be simple "wear and tear" on the joint. People with joint injuries caused by sports, repetitive work-related activities or accidents have an increased risk of developing OA. Another cause may be obesity, resulting in OA of the knees.

Some kinds of OA are hereditary; an imbalance in body chemicals, called enzymes, that allow for the natural breakdown and regrowth of cartilage may play a role. Too much of these enzymes can cause cartilage to break down faster than it is rebuilt.

WHO IS AT RISK?

Before age 45, more men have OA than women. After age 45, it is more common in women. Although age is a risk factor, OA is not a normal part of aging. People who are overweight have a greater risk of developing OA. Injuries and a family history of OA also may increase a person's risk.

In some families, inherited factors play a role in a person’s risk for developing arthritis. If a parent or other close relative has been diagnosed with arthritis, it is important to share this history with a health care provider. Early diagnosis and treatment is the key to successful management of arthritis.

HOW IS IT DIAGNOSED?

Doctors make a diagnosis of OA based on a physical exam and a person's report of symptoms. X-rays may be taken to see if, and how much, joint damage has already occurred. Fluid may be taken from a joint for testing. Other tests may be done to rule out other possible causes of the patient's symptoms.

HOW IS IT TREATED?

The most successful treatment programs involve a combination of medication, self-management, physical and occupational therapy (depending on the patient's needs), lifestyle habits and general health. Cold packs and medications can be used to help reduce pain and inflammation. In some cases, surgery may be needed.

Medications–Cream, gel or spray pain relievers often are applied to the skin to reduce symptoms. Pain relievers such as acetominophen have been shown to be effective for mild to moderate pain. Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, are often used to reduce pain and swelling. Newer drugs called COX-2 inhibitors are used to manage pain and inflammation but are much more expensive. Antidepressants can help to reduce chronic pain as well as treating sleep problems and feelings of depression that accompany OA. Injecting a joint with a corticosteroid may offer pain relief for four to six months, but joint injections cannot be done repeatedly. Another medication, called hyaluronic acid, can be injected into knee joints but requires a series of three or five weekly injections. Pain relief usually is achieved more slowly than with corticosteroids but can be effective for a longer period of time and can be repeated.

Successfully dealing with arthritis pain and disability requires self-management skills. It is important for patients to learn about the disease and to take part in their own care. Working with health care professionals allows a person to share in decision making and gain a sense of control.

Self-management includes arthritis education, exercise programs, rest, relaxation and stress management, eating well-balanced meals and maintaining proper weight, taking care of joints and using assistive devices to rest joints and relieve pressure.

• Exercise can help restore joint movement and increase strength. Research has shown that exercise is one of the best treatments for OA. It can help increase independence, improve mood, decrease pain, increase flexibility, improve blood flow, maintain proper weight and promote general physical fitness. Exercise in a warm water pool is an excellent choice. Physical/occupational therapists can help design programs to meet a person's specific needs.
• Rest also is important. Arthritis may cause tiredness and muscle weakness. A rest or short nap that does not interfere with nighttime sleep may help. Relaxation techniques can be useful in controlling pain. Some people find stress reduction and biofeedback helpful.
• Assistive devices can be used to reduce stress on certain joints. For example, braces or canes may help reduce stress on the knees. Jar grippers or other gadgets may help reduce stress on the small joints of the hands.

Research shows that patients who take part in their own care report less pain and make fewer doctor visits as well as enjoy a better quality of life.

WHEN SHOULD A PERSON GET HELP?

If a person has swelling or stiffness in the joints that lasts for more than two weeks, a doctor should be seen. A person with redness, tenderness and warmth of a joint should see a doctor as this may indicate another form of arthritis or an infection.

RESOURCES