Osteoarthritis: Its Diagnosis and Medical Treatments

Osteoarthritis (OA) is the most common form of arthritis. According to the Centers for Disease Control and Prevention (CDC), over 32.5 million adults in the United States have this condition. It is considered a disease of “wear and tear” on the joints of the body. It destroys the cushioning, slippery cartilage at the ends of bones. It primarily affects the back, hips, knees, and sometimes big toes, fingers, and thumbs. Osteoarthritis is more common in older adults and has no cure. OA can worsen over time, but there are treatments that relieve the symptoms.

Osteoarthritis is a very different disease than rheumatoid arthritis. Osteoarthritis is a degenerative wear and tear disease. Rheumatoid arthritis (RA) is a disease that inflames the tissue of the joints. It is caused by a dysfunctional immune system that attacks healthy cells. Both OA and RA can cause pain, stiffness, and swelling.

The most common targets of rheumatoid arthritis are the feet, wrists, and hands excluding the spine, hips, and knees, which are primarily impacted by OA. Unlike OA, rheumatoid arthritis can also affect organs such as the liver, heart, lungs, and eyes. The symptoms of RA are more widespread. RA can affect younger people, although it typically starts when someone is middle aged. About 8 in 100,000 young adults (ages 18 to 34) get RA. Conversely, OA is a disease of aging.

With RA, symptoms start quickly as opposed to OA symptoms, which are gradual. With RA, joints feel painful and stiff in the morning, but OA pain will usually worsen after activity. RA affects joints on both sides of the body while, with OA, the disease affects joints on one side of the body. Doctors use x-rays to reveal further differences and treatments.

Symptoms of Osteoarthritis:

• Joint pain or aching during or after motion; with hip OA, pain can occur in the buttocks and sometimes the inner aspect of the knee or thigh
• Joint stiffness after inactivity or rest
• Decreased flexibility and limited range of motion
• Bone spurs, which are bony growths on the edge of bones like the fingers
• Grating, crackling, or popping when the joint bends
• Swelling, usually in the ankles and feet
• Tenderness with light pressure (most often in the big toes)
• Joint buckling (often occurs in the knee)

Risk factors:

• Older age – usually over 50 years of age
• Female
• Being overweight, which puts more stress on the hips and knees. Fat cells produce proteins that cause joint inflammation.
• Old injuries of any kind can put you at a greater risk for OA.
• Repetitive stress on the joint through sports and certain strenuous jobs, such as construction, dancing, textile work, music, and teaching.
• Genetics, since OA can run in families
• Malformed, misaligned bone or joint structures or defective cartilage
• Some metabolic diseases, such as diabetes, conditions that cause too much iron in the body, and hormonal disorders
• Weak muscles, which don’t support the joints properly

Diagnosis

Osteoarthritis is diagnosed by reviewing of medical history, including symptoms and how pain affects your self-care and other activities. You may need:

• Physical exam, which involves looking at the joints and having you move them.
• Laboratory tests used to rule out other similar forms of OA.
• Joint aspiration, which involves checking for infection or crystals that can rule out other medical problems.
• X-rays to detect joint damage or changes.
• Magnetic Resonance Imaging (MRI), which shows cartilage and other aspects of a damaged joint.

Treatment

Medications for pain and inflammation relief come in the form of pills, patches, gels, creams, syrups, and injectables. These include:

• Over-the-counter pain pills such as acetaminophen; you will need a prescription for medication like opioids.
• Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, naproxen, and ibuprofen are for inflammation and pain. Those designed primarily for pain are over-the-counter, while those that address both pain and inflammation require a prescription.
• Over-the-counter products like capsaicin and lidocaine aggravate the nerves to distract them from processing pain.
• Prescription corticosteroids are taken orally or are injected into the joint by your physician.
• Platelet-rich plasma is another injectable medication that can reduce inflammation and pain, but it’s not currently approved by the FDA.
• Antidepressants such as Cymbalta and Lyrica can also ease pain; these medications are FDA-approved for this use.

Seek the services of a physical therapist. They can instruct you in a specific exercise program for your OA. It will include:

• Strengthening exercises are a good way to reduce the stress on painful joints by building the muscle around them. Click here to find a basic strengthening program.
• Range-of-motion exercises and stretching are helpful ways to warm up joints and maximize their flexibility. Click here to find a basic stretching program.
• Aerobic or cardiovascular exercises help build endurance and assist with weight loss.
• Balance exercises are helpful in preventing falls by strengthening small muscles in the lower legs.

Joint replacement surgery can be used to ease pain while enhancing self-care, mobility, and quality of life. The most common procedures are performed on the hips and knees. During a hip replacement, the damaged hip ball in the socket joint is removed and replaced with ceramic or metal that is bonded to a stem. This stem fits into the thigh bone known as the femur. Eventually, bone will grow over the material that covers the new ball and socket joint, called a prosthesis. Sometimes they use cement to attach the prosthesis to the bone. The joint socket is often a metal cup with a plastic liner, which snaps into it and allows the new ball to rotate. Prostheses are individually designed for each person.

A knee replacement involves shaving off a thin amount of bone along the bottom surface of the femur and the underside of the kneecap. After shaping the bone surface, an implant is fitted. Like hip replacements, knee replacements can use cement or a special coating into which the bone can grow. Total joint replacement surgery generally takes one to two hours with recuperation lasting one to two days.

OA can be debilitating but can be readily diagnosed. Once diagnosed, there are many treatments available to manage it including medication, physical therapy/exercise, and surgery.