Osteoarthritis

Osteoarthritis is diagnosed and treated by the Rheumatology Division of Premier Medical Group.

What is osteoarthritis?

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Osteoarthritis is a chronic joint condition. Degenerative joint disease occurs when the cartilage, a protective tissue that covers the ends of bones, breaks down at the joints, causing the bones to rub together. This unprotected rubbing causes pain, stiffness, swelling, and a range of other symptoms. Osteoarthritis is an age-related condition, which means it tends to develop later in life. However, the condition is known to develop in younger people when joints are overused, such as during athletic injuries and obesity.

There are two main types of osteoarthritis: Primary and secondary. Primary osteoarthritis is more generalized, affecting varied parts of the body, while secondary osteoarthritis occurs after an injury, typically one that causes inflammation in a joint.

What are the causes and risk factors of osteoarthritis?

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As the most common chronic joint condition, it’s no surprise that osteoarthritis has countless causes and risk factors. The joint damage experienced in osteoarthritis accumulates over time, which means that age is one of the leading causes of the condition. In general, the older a person is, the more stress and use they have put on their joints. This use can lead to osteoarthritis.

There are, however, several other osteoarthritis causes, many relating to injuries. If a past injury has included a dislocated joint, injury to ligaments, or torn cartilage, an individual is more likely to develop osteoarthritis at the site of the injury. Similarly, joint malformation, poor posture, and obesity have been known to cause osteoarthritis. If a condition, lifestyle, or circumstance places significant weight or pressure on a joint, or if that joint cannot hold that weight or pressure comfortably, osteoarthritis is more likely to develop.

As with most chronic conditions, osteoarthritis causes also include hereditary predisposition. If a relative experienced osteoarthritis, either as a senior or younger adult, you are at a greater risk for developing it. This is especially true of individuals born with joint abnormalities, particularly in the spine (scoliosis).

What are the early signs and symptoms of osteoarthritis?

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Osteoarthritis symptoms are nebulous, as they can describe a range of similar health ailments. However, most with the condition experience pain, stiffness, inflammation, and tenderness in the affected joints. Pay special attention to joint aching and soreness, especially during movement, and pain after overuse or inactivity. As osteoarthritis advances, these symptoms will become more intense. Over time, the affected joint and surrounding area may swell.

Like most age-related conditions, osteoarthritis is progressive. There are five stages.

  • Stage 0 represents a normal joint.
  • Stage 1 represents very minor wear and tear on a joint, but pain is unlikely.
  • Stage 2 represents mild osteoarthritis, which is when most will typically begin experiencing pain and discomfort.
  • Stage 3 is designated moderate, where there is obvious cartilage erosion. This may come with joint stiffness, more severe pain, and the experience of popping or snapping sounds.
  • Stage 4 osteoarthritis is severe, where the joint space between the bones is considerably reduced. This creates greater friction, which generates more pain and discomfort.

While it can take several years of neglect to reach state 4 osteoarthritis, people experiencing even minor symptoms should visit the doctor. The best way to prevent severe osteoarthritis is to receive treatment, often in the form of symptom mitigation and management. This can prolong the life of your joints while limiting pain.

What’s the difference between osteoarthritis and other types of arthritis?

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There are more than 100 types of arthritic pain. Osteoarthritis, a degenerative condition, is the most common, but millions are plagued by other forms of arthritis. Three of the most widely experienced are detailed below.

  • Rheumatoid Arthritis – This is an autoimmune disease, which means the immune system attacks the joints, leading to inflammation. The result is severe joint damage if left untreated, and it is commonly experienced in joint areas that receive a lot of pressure, such as the knuckles, elbows, and/or heels.
  • Psoriatic Arthritis – Another autoimmune inflammatory disease, psoriatic arthritis causes raised, red and white patches of inflamed skin with scales, usually on the elbows, knees, scalp, and navel. This type of arthritis can also swell the fingers and toes.
  • Gout – This is a form of inflammatory arthritis. Rather than causing body-wide inflammation, like the autoimmune inflammatory diseases mentioned above, it is more centralized. Gout occurs when uric acid crystals build up in joints, resulting in painful inflammation. This type of arthritis most often affects the big toe.

What are the most common places to get osteoarthritis?

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Osteoarthritis can occur in any joint, but some are more prone than others. Weight-bearing joints have the highest risk. This includes the hands, lower back, neck, shoulders, knees, hips, and feet.

How is osteoarthritis diagnosed?

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If you suspect you have osteoarthritis, you should visit your primary care physician for a physical examination. The doctor will check the affected joints for tenderness, swelling, redness, and flexibility. If osteoarthritis is suspected, the doctor will recommend one or more of several test options.

  • X-Rays – Cartilage loss, a tell-tale sign of osteoarthritis, appears as a narrowing of the space between bones in the joint. While an X-ray image will not show the cartilage itself, your doctor can use this bone proximity to provide a diagnosis. An X-ray can also show bone spurs around a joint, which may cause pain and tenderness.
  • MRI – A magnetic resonance imaging test, or MRI, can produce detailed images of bone and soft tissues. This includes cartilage. This test is not typically needed for an initial diagnosis, but it can provide more information about the disease’s progression.
  • Blood tests – Certain blood tests can help rule out other causes of joint pain, like rheumatoid arthritis, narrowing your doctor’s field of potential diagnoses.
  • Joint fluid analysis – In this test, your doctor will use a syringe to draw fluid from the affected joint. They then test the fluid to determine whether the inflammation is caused by an infection or gout, homing in on a definitive diagnosis.

What is the treatment for osteoarthritis?

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There is no cure for osteoarthritis. As a result, most treatments focus on slowing joint degeneration, managing symptoms, and preventing further damage. The treatment your doctor prescribes will likely depend on the severity of your symptoms and their location. Treatment will include a combination of three categories: medication, therapy, and surgical procedures.

  • Medication – In most cases, pain relieving medications, like acetaminophen, and nonsteroidal anti-inflammatory drugs, like Advil and Motrin, will be recommended for symptom relief. Duloxetine, which is normally used as an antidepressant, is also used to treat chronic pain such as that experienced in osteoarthritis. Corticosteroids can improve symptoms through oral ingestion or injection directly into the joint.
  • Therapy – Physical and occupational therapy are used to strengthen the muscles around the affected joints while working on strategies to relieve joint stress during everyday activities. In earlier stages of arthritis, this therapy may be recommended in the form of light exercise and weight loss, both of which will improve osteoarthritis symptoms. Later stages of arthritis will require guided sessions with a therapy practitioner.
  • Surgical Procedures – If medication and physical therapy do not relieve osteoarthritis symptoms, more invasive procedures should be considered. Bone realignment, or an osteotomy, can be helpful to shift body weight away from worn-out joints. Finally, joint replacement, or arthroplasty, will remove the damaged joint surfaces altogether and replace them with plastic and metal parts. Remember that artificial joints can wear out and need future replacement, and all surgeries come with the risk of infection and blood clot.

What is the best diet and prevention for osteoarthritis?

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Diet and lifestyle are essential to managing osteoarthritis. Omega-3 fatty acids, such as those found in fatty fish, avocado, and fish oil supplements, can improve joint function, while an avocado-soybean unsaponifiable, a nutritional supplement, act as an anti-inflammatory to slow or prevent joint damage. Vitamin C-rich foods, like citrus, bell peppers, and cruciferous vegetables, are essential for cartilage development, and foods with Vitamin D, like eggs, milk, and some seafood, can prevent cartilage breakdown. Regular exercise and weight management will also improve osteoarthritis symptoms and aid in prevention.

There are also several alternative therapies that some patients find helpful in managing osteoarthritis. Topical capsaicin, a pepper extract, can ease arthritic pain when applied to the skin several times per day for several weeks. Some studies also indicate that acupuncture can relieve pain and improve function in joints affected by osteoarthritis. Talk to your doctor about the therapies and treatments that may work for you.