What is osteoarthritis?
Osteoarthritis (OA) is a chronic disease characterized by a loss of cartilage and bony spur formation in joint spaces. Normally, cartilage cushions the joints, which prevents adjacent bones from contacting each other. But when the cartilage is lost, this can result in bony spur formations that rub together, which cause pain and inflammation.
Joints most affected by osteoarthritis include the knee, hip, distal interphalangeal joints (closest to the fingertips), the thumb, and the spine, both in cervical (neck) and lumbosacral (lower back) regions.
What causes osteoarthritis?
The specific cause of osteoarthritis is unknown; while advancing age is the most significant risk for developing osteoarthritis, other risk factors include genetics, obesity, female gender, muscle weakness, joint overuse/repetitive use, joint trauma, and joint instability.
A doctor will take a history and perform a comprehensive physical exam, paying close attention to joint tenderness, limited range of motion, deformity and joint enlargement, swelling, and crepitus (crackling sounds heard in joints).
Diagnosis of osteoarthritis, however, is primarily confirmed by X-ray showing narrowing of the joint spaces, cartilage loss, and spur formation. X-ray radiography can also determine the severity and follow the progression of over time. A doctor may order laboratory tests to rule out other potential causes of arthritis.
Symptoms of osteoarthritis typically include joint pain with movement (alleviated by rest), limited range of motion, joint swelling, and joint stiffness after periods of inactivity. This pain usually occurs within minutes, but can last hours. As osteoarthritis progresses, pain can occur during rest and at night.
Lifestyle changes and non-medical therapies include patient education on resting and restricting use of affected joints, weight reduction, physical therapy, exercise, and more.
For certain joints, steroid and hyaluronic acid injections may be effective for the short-term control of pain.
If osteoarthritis progresses to the point where surgical intervention is necessary because more conservative treatments have failed, joint replacement, arthroscopy, or an osteotomy, in which bone is removed from the joint, may be beneficial. Surgery does involve certain risks, however, if diagnosed with osteoarthritis, a pain management specialist can help navigate the proper course of treatment.
The best way to treat OA is to prevent progression of the disease through lifestyle changes like exercise and weight reduction.
The goal for treating osteoarthritis is to control pain and minimize disability through a large spectrum of treatment options. These options depend on the progression of disease and the severity of pain, and include lifestyle changes, medications, and surgery.
At early stages of osteoarthritis, pain can be alleviated with conservative treatment, primarily rest and over-the-counter analgesics such as acetaminophen (Tylenol™) and non-steroidal anti-inflammatory drugs such as ibuprofen (Advil ™). Additionally, for severe cases of pain and inflammation, more selective anti-inflammatory and opioid medications can be prescribed.