Osteoarthritis Health Article

Signs and symptoms

Although up to 85% of people over 65 show evidence of osteoarthritis on x ray, only 35-50% experience symptoms. Symptoms range from very mild to very severe, affecting hands and weight-bearing joints such as knees, hips, feet, and the back. The pain of osteoarthritis usually begins gradually and progresses slowly over many years.

Osteoarthritis is commonly identified by aching pain in one or more joints, stiffness, and loss of mobility. The disease can cause significant trouble walking and stair climbing. Inflammation may or may not be present. Extensive use of the joint often exacerbates pain in the joints. Osteoarthritis is often more bothersome at night than in the morning and in humid weather than dry weather. Periods of inactivity, such as sleeping or sitting, may result in stiffness, which can be eased by stretching and exercise. Osteoarthritis pain tends to fade within a year of appearing.

Bony lumps on the end joint of the finger, called Herberden's nodes, and on the middle joint of the finger, called Bouchard's nodes, may also develop.

Diagnosis

A diagnosis of osteoarthritis is made based on a physical exam and history of symptoms.

X rays are used to confirm diagnosis. In people over 60, the disease can often be observed on x ray. An indication of cartilage loss arises if the normal space between the bones in a joint is narrowed, if there is an abnormal increase in bone density, or if bony projections or erosions are evident. Any cysts that might develop in osteoarthritic joints are also detectable by x ray.

Additional tests can be performed if other conditions are suspected or if the diagnosis is uncertain. Blood tests can rule out rheumatoid arthritis or other forms of arthritis.

It is possible to distinguish osteoarthritis from other joint diseases by considering a number of factors together:

• Osteoarthritis usually occurs in older people.
• It is usually located in only one or a few joints.
• The joints are less inflamed than in other arthritic conditions.
• Progression of pain is almost always gradual.

A few of the most common disorders that might be confused with osteoarthritis are rheumatoid arthritis, chondrocalcinosis, and Charcot's joints.

Treatment and management

There is no known way to prevent osteoarthritis or slow its progression. Some lifestyle changes can reduce or delay symptoms. Treatment often focuses on decreasing pain and improving joint movement. Prevention and treatment measures may include:

• Exercises to maintain joint flexibility and improve muscle strength. By strengthening the supporting muscles, tendons, and ligaments, regular weight-bearing exercise helps protect joints, even possibly stimulating growth of the cartilage.
• Joint protection, which prevents strain and stress on painful joints.
• Heat/cold therapy for temporary pain relief.
• Various pain control medications, including corticosteroids and NSAIDs (nonsteroidal anti-inflammatory drugs such as aspirin, acetaminophen, ibuprofren, and naproxen). For inflamed joints that are not responsive to NSAIDS, injectable glucocorticoids may be used. For mild pain without inflammation, acetaminophen may be used.
• Weight control, which prevents extra stress on weight-bearing joints. One study reported that weight loss seemed to reduce the risk for symptomatic osteoarthritis of the knee in women, and in another, women who lost 11 pounds or more cut their risk for developing osteoarthritis in half.
• Surgery may be needed to relieve chronic pain in damaged joints. Osteoarthritis is the most common indication for total joint replacement of the hip and knee.

New treatment findings

Studies have found that estrogen may promote healthy joints in women. Hormone replacement therapy may significantly reduce the risk in postmenopausal women, particularly in the knees.

It has been reported that deficiencies in vitamin D in older people may worsen their condition, so individuals with osteoarthritis should strive to get the recommended 400 IU a day. To protect bones, adults should also consume at least 1,000 mg of calcium daily.

Glucosamine and chondroitin sulfate are popular nutritional supplements that may diminish the symptoms of osteoarthritis. According to some reports, a daily dose of 750–1,500 mg of glucosamine and chondroitin sulfate may result in reduced joint pain, stiffness, and swelling, however these supplements are not approved by the Food and Drug Adminstration as effective treatment of osteoarthritis. A person with osteoarthritis should consult with a doctor before using dietary supplements to treat symptoms.

Prognosis

Osteoarthritis is not life threatening, but quality of life can deteriorate significantly due to the pain and loss of mobility that it causes. Advanced osteoarthritis can force the patient to forgo activities, even walking, unless the condition is alleviated by medication or corrected by surgery.

There is no cure for osteoarthritis, and no treatment alters its progression with any certainty. Only heart disease has a greater impact on work, and 5% of those who leave the work force do so because of osteoarthritis.