Osteoarthritis OA is by far the most common form of arthritis in the United States, affecting up to 15% of the general population. Whether or whether the changes revealed are causing pain, tightness, or other symptoms, the majority of people over the age of 80 who have x-ray scans show indications of Osteoarthritis. This makes OA the primary cause of surgery for joint replacement in this nation. With the exception of the hip, where males typically outnumber women, every joint has a higher frequency of OA in women than in men.
Many people mistakenly think that OA is only "old age" because of the strong relationship between OA and advanced age, however OA is much more than this. It is a condition that affects the cartilage, the layer of protection that sits between joints and usually makes it possible for the bony surfaces to move smoothly. Joint mobility is restricted and frequently painful or accompanied by a "crunching" sensation we refer to as crepitus as the cartilage begins to wear down. This is due to the cartilage's smooth surface becoming worn down. A person is more likely to develop OA of a certain joint if they are overweight, older, injured, overusing a joint repeatedly, have concurrent inflammatory illnesses like rheumatoid arthritis (RA), or all of these factors.
Weight-bearing joints, including the knees, hips, neck, and lumbar spine, are those most frequently afflicted by OA (lower back). The two rows of knuckles at the tips of the fingers, the joint at the base of the thumb, the balls of the foot, and the points of the toes are frequently affected in the hands. Except in cases where another inflammatory disease or injury is concurrently present, the wrists, elbows, and ankles are typically spared.
Even while many OA patients may experience symptoms in several joints at once, it is more typical to observe that only a few joints exhibit symptoms at once. Even while pain normally comes on gradually, it can occasionally be preceded by swelling or localised warmth over the affected joint, as well as a brief morning stiffness. Even yet, the level of inflammation is typically lower than that seen in gout or RA. It is thought that the underlying bone expands around afflicted joints as a response to the harm done to the joint.
Erosive or inflammatory OA is a specific type of OA that affects primarily the hands and is more common in women in their 40s or 50s. This disorder is frequently inherited and is associated by more obvious symptoms of inflammation, such as redness, inflammation, or warmth over the finger joints.
Typically, the active inflammatory phase of erosive OA lasts up to 10 years, after which time the disease “burns out” and usually leaves behind areas of bony enlargement near the fingertips known as Heberden’s nodes.
When the sequence of symptoms, the joints affected, and the examination results are in agreement with this diagnosis, OA is frequently considered. For instance, observations of bony expansion over the fingers or a patient over the age of 65 with a chronically aching knee with crepitus and reduced range of motion would definitely suggest OA.
X-ray scans can assist confirm the diagnosis and also rule out other illnesses that may also be present in addition to OA (for more information, see the section on Calcium Pyrophosphate Disease/Pseudogout, for example). Joint space narrowing is an usual finding. However, it cannot be inferred from this data alone that the symptoms are brought on by the narrowing of the joint space. Additionally, x-rays can help the doctor decide whether joint replacement surgery is the best course of action by evaluating the severity or progression of joint degeneration.
The diagnosis of OA cannot be supported by laboratory tests. Test results for the majority of common "autoimmune" disorders and typical markers of inflammation are often negative for OA. Erosive OA might be an exception, in which the inflammatory markers might be a little higher. In some cases, aspirating fluid from such a swollen joint may be necessary. By counting the white blood cells in the joint fluid, this procedure can assist distinguish between OA and a more inflammatory condition. Compared to RA, the white blood cell count in OA ought to be significantly lower.
Although OA is fairly frequent, we regrettably lack particular treatments that have been demonstrated to target the primary issue in this condition: cartilage loss. Because of this, the goal of treatment is to lessen symptoms while reducing risk factors like obesity that could exacerbate joint injury. Depending on the intricacy of each case, primary care doctors may be able to manage OA well without consulting a rheumatologist.
Exercises designed to increase muscle tone around afflicted joints can be quite beneficial. Studies show that having weak thigh muscles increases the chance of developing progressive OA of the knees, therefore it seems sense to take comparable steps to strengthen the muscles around affected joints. These activities ought to be symptom-limited, that is, done so long as there is no lasting discomfort thereafter. A physical therapist may be useful in overseeing an exercise regimen that focuses on boosting range of motion, flexibility, and muscular strengthening. The therapist may also be useful in guiding a patient through the use of aids like a cane, walker, or splint.
Simple analgesics like acetaminophen (Tylenol) for mild symptoms and non-steroidal anti-inflammatory drugs (NSAIDs) for even more pronounced symptoms are some of the medications used to treat OA (see Medications section). Your doctor may decide that you might benefit more from receiving one of the new NSAIDs known as "COX-2 selective" medications depending on other considerations.
These drugs include valdecoxib and celecoxib (Celebrex) (Bextra). These medications lessen the likelihood of gastrointestinal bleeding or ulcer development. While each of these drugs often lessens the symptoms of OA, they do not stop the joint degeneration from progressing.
In recent years, the use of over-the-counter glucosamine & chondroitin sulphate treatments has become more common. After 1-2 months of treatment, these preparations, which are derived from normal cartilage components, seem to lessen OA symptoms in patients, though research is mixed. A more audacious claim is that these substances lessen joint injury or even "grow cartilage," neither of which have been clearly proven. Currently, these medications could be helpful and worthwhile for certain individuals to try, but it is unlikely that they would be helpful for any other ailment besides OA.
Certain joints, including the knee, may be injected with steroid formulations with or without anaesthesia, and this can be quite beneficial in easing symptoms in the affected joint. The risk of the injection itself consists mostly of a 1 in 20,000 chance of an infection being delivered into the joint via the needle because the steroid is not administered in doses that would cause side effects inside the rest of the body.
Conventional wisdom once held that there was a maximum number of injections that might be administered, but new research suggests that as long as they are administered no more frequently than every three months, steroid injections do not cause further joint damage.
Hyaluronic acid- or hylan-containing preparations are among other chemicals that can be injected into the joint. When administered into an affected joint, these chemicals offer lubrication and may even cover the injured cartilage. This is a typical joint fluid component that is decreased in OA. Synvisc, Hyalgan, Supartz, & Orthovisc are all currently accessible preparations that can all be administered in a course of 3 to 5 weekly injections. All of these drugs currently only have FDA approval for injection into the knee. On average, 2/3 of patients who receive these injections report symptom relief lasting up to 6 months at a time. The majority of these preparations are best utilised on patients who have not responded to more conservative treatments or who are not ideal surgical candidates.
One could argue that surgery is the sole effective treatment for OA. The main consideration in deciding whether surgery is the best course of action depends on a number of variables, including the patient's age, health status, the involved joint, the failure of other treatments, the degree of joint space narrowing, and—most importantly—the level of pain and functional limitation they are currently experiencing.
The most crucial factor in making this decision is a conversation between you and your doctor.
While it's important to choose a qualified and experienced surgeon, up to 90% of individuals who have hip or knee replacements surgery report satisfactory or exceptional results. The success rate of surgeries on the spine or other joints is lower, but if patients are carefully chosen for such procedures, they too may have great pain reduction and functional rehabilitation. The protracted investment is typically justified, even after taking into account the short-term danger and the subsequent recuperation procedure.
