What is Osteoarthritis?
Osteoarthritis (OA) is a joint disease that affects more than 30 million people in the United States alone. It results from the breakdown of cartilage that helps cushion joints.
What Joints are Involved in OA?
Often, it affects weight bearing joints such as knees, hips, and feet, but damaged joints can also be seen involving the hands and spine.
How Will I Know if I Have OA?
You may have symptoms that suggest OA, such as pain, especially with activity and movement of the joint. Also, you may have stiffness on awakening or with inactivity. Other symptoms include reduced range of motion around the joint, soft tissue swelling around the joint, or tenderness when pressure is applied to the joint. A crunching feeling or sound called “crepitus” is often associated with OA.
Are There Certain Risk Factors for Developing OA?
Risk factors associated with OA include older age, sex, obesity, joint trauma, and genetics. 80-90% of individuals over the age of 65 have x-ray evidence of OA, and women over the age of 55 are more affected than men of the same age. Increased weight adds stress to weight bearing joints such as hips and knees. Joint trauma, such as from old sports injuries and accidents, can predispose one to developing OA.
How Will my Doctor Diagnose OA?
Osteoarthritis is primarily a clinical diagnosis, based on history and physical exam. Plain x-rays of the joint can reveal joint space narrowing from cartilage loss, bone spurs, and joint destruction, all confirming the diagnosis of OA. Joint damage from OA cannot be reversed, but treatments may help to slow progression, and help improve pain and function.
How is OA Treated?
- Nonpharmacological treatment includes regular exercise to strengthen the muscles around the joint and improve mobility. Weight loss in overweight or obese individuals helps to reduce stress on the joint.
- Pharmacological treatment usually starts with acetaminophen (Tylenol) for mild to moderate pain, with step up to Nonsteroidal Anti-inflammatory drugs (NSAIDS), either using over the counter medication such as ibuprofen (Advil, Motrin), naproxen (Aleve) or prescription NSAIDS. All NSAIDS however can cause gastrointestinal, or stomach upset with abdominal pain and even internal bleeding. Topical NSAIDS applied to the skin over the joint can help alleviate pain with less systemic effects. Other medications that have been used for OA pain include antidepressant medication duloxetine (Cymbalta), and topical capsaicin cream.
- Intraarticular joint injections are commonly used to treat symptoms of severe OA pain. Cortisone injection for knee OA can offer pain relief for 4-8 weeks but is limited to no more than 3-4 injections per year. Joint injection for the knee with viscosupplement, such as with hyaluronic acid found in joint fluid, helps to lubricate the joint and can improve pain and function for up to four months. Platelet-rich plasma (PRP) is created by removing one’s own blood and spinning it down so that there is a greater concentration of platelets. The platelets are rich in growth factors that help promote cartilage growth. This is then injected into the joint. Lastly, there is some evidence that stem cell injection could be of benefit in the treatment of knee OA. Stem cells could develop into cartilage producing cells. However, this would require bone marrow aspiration and subsequently would be a more complicated procedure.
- Surgical option is considered when conservative treatments have failed to improve pain and disability. Total joint replacement is most effective for hip, knee, and shoulder joints with duration of function lasting up to 15 years.
Chase Medical Research & Clinical Trials
Lozada, Carlos J., Dec. 01, 2015, Progression of Osteoarthritis, Medscape.
“Osteoarthritis.” National Institute on Aging, U.S. Department of Health and Human Services, www.nia.nih.gov/health/osteoarthritis.
Sinusas, Keith, Jan. 01, 2012, Osteoarthritis: Diagnosis and Treatment, American Academy of Family Physicians, Volume 85, Number 1.