Osteoarthritis

Osteoarthritis is the most common joint disorder. The chronic disease causes the cushioning (cartilage) between the bone joints to wear away, leading to pain and stiffness. It can also cause new pieces of bone, called bone spurs, to grow around the joints.

What causes osteoarthritis?

Primary osteoarthritis is mostly related to aging. With aging, the water content of the cartilage increases and the protein makeup of cartilage degenerates. Repetitive use of the joints over the years irritates and inflames the cartilage, causing joint pain and swelling. Eventually, cartilage begins to degenerate by flaking or forming tiny crevasses. In advanced cases, there is a total loss of the cartilage cushion between the bones of the joints. Loss of cartilage cushion causes friction between the bones, leading to pain and limitation of joint mobility. Inflammation of the cartilage can also stimulate new bone outgrowths (spurs) to form around the joints. Osteoarthritis occasionally can be found in multiple members of the same family, implying an heredity (genetic) basis for this condition.

Symptoms

• gradual and subtle onset of deep aching joint pain
• joint swelling
• limited movement
• morning stiffness
• grating of the joint with motion
• joint pain in rainy weather

How Do You Know if You Have Osteoarthritis?

Usually, osteoarthritis comes on slowly. Early in the disease, your joints may ache after physical work or exercise. Later on, joint pain may become more persistent. You may also experience joint stiffness, particularly when you first wake up in the morning or have been in one position for a long time.

Although osteoarthritis can occur in any joint, most often it affects the hands, knees, hips, and spine (either at the neck or lower back). Different characteristics of the disease can depend on the specific joint(s) affected. For general warning signs of osteoarthritis, see the box on the next page. For information on the joints most often affected by osteoarthritis, please see the following descriptions below:

Hands: Osteoarthritis of the hands seems to have some hereditary characteristics; that is, it runs in families. If your mother or grandmother has or had osteoarthritis in their hands, you’re at greater-than-average risk of having it too. Women are more likely than men to have hand involvement and, for most, it develops after menopause.

When osteoarthritis involves the hands, small, bony knobs may appear on the end joints (those closest to the nails) of the fingers. They are called Heberden’s (HEBerr-denz) nodes. Similar knobs, called Bouchard’s (boo-SHARDZ) nodes, can appear on the middle joints of the fingers. Fingers can become enlarged and gnarled, and they may ache or be stiff and numb. The base of the thumb joint also is commonly affected by osteoarthritis.

Knees: The knees are among the joints most commonly affected by osteoarthritis. Symptoms of knee osteoarthritis include stiffness, swelling, and pain, which make it hard to walk, climb, and get in and out of chairs and bathtubs. Osteoarthritis in the knees can lead to disability.

Hips: The hips are also common sites of osteoarthritis. As with knee osteoarthritis, symptoms of hip osteoarthritis include pain and stiffness of the joint itself. But sometimes pain is felt in the groin, inner thigh, buttocks, or even the knees. Osteoarthritis of the hip may limit moving and bending, making daily activities such as dressing and putting on shoes a challenge.

Spine: Osteoarthritis of the spine may show up as stiffness and pain in the neck or lower back. In some cases, arthritis-related changes in the spine can cause pressure on the nerves where they exit the spinal column, resulting in weakness or numbness of the arms and legs.

Treatment

There's no known cure for osteoarthritis, but treatments can help to reduce pain and maintain joint movement. Your doctor may recommend a combination of treatments that may include medication, self-care, physical therapy and occupational therapy. In some cases, surgical procedures may be necessary

Self-care

Fortunately, you can relieve much of the discomfort associated with osteoarthritis through healthy-living strategies and self-care techniques, such as the following:

Exercise regularly. Different types of exercise achieve different goals. Check with your doctor before beginning a regular exercise program. Your doctor may recommend working with a physical therapist who can design an exercise program to meet your specific needs, and who may also perform manual exercises that stretch and strengthen the muscles around your arthritic joints. If you can walk, walking is a good starter exercise. If you can't walk, try a stationary bicycle using no resistance or do hand or arm exercises. Aquatic exercise is another option, and many health clubs with pools offer classes. If you don't have access to a pool, tai chi may be a good alternative. It teaches strengthening, range of motion exercises and relaxation techniques, and can improve balance. It's good to move each joint in its full range of motion every day. As you move, maintain a slow, steady rhythm. Don't jerk or bounce. Also don't hold your breath, as this can temporarily deprive your muscles of oxygen and tire them. Maintain good posture while you exercise. Avoid exercising tender, injured or severely inflamed joints. If you feel new joint pain, stop. New pain that lasts more than two hours after you exercise probably means you've overdone it. If pain persists for more than a few days, call your doctor.

Control your weight. Excess weight puts added stress on joints in your back, hips, knees and feet — places where arthritis pain is commonly felt. Excess weight can also make joint surgery more difficult and risky.

Eat a healthy diet. A healthy diet emphasizing fruit, vegetables and whole grains can help you control your weight and maintain your overall health, allowing you to deal better with your arthritis. However, there's no special diet effective for treating arthritis. It hasn't been proved that eating any particular food will make your joint pain or inflammation better or worse.

Apply heat. Heat will ease your pain, relax tense, painful muscles and increase the regional flow of blood. You may find it especially helpful to apply heat before exercising. One of the easiest and most effective ways to apply heat is to take a 15-minute hot shower or bath. Other options are a hot pack, an electric heating pad on its lowest setting or a radiant heat lamp with a 250-watt reflector heat bulb. If your skin has poor sensation or if you have poor circulation, don't use heat treatment.

Choose appropriate footwear. Wearing comfortable cushioned shoes that properly support your weight is especially important if you have arthritis in your weight-bearing joints or back.

Apply cold for occasional flare-ups. Cold may dull the sensation of pain during the first day or two. Cold also has a numbing effect and decreases muscle spasms. Don't use cold treatments if you have poor circulation or numbness.

Practice relaxation techniques. Hypnosis, guided imagery, deep breathing and muscle relaxation can all be used to control pain.

Take your medications as recommended. By taking medications regularly instead of waiting for pain to build, you will lessen the overall intensity of your discomfort.