Osteoarthritis
A joint is where two or more bones come together, letting you bend at the knee, hip, spine, elbow, wrist, shoulder, ankle, hand, thumb and many other parts of the body. A healthy joint glides easily without pain because a smooth, elastic tissue called articular cartilage covers the ends of the bones that make up the joint.
In the progressive disease osteoarthritis (OA), the covering on the ends of bones gradually wears away, becoming frayed and rough, like sandpaper. This can make it painful to move the joint. Also known as "wear and tear" arthritis, OA usually develops after many years of use and affects people who are middle aged or older. Other risk factors for OA include obesity, injury to a joint and family history of osteoarthritis.
Symptoms
Osteoarthritis can affect any joint in the body, with symptoms ranging from mild to disabling. A joint affected by OA may have pain and inflammation, swelling and stiffness, loss of range of motion, "sticking" and weakness.
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Pain and inflammation. Without cartilage, bones rub directly against each other when you move, causing pain and inflammation. Joint pain usually develops gradually and may feel dull or aching. Pain may be worse in the morning and feel better with activity. Vigorous activity may cause pain to flare up.
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Swelling and stiffness. The joint may stiffen and look swollen, enlarged or "out of joint." A bump may develop over the joint.
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Loss of range of motion. Motion may be limited if bending the joint becomes difficult.
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"Sticking" and weakness. Loose fragments of cartilage and other tissue can cause locking or "sticking" when you use the joint, it may creak, click, snap, or make a grinding noise (crepitus). The joint may lose its strength (atrophy) and buckle or lock.
See a doctor right away if you have symptoms of osteoarthritis. Although osteoarthritis cannot be cured, early identification and treatment can slow progression of the disease, relieve pain and restore function.
Doctor's exam
To diagnose osteoarthritis and determine the extent to which it has progressed, a doctor relies upon your complete medical history, physical examination, X-rays and possibly lab tests.
- Medical history. Tell the doctor everything in your medical history, including current symptoms. When did joint pain begin? Is pain continuous, or does it come and go? Is it worse at night? When you walk or run? Be sure to mention if you ever injured the joint, or if you also have pain in other parts of the body.
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Physical examination. The doctor will look at the affected joint, and may ask you to move it into various positions. He or she may check for pain and restricted motion, crepitus, muscle atrophy, involvement of other joints or signs of injury to muscles, tendons and ligaments.
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X-rays. X-rays can show the extent of joint deterioration, including narrowing of joint space, thinning or erosion of bone, excess fluid in the joint, bone spurs or other abnormalities. This may help the doctor distinguish various forms of arthritis.
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Lab tests. Sometimes laboratory tests can help rule out other diseases that cause symptoms similar to OA.
Early treatment
Early, non-surgical treatment can slow progression of OA, increase motion and improve strength. Most treatment programs combine lifestyle modifications, medications and physical therapies.
- Lifestyle modifications. The doctor may recommend that you rest or change activities to avoid provoking osteoarthritis pain. You may need to modify job or sports activities. This could mean switching from high impact activities (such as aerobics, running, jumping or competitive sports) to low impact exercises (such as stretching, walking, swimming or cycling). If osteoarthritis affects weight-bearing joints (such as the knee, hip, spine or ankle) and you are overweight, you may also need to start a weight loss program.
- Medications. Non-steroidal anti-inflammatory medications can help reduce inflammation. Sometimes the doctor may recommend strong anti-inflammatory agents called corticosteroids, which are injected directly into the joint for temporary relief of pain and swelling. Dietary supplements called glucosamine and chondroitin sulfate may also help relieve osteoarthritis pain. (Glucosamine stimulates formation and repair of articular cartilage. Chondroitin sulfate prevents cartilage from degrading. Caution: The U.S. Food and Drug Administration does not test or analyze dietary supplements. These compounds may also cause negative interactions with other medications or cause excessive bleeding during surgical procedures. Always consult your doctor before taking dietary supplements.)
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Physical therapy. The doctor may prescribe a balanced fitness program, physical therapy and/or occupational therapy to improve joint flexibility, increase range of motion, strengthen muscle, bone and cartilage tissues and reduce pain. You may need to use supportive or assistive devices (i.e., brace, splint, elastic bandage, cane, crutches or walker) and/or apply ice or heat to the affected joint for short periods, several times a day.
Surgery
If early treatments do not stop the pain, the doctor may consider surgery to treat advanced osteoarthritis. It depends upon your age and activity level, the condition of the affected joint, and the extent to which osteoarthritis has progressed. Surgical options for osteoarthritis include arthroscopy, joint fusion and joint replacement.
- Arthroscopy. A surgeon uses a pencil-sized instrument (arthroscope) and two or three small incisions to remove bone spurs, cysts, damaged lining or loose fragments in the joint.
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Joint fusion. A surgeon eliminates the joint by binding together the ends of bone (fusion). Pins, plates, screws or rods may hold bones in place while they heal. This procedure eliminates the joint's flexibility.
- Joint replacement. A surgeon removes parts of the bones and creates an artificial joint with metal or plastic components (total joint replacement or arthroplasty).
July 2002
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