Osteoarthritis

The most common form of arthritis, osteoarthritis is chronic, causing deterioration of the joint cartilage and formation of reactive new bone at the margins and subchondral areas of the joints. This degeneration results from a breakdown of chondrocytes, most often in the hips and knees.

The word "arthritis" is a blend of the Greek words "arthron," for joint, and "itis," for inflammation. In other words, arthritis literally means "joint inflammation." Although arthritis is often referred to as one disease, it's not. Arthritis has more than 100 forms and is common cause of disability.

There's no cure for osteoarthritis, but available treatments can relieve pain and help you remain active. In addition, how well you live with osteoarthritis often depends on your behaviors and attitude. If you actively manage your osteoarthritis, you may be able to gain control over your pain.

Causes

Osteoarthritis is a condition once thought to be due simply to wear and tear on the cartilage of a joint. Osteoarthritis is now known to be a complex process that involves an active disease process.

Normal joint surfaces are covered with a smooth layer of cartilage. This cartilage is the surface that is worn thin in the condition called osteoarthritis. The problem that causes osteoarthritis is due to more wearing away (degradation) and less repair of the cartilage surface. There is both a mechanical (wearing away) part of osteoarthritis, and a biologic (abnormal joint biology) part of the disease.

Signs and symptoms

The symptoms of osteoarthritis include joint pain, especially after overuse or long periods of inactivity; joint creaking or grating sound; joint swelling, stiffness, and limited movement, especially upon awakening; muscle weakness around the sore joint from lack of use; and joint deformity. Osteoarthritis is a degenerative disease, meaning it worsens over time.

Diagnosis

In addition to a complete medical history and physical examination, diagnostic procedures for osteoarthritis may include the following:

• x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
• joint aspiration - involves a removal of fluid from the swollen bursa to exclude infection or gout as possible causes.

Treatment

The goal of treatment is to relieve pain, maintain or improve mobility, and minimize disability. Medications include aspirin (or other nonnarcotic analgesics), phenylbutazone, indomethacin, fenoprof en, ibuprofen, propoxyphene and, in some cases, intra-articular injections of corticosteroids. Such injections, given every 4 to 6 months, may delay the development of nodes in the hands.

Effective treatment also reduces stress by supporting or stabilizing the joint with crutches, braces, cane, walker, cervical collar, or traction. Other supportive measures include massage, moist heat, paraffin dips for hands, protective techniques for preventing undue stress on the joints, adequate rest (particularly after activity) and, occasionally, exercise when the knees are affected.

Surgical treatment, reserved for patients who have severe disability or uncontrollable pain, may include the following:

• arthroplasty (partial or total): replacement of deteriorated part of joint with prosthetic appliance
• arthrodesis: surgical fusion of bones; used primarily in spine (laminectomy)
• osteoplasty: scraping and lavage of deteriorated bone from joint
• osteotomy: change in alignment of bone to relieve stress by excision of wedge of bone or cutting of bone.

Prevention

No absolute way to prevent osteoarthritis is available. But lifestyle changes may reduce or limit symptoms.