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WHAT IS OSTEOARTHRITIS (OA)?
It is also called “wear and tear” arthritis or degenerative joint disease, and is the progressive breakdown of the joints’ natural shock absorbers. Discomfort results when you use the affected joints – perhaps an ache when you bend at the hips or knees, or sore fingers when you type. Most people over 60 have some degree of OA, but it also affects people in their 20’s and 30’s.
The symptoms of OA tend to develop slowly. You may experience pain or soreness when you move certain joints or have been inactive for a prolonged period. Affected joints may also be stiff or creaky. Typically, OA leads to morning stiffness that resolves in 30 minutes. When OA affects the hands, some people develop bony enlargements in the fingers, which may or may not cause pain?
OA: WHERE DOES IT HURT?
Mostly, OA develops in the weight-bearing joints of the knees, hips, or spine. It’s also common in the fingers, thumb, neck, and big toe. Unless an injury is involved, other joints are not usually affected.
OA: WHAT CAUSES IT?
All joints have a natural shock absorber – cartilage. This firm rubbery material cushions the ends of the bones and reduces friction in healthy joints. As we get older, joints become stiffer and cartilage is more prone to wear and tear. At the same time, constant use of the joints over the years irritates the cartilage. If it deteriorates enough, bone rubs against bone, leading to pain and reducing range of motion.
RISK FACTORS YOU CAN’T CONTROL
One on the major risk factors for OA is something none of us can control – getting older. Gender is important too. Over age 50, more women than men get OA. In most cases, the condition results form normal wear and tear over the years. However, some people have a genetic defect or joint abnormality that makes them more vulnerable.
RISK FACTORS YOU CAN CONTROL
Injured joints are more prone to OA, so doing anything that damages the joints can raise your risk. This includes sports that have a high rate of injury and jobs that require repetitive motion. Obesity is another risk factor, especially for the hip and knee joints.
OA: IMPACT ON DAILY LIFE
OA affects each person differently. Some people have few symptoms despite severe joint degeneration. Others undergo pain and stiffness that may affect daily activities. If bony knobs develop in the small joints of the fingers, tasks such as buttoning a shirt can become a problem. OA of the knees or hips can cause a limp. And OA of the spine can cause serious pain and/or numbness.
To assist doctor to make an accurate diagnosis you need to describe your symptoms in detail, including the location and frequency of any pain. Doctor will examine the affected joints and may order X-Rays or other imaging studies to see how much damage there is, and to rule out other joint problems. Sometimes blood tests are needed to rule out other forms of arthritis.
LONG TERM COMPLICATIONS
Rheumatoid arthritis can affect the body’s organs and cause illness. Not so with OA. But it can lead to deformities that take a toll on mobility. Severe loss of cartilage in the knee joint can cause the knees to curve out, giving a bow-legged appearance. Bony spurs along the spine can irritate nerves, causing pain, numbness or tingling in some body parts.
TREATMENT: PHYSICAL THERAPY
No treatment can stop the erosion of cartilage in the joints, but there are ways to improve joint function. Physical therapy is one of these, to increase flexibility and strengthen muscles around the affected joints. The therapist may also apply hot or cold therapies such as compresses to relieve pain.
Finger splints or knee braces can decrease stress on joints and ease pain. Canes, crutches or walkers may be helpful if walking is difficult. People with OA of the spine may benefit from switching to a firmer mattress (not too firm) and wearing a back brace or neck collar.
MEDICATIONS FOR OA
For OA flare-ups, over-the-counter anti-inflammatory pain relievers, or acetaminophen (Tylenol, Paracetamol), may give relief. Pain-relieving creams or sprays can help when applied directly to the sore area. If there is pain despite pills or creams, doctor may suggest an injection of steroids directly into the joint. This should not be done too often.
Supplements. Overall studies suggest no benefit of glucosamine and chondroitin – supplements available at pharmacies and health food stores touted for relieving pain and stiffness for people with osteoarthritis. If your doctor prescribes them, ask a question. If you decide to use chondroitin, don’t do so while taking blood-thinners.
OA AND WEIGHT
Losing weight cuts down on pain and reduce long term damage; even modest weight loss is beneficial to weight-bearing joints.
OA AND EXERCISE
Low-impact activities like swimming, walking or bicycling can improve mobility and increase strength. Light weight training can strengthen muscles that surround your joints. For example, quadriceps strengthening can reduce pain in the knees.
IS SURGERY FOR YOU?
If OA badly interferes with everyday life and symptoms don’t go with physical therapy or medication, joint replacement surgery is an option. The knee, hip, and shoulder are most often replaced.
The most important way is to keep your weight in check. Preventing injuries is also important. Be careful on the job, and use proper equipment and observe safety guidelines if you play a sport.
See you next week.
Dr. Emanuel, based in the Commonwealth of Dominica, has been an educator of medical professionals, in training and the public, for over 20 years.