Osteoarthritis (OA) also known as “wear and tear arthritis” is the most common form of arthritis. Approximately 46 million people in the United States have symptomatic osteoarthritis, 64% of whom are of working age. The exact cause of OA is unknown but it results in a breakdown in the articular cartilage of joints. The articular cartilage is on the surface of all synovial joints and allows for the joint surfaces to glide together with minimal friction, also acting as a “shock absorber.” The joint is then lubricated with synovial fluid which also helps to maintain the proper viscosity. In OA the articular cartilage becomes damaged and starts to wear away while the synovial fluid also changes in viscosity, resulting in inflammation. Eventually, the articular cartilage deteriorates resulting on a painful “bone on bone” condition.
OA most commonly affects the weight bearing joints including knees and hips. Other commonly affected joints are the hands and fingers, although any joint can be affected with OA. When the weight bearing joints are inflamed, this can lead to disability with daily activities including walking and stair climbing. In the older population this can result in mobility problems, requiring home adaptations and can lead to a loss of independence
You may be concerned about OA if you begin noticing pain and loss of motion in a joint. Your primary care provider will begin by taking a thorough history, documenting your work history, lifestyle, any previous injury and family medical history. They will then perform an examination of the joints looking for deformity, pain, inflammation or a grinding, also known as “crepitus.” X-rays of your joints will be the next step and this will often reveal signs of OA including loss of joint space, erosion of the bone and bone spurs.
Treating OA often begins with lifestyle changes including weight loss and adjusting physical activity levels. Your doctor may recommend switching from high impact activities like running to activities like swimming which cause less stress on the affected joints. Over the counter medications like ibuprofen (Advil, Motrin), naproxen (Aleve), acetaminophen (Tylenol) and glucosamine with chondroitin may be helpful in managing the pain associated with OA, and should only be taken as recommended by your primary care provider.
As arthritis progresses you might be referred to an Orthopedic Surgeon who may recommend additional therapies such as physical therapy or injections. Injections can include the use of cortisone, which can be used on a limited basis, or the use of visco supplementation, in which a gel-like fluid is injected into the affected joint, reducing friction and decreasing pain and swelling. Depending on the extent of damage to your joints, an arthroscopy can sometimes be used to remove damaged tissue, but there is no treatment that will restore the cartilage. Once the joint becomes too damaged then joint replacement may become an option. The most common joint replacement surgeries are Total Hip Replacement Total Knee Replacement, in which the arthritic joint is removed and replaced with metal and plastic prosthetic devices. This requires a stay in the hospital and physical therapy after the surgery. The results are improved mobility, relief of pain and often a return to normal lifestyle.
While OA is most likely to affect each of us as we get older, there are ways to control the symptoms and prevent damage to the joints. Early intervention, a healthy lifestyle and physical activity can all help to limit the pain and disability from this disease. Early evaluation with your medical practitioner will lead you to various treatment options. Helpful information can also be found on websites such as the American Academy of Orthopedic Surgery (aaos.org) Web MD (webmd.com) and the Center for Disease Control (cdc.gov).
Wayne Temmen, PA-C is a certified physician assistant at BMH Orthopaedics & Sports Medicine, a department of Brattleboro Memorial Hospital. Wayne Temmen can be reached at 802-251-8611.