Anand Joshi
Osteoarthritis is the most common form of arthritis. It is the leading cause of disability in older adults and may affect as many as 27 million Americans. There are many different forms of arthritis. However, osteoarthritis is a particular type that can be thought of as damage to the cartilage (the softer cushion within the joint) and an overgrowth of bone (“bone spurs”) when the joint tries to stabilize itself. Because of this, osteoarthritis can affect nearly any joint in the body—most commonly the knees, hips and spinal joints.
This can be a little bit tricky to answer. We must remember that osteoarthritis can show up on an X-ray before a person is aware of it. For example, a person may get an X-ray for a totally unrelated reason, and we may also see some arthritis there. Also, osteoarthritis is more common in some joints of the body but less common in others. There are a few studies that have looked at how common osteoarthritis is, and they have come up with some different results, for various reasons. Also, as many of us know, osteoarthritis becomes more common with age. With all of these factors in mind, the Framingham Osteoarthritis Study is one of the largest ones. This study found that, in adults age 45 and older, osteoarthritis will show up on an X-ray 19% of the time. The same study found that, in the same age group, osteoarthritis will both show up on an X-ray and cause pain/other problems 7% of the time. These numbers apply to the knee and there would be other numbers for other parts of the body and for other age groups. However, to put it all in perspective, osteoarthritis is the most common reason why older adults have trouble walking.
There are several risks for osteoarthritis. Some of them are unique to the individual joint. An example of this is injury to the joint. An injured joint is more likely to develop osteoarthritis in the future. If a joint is shaped abnormally, it is also at higher risk for developing osteoarthritis. Some risks affect the body as a whole. These include older age, female gender, African-American race, genetics and obesity. Of course, some of these risks, like age, gender, race and genetics, are not in our control. However, others, such as obesity are more within our control. Of course, we want to focus on those risks that we can control.
The way that osteoarthritis shows up depends on what parts of the body it affects. Generally speaking though, pain is the most common symptom. Initially, the pain is usually worse when you use the joint and better with rest. However, if the osteoarthritis worsens, the pain may become constant. The affected joint may also be tender, that is, painful to apply pressure to. A joint with osteoarthritis may not be able to move through its full range-of-motion. You may see bony swelling (“bone spurs”) near the joint—these are noticeable near the fingers. A joint with severe osteoarthritis may be deformed and may not be able to support weight.
It is important to remember that we do not yet have a way to reverse osteoarthritis once it has developed. So preventing the problem will be preferred over trying to treat it. One of the most important things that we can control to help prevent osteoarthritis is maintaining a healthy weight. A leading study has found that losing about 11 pounds can reduce the risk of developing osteoarthritis by as much as half! It is easy to see why, when we recognize that 1 pound of body weight translates into about 4 pounds of load on the knee! Staying active and exercising is also felt to have a beneficial effect on the health of the joints.
Yes, there are things you can do keep pain from getting worse and keep the joint working! Even if you have osteoarthritis, it is not too late to reach a healthy body weight and find an exercise program that is safe and enjoyable for you. In fact, resistance exercise has been shown to decrease pain and improve the function of the joint. If you have any difficulty deciding what to do for exercise, consulting with a physical therapist can be helpful. A physical therapist can help you design an exercise program that is tailored to your condition. A physical therapist can even develop a water-based “aquatic” program for you if exercise on land is too painful.
Medication does not reverse osteoarthritis, but can certainly help with the pain. Prescription medications are not always necessary, and in fact, acetaminophen is considered one of the best starting points. More severe pain may benefit from adding a nonsteroidal anti-inflammatory drug (NSAIDs), like ibuprofen or naproxen. Strong prescription opioid medications are usually not recommended, though less potent opioids, such as tramadol may be tried. Not all medications are pills. Some NSAID medications can be applied to the skin or given through a patch.
Glucosamine and chondroitin are among the best-selling supplements that are supposed to help osteoarthritis. Another supplement that is less commonly heard of is called “avocado soybean unsaponifiables”. The benefit of these supplements is controversial, and it may be best to consult with your doctor about whether you should take them or not.
Injections are a way to put medication directly into the joint. They should be considered if the pain is not responding, or if you are waiting on surgery. The most common medications that are injected are steroids (“cortisone”) and hyaluronic acid. Steroid injections are most common. They can be considered to help pain and help the joint move better for up to 3 weeks, but should not be done more often than every 3 months. Hyaluronic acid injections (sometimes called a “rooster comb” shot!) can also be considered, but it is best to remember that several of these injections may be required, and the effect may take several weeks to notice.
A brace is a way to reduce pain and help the stability of the joint. They are not available for all joints and are most commonly available for the knee. They can range from simple, soft knee sleeves, to more complex, custom-designed braces. If you have osteoarthritis in the knee, you may also want to consider an insole for your shoe. These can help reduce the forces on the knee. Remember, these are only effective if you wear them!
A joint with severe osteoarthritis that is very painful and not responding to other treatments may be a candidate for surgery. This type of surgery is called a “joint replacement” and can be referred to as an arthroplasty. Joint replacements are not available for all joints but can be done in the hip, knee, shoulder, elbow, and ankle. Hip replacements are among the most successful of “replacement” surgeries. These are usually done by an orthopaedic surgeon. However, joint replacement is not an option for arthritis of the spine. However, a treatment called radiofrequency ablation is available for painful arthritis of the spine. This is an outpatient procedure done with a needle. The treatment is meant to reduce transmission of pain by disconnecting some of the nerve endings. It is an outpatient and relatively safe procedure. Like all more aggressive treatments, you will want to consult with you doctor first to see if you would be a candidate for joint replacement or radiofrequency ablation.
If a person has some of the complaints above, a plain X-ray of the joint is usually enough to find the osteoarthritis. It is rare to need anything more advanced, such as an MRI. If there are any doubts, it can be helpful to draw some fluid from the joint and examine under a microscope, but this is usually not necessary.
TBD