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Living With Osteoarthritis
|Definition: Osteoarthritis is also called wear and tear arthritis or degenerative joint disease.
What Is Osteoarthritis?
Osteoarthritis is the most common form of arthritis. It occurs when the protective cartilage on the end of your bones breaks down over time. As a result bones are exposed and begin to grate against each other causing pain when you move. As time goes on the bones thicken and lumps can grow on the sides called bone spurs or osteophytes. Fluid filled cysts can also occur and the surrounding area may become inflamed. Despite the suffix '-itis' which implies inflammation, the pain associated with osteoarthritis is due primarily to loss of cartilage rather than inflammation. Osteoarthritis tends to occur in weight-bearing joints like the hips, knees, spine, big toe and thumb. Unlike bone, cartilage cannot repair itself. Once it’s gone, it’s gone. Any damage is irreversible. That means, there is no cure for osteoarthritis. Treatment can only reduce symptoms and delay the progression of the disease.
What Causes It?
Primary osteoarthritis occurs when the cartilage (the protective tissue that surrounds the ends of bones, allowing them to glide over each other when we move) wears away. The exposed bones grate against each other, causing friction and pain. Eventually the bones grow lumps on the sides and develop fluid filled cysts which make movement even more difficult. In some cases, osteoarthritis runs in the family. No single gene has been pinpointed; it is more likely that several genes are involved. However scientists have identified one gene mutation (gene defect) that affects collagen, an important component of cartilage, that has been found in people with an inherited kind of osteoarthritis. Women with knee arthritis (associated with cartilage break down) in particular may pass this gene onto daughters.
Osteoarthritis can also develop in a joint which has suffered an injury (this is known as secondary osteoarthritis), or it can occur in joints damaged by other types of arthritis such as gout and rheumatoid arthritis. Diseases like hypothyroidism, diabetes or Paget’s disease can increase your risk of osteoarthritis. Being obese may also be a contributory factor as excess weight places strain on weight bearing joints.
What Are The Symptoms?
For some people with osteoarthritis changes are so subtle, appearing gradually over time, that they are hardly notice them. For others, symptoms worsen considerably over fewer years. Signs include:
Location: Symptoms usually start on one side of the body (although it can spread to the other side eventually).
Pain: Pain only usually occurs when you move the affected joint (unlike rheumatoid arthritis where the joint aches, even if you don’t move it).
Stiffness: Joint(s) may feel stiff after a period of inactivity, such as first thing in the morning when you wake.
Loss of movement: Lack of full range of movement of the joint.
Grating sensation: High pitched grating noise (called crepitus) when the joint is moved. However cracking and creaking noises can also occur in ‘normal’ joints and does not necessarily indicate anything is wrong with the joint.
Bone spurs: Feel like little hard lumps of extra bone around the affected joint.
Lumps on the fingers: Called Heberden’s and Bouchard’s nodes, these lumps can develop on the middle or end joints of the fingers.
See: symptoms of osteoarthritis for more...
Osteoarthritis In The Knees
Unless osteoarthritis is caused by an injury, it is likely to affect both knees eventually (although it may start in one knee). You will experience pain when walking, particularly when going upstairs or uphill. The knees may ‘lock’ making it difficult to straighten the leg. Or the knee may suddenly give way if you put pressure on it. There may also be a soft, grating noise when you move. See, knee arthritis.
Osteoarthritis In The Hips
Anything that requires hip movement causes pain, such as putting on your shoes or getting in and out of a car. You will also feel pain while walking. Although hip pain is common, you may also feel pain in the knees, or even the thighs, ankles or buttocks. See, hip arthritis.
Osteoarthritis Of The Hands
The thumb, top joint of the fingers (closest to the nail) or the middle joint of the finger can be affected. The fingers can be swollen and painful. Some bumps can appear on the joints. Eventually pain may permanently disappear but the fingers remain knobbly looking. See, arthritis of the hand.
How Is It Diagnosed?
Your doctor will take a history of your symptoms. For example, he will want to know which joints are affected and if pain only occurs when you use move those joints. He will check for signs of lumps around the joints and whether there is any sign of crepitus when the joint is moved. Finally an X-ray or MRI scan will be ordered to find out if there is cartilage loss. Even if osteoarthritis is suspected, your doctor may want to perform some blood tests. These will check for disorders that can co-exist with osteoarthritis such as gout (uric acid crystals accumulating in the joint), rheumatoid arthritis or pseudogout (calcium crystals gathering in the joints). See, osteoarthritis diagnosis for more ...
How Is It Treated?
Antiinflammatory drugs (like aspirin or Tylenol) are not effective in treating osteoarthritis although they can be effective painkillers. This is probably because osteoarthritis rarely involves inflammation. An exception is osteoarthritis of the hip which for some unknown reason is often relieved with nonsteroidal anti-inflammatory agents like Tylenol typically used for rheumatism. For more, medications for osteoarthritis.
Cortisone shots injected directly into the joint can give almost instant pain relief, but the number of shots you receive in a year are limited because it can cause joint damage. Alternatively lubrication injections (Hyalgan, Synvisc) can offer some pain relief by providing temporary cushioning in the joint.
Ultimately the only way to definitively treat a troublesome joint is to replace it with an artificial one. This surgery is called arthroplasty. Surgery should only be considered where the patient is so advanced that pain interferes with sleep. Occasionally a surgeon will attempt a less radical surgery, by for example fusing osteoarthritic joints together (so they no longer grate; downside: mobility is restricted). This is usually done on the joints of the big toe, thumb or hand. Young people with knee deformities (bowlegs or knock-knees) that predispose them to osteoarthritis may be offered a surgery called tibial osteotomy. A wedge of bone is removed from the shin bone to realign their legs. The major disadvantage of this surgery is that the patient will need crutches for several months.
For more: osteoarthritis treatment
Natural Treatments For Osteoarthritis
Exercise: Gentle exercises like swimming, biking, walking, yoga and tai chi can help strengthen the muscles around the joints. If you feel new joint pain, stop. It means you have done too much.
Weight loss: Losing weight has little effect on symptoms of osteoarthritis once degeneration of the cartilage has begun. Doctors usually recommend weight loss to obese patients because it reduces the risks associated with surgery, should it be required. It may also help prevent or delay the development of symptoms in other joints.
Hot and cold therapy: In the early phases of the condition both heat and cold can relieve pain. Over the counter creams or gels from the drugstore can help numb pain by creating a cooling or heating sensation. Some creams contain compounds of aspirin that are absorbed into the skin. Creams/gels work better on joints that are near the surface of the skin, like the fingers and knees.
Also: natural treatments for arthritis, for information on natural therapies like acupuncture.
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