Osteoarthritis is a chronic disease causing deterioration of the joint cartilage (the softer parts of bones, which cushion their connections to each other) and the formation of new bone (bone spurs) at the margins of the joints.

For most people, the cause of osteoarthritis is unknown, but metabolic, genetic, chemical, and mechanical factors play a role in its development. It is associated with the aging process and is the most common form of arthritis.

It may first appear without symptoms between 30 and 40 years of age and is present in almost everyone by the age of 70. Symptoms generally appear in middle age. Before the age of 55 it occurs equally in both sexes. However, after 55 it is more common in women.

The cartilage of the affected joint is roughened and becomes worn down. As the disease progresses, the cartilage becomes completely worn down and the bone rubs on bone. Bony spurs usually develop around the joint.

Systemic symptoms, sometimes associated with other arthritic conditions, are not associated with osteoarthritis. The joints of the hands and fingers, hips, knees, big toe, and cervical and lumbar spine are commonly affected.

The degeneration of the joint may begin as a result of trauma to the joint, occupational overuse, obesity, or mal-alignment of the joints (for example being bow-legged or knock-kneed).

• gradual and subtle onset of deep aching joint pain
  • worse after exercise or weight bearing
  • often relieved by rest
• joint swelling
• limited movement
• morning stiffness
• grating of the joint with motion
• joint pain in rainy weather

Note: There may be no symptoms.

A physical exam can show limited range of motion, grating of a joint with motion, joint swelling, and tenderness.

An x-ray of affected joints will show loss of the joint space, and in advanced cases, wearing down of the ends of the bone and bone spurs.

The goals of treatment are to relieve pain, maintain or improve joint mobility, increase the strength of the joints, and minimize the disabling affects of the disease. The specific treatment depends upon the affected joints.

MEDICATIONS

Medications used to treat osteoarthritis include a variety of nonsteroidal, anti-inflammatory drugs (NSAIDs). A two-week trial period is generally necessary to evaluate the benefit of a particular medication.

A new class of drugs (called COX 2 inhibitors) that have the anti-inflammatory effects of NSAIDs, but don't upset most people's stomachs are now used commonly. Celebrex and Bextra are the currently available forms of this type of drug.

Steroids, which are injected directly into the joint, may also be used to reduce inflammation and pain.

Many people are helped by over-the-counter remedies like glucosamine and chondroitin sulfate. There is some evidence that these supplements are helpful in controlling pain, although they do not appear to grow new cartilage.

Artificial joint fluid (Synvisc, Hyalgan) can be injected into the knee and lead to temporary relief of pain for up to six months.

LIFESTYLE CHANGES

Exercises are important to maintain joint and overall mobility. Physical therapists and occupational therapists can prescribe an appropriate home exercise treatment. Exercises done in water are often effective for increasing mobility.

Heat and cold treatments, protection of the joints, the use of self-help devices and rest are all recommended.

Good nutrition and careful weight control are important. Weight loss for overweight individuals will decrease the mechanical strain placed on the joints of the lower extremities.

PHYSICAL THERAPY

Physical therapy can be useful to improve muscle strength and the motion at stiff joints. Therapists have many techniques for treating osteoarthritis, each of which some patients find helpful. If therapy is not helping after 3-6 weeks, then it will likely not be of benefit.

SURGERY

Surgery to replace or repair damaged joints may be needed in severe, debilitating cases. Surgical options include:

• arthroplasty (total or partial replacement of the deteriorated joint with an artificial joint -- see knee arthroplasty, hip arthroplasty)
• arthroscopic surgery to trim torn and damaged cartilage and wash out the joint
• osteotomy (change in the alignment of a bone to relieve stress on the bone or joint)
• arthrodesis (surgical fusion of bones, usually in the spine)

Disability with osteoarthritis is less common than with rheumatoid arthritis, but movement may become very limited. Treatment generally improves function.

• decreased ability to walk or perform activities of daily living (personal hygiene, house chores, cooking, etc.)
• complications from treatments including adverse reactions to drugs or surgical complications

Call your health care provider if you have symptoms of osteoarthritis.

Weight loss can reduce the risk of developing knee osteoarthritis in overweight women.