What is Osteoarthritis?
Osteoarthritis, or OA, is the most common type of arthritis around the globe. There are two main kinds: primary osteoarthritis and secondary osteoarthritis. Usually, osteoarthritis causes joint pain and makes it hard to move; however, the symptoms can vary greatly from person to person. Some people might not have any symptoms at all, only discovering they have osteoarthritis during a checkup for something else. On the other hand, for some people, osteoarthritis can be very severe, leading to permanent disability.
What Causes Osteoarthritis?
Osteoarthritis (OA), a type of arthritis, can occur due to several factors. These include getting older, being a woman, being overweight, having weak muscles, and having experienced an injury to the joint due to work or sports activities.
The most common type of osteoarthritis is “Primary OA.” This means it happens on its own and is not caused because of an injury or another disease. However, the risk factors mentioned earlier can increase the chances of developing this type of OA.
There’s also a type called “Secondary OA,” which occurs when there’s already an issue with the joint. These issues could be due to a past injury, birth defects in the joint, inflammation of the joint, bone death due to poor blood supply, infection in the joint, or other diseases like Paget’s disease or osteopetrosis. It could also come from conditions affecting the overall body like metabolic disorders (such as hemochromatosis, a condition where there’s too much iron in the body, or Wilson’s disease, where there’s too much copper), blood conditions, or inherited conditions like Ehlers-Danlos syndrome or Marfan syndrome, which affect the body’s connective tissues.
Risk Factors and Frequency for Osteoarthritis
Osteoarthritis, or OA, affects approximately 3.3 to 3.6% of the global population and is responsible for causing moderate to severe disability in about 43 million individuals. This makes it the 11th most debilitating disease worldwide. In the United States, markers of OA are found in about 80% of people over the age of 65, as shown by radiographic images. However, only 60% of those people actually experience symptoms. This indicates that not everyone with OA will show symptoms of the disease. In 2011, the United States recorded nearly 1 million hospitalizations due to OA, total costing around $15 billion. This makes OA the second most expensive disease in the country.
- Osteoarthritis (OA) affects around 3.3 to 3.6% of people worldwide.
- It causes moderate to severe disability in about 43 million people globally.
- In the United States, about 80% of individuals over 65 have signs of OA in radiographic scans.
- Despite this, only 60% of these individuals actually have symptoms of OA.
- Radiographic signs of OA do not always correspond with the conditions symptoms.
- In 2011, nearly 1 million hospitalizations were due to OA, costing about $15 billion, making it the second most expensive disease in the United States.
Signs and Symptoms of Osteoarthritis
Osteoarthritis (OA) is a condition that affects different people in various ways. The most common symptoms include joint pain, stiffness, and difficulty in movement. Other symptoms can include muscle weakness and balance problems.
The joint pain associated with OA usually gets better with rest and worsens with activity. As the disease advances, people may experience persistent pain that interferes with their daily activities. Other signs of OA can include swelling around the joints, deformation of the joint, and feelings of instability. Some people describe this as their joint ‘giving way’ or ‘buckling’—an indication of muscle weakness.
OA commonly affects the joints in the fingers, thumb base, hips, knees, toes, and the neck and lower back. It can either affect one joint (monoarticular) or multiple joints (polyarticular). Different joints can be in different stages of the disease. Typical signs seen during a physical exam include swelling of the joint, a crunchy sound or feeling inside the joint (crepitus), fluid around the joint (non-inflammatory), and limited range of movement. The joints can also be tender to touch, and moving the joint might cause pain.
Specific physical findings in OA affecting the hand include Heberden’s nodes (swelling on the finger joints closer to the fingertips), Bouchard’s nodes (swelling on the middle joints of the fingers), and a ‘squaring’ appearance at the base of the thumb.
- Joint pain, stiffness, and difficulty in movement
- Muscle weakness and balance problems
- Joint swelling and deformation
- Feelings of joint instability (‘giving way’ or ‘buckling’)
- Effects on various joints, including fingers, thumbs, hips, knees, toes, and the neck and lower back
- Possibility of affecting one or multiple joints
- Swelling of the joint, crepitus, fluid around the joint, and limited range of movement
- Tenderness and pain at the joint lines
- Specific physical findings in hand OA: Heberden’s and Bouchard’s nodes, ‘squaring’ at the thumb base
Testing for Osteoarthritis
When assessing patients, doctors conduct a thorough review of their medical history and carry out a specific physical examination, which involves checking the body’s muscles and joints. Osteoarthritis (OA), a type of joint disease, can be reliably diagnosed if certain conditions are met, such as: The patient’s pain increases with activity and decreases with rest, the patient is over 45 years old, the patient experiences stiffness in the morning that lasts less than half an hour, there are visible enlargements in the joint bones, and the patient’s movement range is limited. However, other conditions that can produce similar symptoms, such as rheumatoid arthritis, psoriatic arthritis, and bursitis, should also be considered.
Usually, blood tests like a complete blood count (CBC), erythrocyte sedimentation rate (ESR), rheumatoid factor, and ANA tests are normal in patients with OA. But doctors may perform these tests to ensure that the joint inflammation is not stemming from other types of arthritis. If fluid from the joints is tested, it’s normal for OA patients to have less than 2000 white blood cells per micro-liter of fluid, mostly mononuclear cells, which are not associated with inflammation.
Doctors can look for signs of OA with X-rays of the affected joint, which may show marginal osteophytes (bony projections along the edges of bones), a narrowing of space within the joint, a hardening of the bone beneath the cartilage, and cysts. These X-ray findings, however, do not necessarily measure the disease’s severity, and they may not be present in the early stages of the disease. Though MRI scans are not routinely used for diagnosing OA, they can identify OA earlier than X-rays. Ultrasounds might also be used, as they can show inflammation of the synovium (the soft tissue that lines the spaces of diarthrodial joints, tendon sheaths, and bursae), fluid accumulation, and osteophytes, all of which can indicate OA.
There are several ways to categorize OA, including looking at which joints are affected, the patient’s age when symptoms began, the appearance of the joints on an X-ray, the suspected cause of the arthritis, and how quickly the disease is progressing. The classification system used by the American College of Rheumatology is the most widely accepted. At the moment, it is not possible to predict which patients will develop severe OA and which ones will experience early-stage symptoms.
Treatment Options for Osteoarthritis
The aim of treating Osteoarthritis (OA), a type of joint disease, is to lessen pain and maintain functionality. OA treatment encompasses two types: non-medication therapies and medication therapies. Patients with less severe symptoms can often be treated effectively with non-medication methods, but those with more advanced OA usually require both methods combined.
Key strategies of non-medication therapy include: 1) evading activities that worsen pain or put extra stress on the joint; 2) exercising to build strength; 3) losing weight; 4) occupational therapy to lessen the strain on joints using braces, splints, canes, or crutches. Especially in overweight and obese patients, weight loss can greatly alleviate the stress on the knee. Physical therapy can also be very useful; it can assist in the correct use of equipment like canes and direct patients towards beneficial exercises. Programs that incorporate both aerobic and resistance training exercises can lessen pain and boost physical performance. If a joint is not properly aligned, it should be corrected by mechanical means such as a knee brace or orthotics.
OA medications can be administered orally, topically, or injected within a joint. Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are typically the first choice for OA treatment due to their affordability and availability. These are usually initially taken as required rather than on a set schedule. Oral NSAIDs should be used with caution because long term use can lead to digestive, kidney, and heart issues. Topical NSAIDs, though not as effective, have fewer systemic side-effects and are generally safer; however, they can sometimes irritate the skin.
Joint injections can be effective in treating OA, and are especially helpful during severe pain episodes. Glucocorticoid injections have varying success and their repeated use is debated among doctors. Hyaluronic acid injections are another option, though their efficacy is also controversial. Notably, oral glucocorticoids aren’t helpful in treating OA.
Duloxetine, a medication used for depression and nerve pain, can be mildly effective in treating OA, and painkillers can be used in patients who don’t find relief from other treatments, or for those who are not suitable for, or don’t wish to undergo, surgery.
It’s important to note that every patient reacts differently to treatments, so finding the most effective treatment often involves some trials . If all previous treatment options fail for OA specifically in the knee or hip, surgery is the next option. Knee and hip replacements have low failure rates and can Offer great relief from pain and improve functionality. However, the timing of the surgery is crucial. Surgery performed too late in the disease progression, when the patient has lost a lot of muscle strength and function, may not improve functionality as much as when performed at earlier stages.
What else can Osteoarthritis be?
When a patient presents with certain symptoms, doctors will consider different possible diagnoses. These could include:
- Rheumatoid arthritis
- Psoriatic arthritis
- Crystalline arthritis
- Bursitis
- Tendinitis
- Hemochromatosis
- Avascular necrosis
- Radiculopathy (nerve root irritation)
- Other conditions impacting the soft tissues
Each of these conditions could potentially explain the symptoms, therefore they all need to be explored as part of the diagnostic process.
What to expect with Osteoarthritis
The outcome for people with osteoarthritis can vary, depending on which joints are impacted and how severe the symptoms and functional limitations are. Functional limitations refer to difficulties performing daily activities due to the condition. Some people see little effect from osteoarthritis, while others might experience severe disability. In some cases, the best long-term result might come from joint replacement surgery.
Possible Complications When Diagnosed with Osteoarthritis
Common Issues:
- Pain
- Falling down
- Problems walking
- Misalignment of joints
- Decreased ability to move the joint fully
- Nerve root damage causing pain along the nerve path
Recovery from Osteoarthritis
Simple changes to your daily habits, particularly starting exercise routines and working towards weight loss, can greatly improve your wellbeing.
Preventing Osteoarthritis
The medical team must explain the causes and disease process of arthritis to patients in a way they can understand. They also need to share the treatment plan, which will be different for each person, based on factors like the extent of the disease, which joints are affected, how much it’s affecting your day-to-day life, your age, your expected activities in the future, and what treatments are realistically possible. It’s important to follow what the doctors advise; taking all medications as prescribed, attempting to lose weight if needed, and being consistent with any suggested exercise or physical therapy routines.
