is one of the more than 120 forms of arthritis which can occur
in patients. Osteoarthritis, also known as OA, osteoarthrosis,
or degenerative joint disease (DJD), is the type of arthritis
that almost everyone develops in their lifetime. It is a form
of arthritis that develops gradually, usually occurring sometime
after the age of 45. OA is usually chronic in nature but fortunately
occurs most frequently as a relatively mild condition. Some
patients, however develop more severe symptoms requiring treatment
and even joint replacement.
OA - The Five
W's - Who What Where When Why
exactly is osteoarthritis?
is the type of arthritis involving the cartilage of a joint.
The cartilage of a joint is a tough, gristle-like material
which is found on the ends of the bones. It forms the surface
of the joint on either side. Cartilage is durable and somewhat
elastic. It does not have a blood supply and therefore gets
its oxygen from the joint fluid surrounding it. When you use
a joint, fluid and waste products are removed from the cartilage
by the pressure involved. When pressure is relieved, oxygen
and other nutrients are returned to the cartilage. Cartilage
also has no nerve supply. It is this characteristic that allows
large forces to be transferred without pain. Over time, the
cartilage may become worn. The bony surface of the joint may
begin to grate against the bone on the other side and the
elasticity of the cartilage may be decreased. Eventually the
cartilage may wear away entirely. This cartilage deterioration
is, in fact, what defines osteoarthritis. Unlike some other
types of arthritis, OA does not affect the whole body. However,
the changes which it can cause may limit patients due to pain
and loss of movement.
does OA occur?
can occur in any joint and may occur only on one side of the
joint. Usually it is seen in the joints of the fingers, spine,
hips, and knees. These joints fall into three common types
of osteoarthritis(1). The first and usually mildest
is the OA which affects the hands, causing knobby enlargement
of the finger joints. When this occurs at the end joints of
the fingers, these enlargements are called Heberden's nodes.
Growths in the middle of the fingers are called Bouchard's
nodes. This type of OA may cause stiffness and changes in
the cosmetic appearance of the hand.
second type of OA involves the spine. This can involve the
neck area as well as the back. Bone spurs are symptoms of
arthritis not necessarily the cause of pain.
third type of OA commonly seen involves the weight-bearing
joints, most frequently the hips and knees. This form of OA
can become quite severe and limiting, or may only periodically
cause symptoms. In extreme cases walking may become extremely
difficult or impossible. This type of OA frequently involves
both sides of the body, and may cause a deformity in the lower
extremity due to the degeneration process.
does OA occur?
can develop as a natural process of aging or it may occur
as a result of a traumatic injury such as a fracture. Patients
who have a congenital malformation of a joint also tend to
develop OA at an earlier age than normally seen.
common idea in past years was that osteoarthritis developed
because of "wear and tear" or over-use of a joint.
Research studies of people who participate in strenuous activities
have failed to show a relationship between these activities
and the development of arthritis. Furthermore, most experts
agree that a patient, even when diagnosed with OA, needs to
continue a program of exercise to maintain optimal function
of the joint.
does OA occur?
one knows for sure what causes osteoarthritis. Some experts
believe that people are born with defective cartilage or abnormalities
in their joints which lead to the changes seen in OA. Others
believe that OA develops as a result of over-using an already
injured joint or because of joint damage caused by other arthritic
conditions. Research into the causes, prevention, and treatment
of OA as well as other types of arthritis continue to provide
improved methods for the relief of symptoms and will continue
to aid in the understanding of these disease processes.
mentioned earlier, there are over 120 types of arthritis.
Correctly diagnosing the type of arthritis a patient has
may take several visits to a physician and perhaps a referral
to a rheumatologist, a physician who specializes in the
diagnosis and treatment of people with various forms of
arthritis. While OA can be slow to cause any noticeable
symptoms, once symptoms occur it is important that a physician
be involved in your care. By seeking medical attention early,
you may prevent or decrease serious joint damage. You also
will be able to work with your physician in developing a
treatment plan which is individualized for your needs and
tailored to your lifestyle.
and symptoms of osteoarthritis can be difficult to assess,
however, it is important to make a diagnosis of OA correctly
to ensure the optimum treatment plan. The American College
of Rheumatology has established guidelines for the diagnosis
of OA2. These guidelines, included in Table 1
and Table 2 establish the classification criteria as well
as the signs and symptoms of OA. As indicated by these tables,
diagnosis is based on patient history and exam, blood tests,
and x-rays. Certainly if you or a family member are demonstrating
any of these symptoms you should strongly consider a formal
visit to your physician.
Classification criteria for osteoarthritis
the hip (3,4)
pain and at least 2 of the following:
sedimentation rate <20 mm/hr
femoral or acetabular osteophytes
joint space narrowing
the knee (3,5)
pain and radiographic osteophytes and at least 1 of
stiffness <30 min in duration
S, ©1998, by The McGraw-Hill Companies, Inc.
Signs and symptoms of osteoarthritis (3)
of range of motion
and/or joint deformity
S, ©1998, by The McGraw-Hill Companies, Inc.
of osteoarthritis has two goals as its main objectives. The
first goal is to decrease the pain and discomfort you may
be experiencing. The second goal is to decrease any disability
you may have.
of treating osteoarthritis vary according to each individual's
needs. In some cases non-pharmacological treatment may be
started, with the patient educated in physical and occupational
therapy programs to achieve the goals of decreasing pain and
disability. More involved cases of osteoarthritis may require
pharmacological management with regular monitoring by your
physician as well as physical and occupational therapy programs.
In several cases, especially those involving the weight bearing
joints, surgery may become necessary to decrease the pain
Treatment of osteoarthritis has three goals:
Methods of treatment vary according to an individual's needs.
methods for patients include:
changes - education of patients and family members, weight
loss, diet instruction, energy management tips and joint preservation
techniques can all be effective and useful management tools.
therapy - with emphasis on maintaining the patients joint
motion, muscle strength, and ambulation
therapy - to assist patients in maintaining independence and
self reliance in performing activities of daily living.
times a physical and occupational therapist will work together
with the patient to not only supply the necessary instructions
needed, but also the equipment and ideas to simplify tasks
osteoarthritis is a degenerative process and not an inflammatory
one, pharmacological treatment can be managed in several ways.
(Tylenol) - initially, this may be the drug of choice and
clearly has a lower incidence of side effects than other agents
which may be used.
or NSAIDS (non-steroidal anti-inflammatory medications) are
frequently used if patients do not respond to Tylenol. Gastrointestinal
complications are more likely to occur in this group, with
this risk being increased threefold in patients treated with
medications such as darvon, codeine, or in some cases other
narcotic agents, can be helpful in short term management of
injections - not usually recommended in early treatment, joint
injections may be helpful to elderly patients or patients
in which other medications are ineffective or unsafe to use.
are many over-the-counter nutritional supplements that claim
they can improve the symptoms of arthritis. These supplements
should be discussed with your physician. Many of these supplements
have not been scientifically studied or proven to be of benefit
to the patient.
much interest has been generated in the use of glucosamine,
chondroitin sulfate, or the combination. Laboratory and clinical
studies have suggested that these materials, which are the
building blocks for cartilage, may have a positive effect
on cartilage and arthritis. One nutritional supplement, Cosamin
DS, is a patented combination of these two materials. In a
small clinical study, this combination was shown to improve
the pain and function in patients with mild to moderate osteoarthritis.
We are currently involved in a larger study to evaluate this
studies that we have participated in have evaluated the application
of electrical stimulation to the treatment of patients with
osteoarthritis and rheumatoid arthritis of the knee and hand.
The latest study indicated that treatment with Bionicare®
Electrostimulation was effective in delaying the need for
prosthetic reconstruction in patients with severe OA of the
knee. As this treatment becomes available, it may be a useful
method for certain types of arthritis.
- Various surgeries may be beneficial
to patients with osteoarthritis, especially when the joints of
the lower extremities, or weight bearing joints, are involved.
Surgeries which can be performed are:
of the hip or knee
K., Fries, P.H., James, F., The Arthritis Helpbook, 4th
ed., Addison-Wesley Publishing Co., 1995.
S., Clinical Evaluation of the Patient with Osteoarthritis,
Postgraduate Medicine Special Report, McGraw-Hill Healthcare
Information Programs, August 1998.
M.C., Altman, R.D., Brandt, K.D., et al., Guidelines for
the Medical Management of Osteoarthritis, Arthritis Rheum.,
38 (II): 1535-1546, 1995.
R., Alarcon, G., Appelrouth, D., et al., The American College
of Rheumatology Criteria for the Classification and Reporting
of Osteoarthritis of the Hip, Arthritis Rheum., 34 (5):
R., Asch, E., Block, D., et al., Development of Criteria
for the Classification of Osteoarthritis of the Knee, Arthritis
Rheum., 29 (8): 1039-1049, 1986.