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Understanding Osteoarthritis

Osteoarthritis is the most common form of the many different kinds of arthritis (it's also the most easily managed).  Osteoarthritis, sometimes called simply OA, is caused by the breakdown of cartilage inside certain joints.  Degeneration of joint cartilage is a part of the aging process; nearly 90 percent of all people over the age of 60 show some signs of osteoarthritis.  Although there is no cure for osteoarthritis, with new drugs, physical therapy, and, in some cases, surgery, it can be managed, allowing you to live a more active life.

Causes and Symptoms
The cause of osteoarthritis is not completely known, but it is associated with the breakdown of the articular cartilage that covers the gliding surfaces of the bones in certain joints.  The normally smooth cartilage becomes rough and pitted, restricting movement and causing pain.

The symptoms of osteoarthritis vary greatly.  For many people, it is only a minor, temporary nuisance.  For others, it can be very uncomfortable.  Painful, stiff joints can keep many people from doing the simple things in life: working around the house, taking a walk, or just getting a good night's rest.

Treatment Goals
Osteoarthritis can't be cured; the degeneration process can't be stopped.  But a balanced treatment program can reduce pain and improve joint function allowing you to become more active.


To better understand osteoarthritis, you need to learn the basic anatomy of the normal, movable joint.  Its major features: 1) the slick articular cartilage covering the bones; 2) the synovial membrane that secretes a lubricating fluid; and 3) the tough joint capsule, encasing the entire joint.

The OA Joint
Osteoarthritis develops when articular cartilage when articular cartilage begins to break down and normally smooth sliding surfaces of the bones become pitted and irregular.  Localized inflammation or swelling may also occur.

The second most common form of arthritis, rheumatoid arthritis (RA) involves the synovial membrane and is characterized by a much greater degree of painful inflammation.


Because there are over one hundred different types of arthritis, a complete medical evaluation is needed to confirm the diagnosis of osteoarthritis.  By knowing which joints are involved and what extent, your doctor can devise a treatment program just for you.  Regular follow-up visits are necessary.

Because OA has a recognizable pattern of pain and stiffness, the diagnosis can often be suspected on the basis of your medical history alone.

Physical Exam
Determining which joints are involved and to what degree their function is impaired helps your doctor to distinguish OA from other forms of arthritis such as RA.  Joints that aren't used because of stiffness and pain will show signs of weakness in the surrounding muscles.

Blood Tests
Blood tests are necessary to be sure that other types of arthritis, such as RA and gout, are not also present.  Blood from patients with RA often contains a "rheumatoid factor," while blood from patients with gout contains an abundance of uric acid.

Changes in joint structure can be seen using x-rays.  Although cartilage cannot be seen directly, its breakdown will show up on an x-ray as a narrowing of the gap between bones.

Joint Aspiration
A few ounces of synovial fluid may be removed from a swollen knee.  The fluid from an OA joint is usually clear, whereas in RA, it is cloudy due to the presence of numerous white blood cells.


Many drugs are available to treat the pain and stiffness of osteoarthritis.  Your doctor will determine which drug program is right for you.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Medications are available for the treatment of the pain and inflammation of osteoarthritis.  The drugs do not contain steroid hormones (hence their name).  The advantage of NSAIDs is that, for many people, they are less likely to cause stomach upset.  However, for some, the drugs may cause other problems.  Should you experience any unusual symptoms while taking NSAIDs, tell your doctor; in many cases, a different NSAID may work as well for you but have fewer side effects.

When an osteoarthritic joint becomes so swollen and painful that movement becomes nearly impossible, and other treatments fail to bring relief, corticosteroids may be helpful.  When injected directly into the inflamed joint, these hormones markedly decrease the swelling of soft tissues and reduce the accompanying pain.  However, corticosteroids have been associated with adverse side effects when given indiscriminately or over a long period of time.  Therefore, corticosteroids should be used only for the relief of occasional problem pain.  Fortunately, in many cases, relief of symptoms may last for months following a single injection.

Body Weight and Nutrition
Excess weight places stress on arthritic joint, especially the hip, knee, and back.  This may lead to pain and further degeneration of cartilage.  To reduce the load on sensitive joints, strive for a weight that suits your height, age, sex, and frame.  By keeping portions small and watching calorie, you can lose weight and still enjoy your favorite foods.


Physical therapy, including exercise and heat treatments, helps to reduce pain and restore joint function by increasing range of motion and by strengthening surrounding muscles.  Your doctor may arrange for sessions after medical treatments have begun.

Application of heat to sore joints is designed to relieve the discomfort of osteoarthritis and reduce muscle spasm.  Ultrasound, hot packs, or immersion into warm wax all brings soothing heat to sore joints.  Heat treatments can be used alone or in conjunction with cold treatments, and may be administered several times a week.  Your physical therapist can teach you some simple methods to use at home to relieve occasional flare-ups of pain.

OA Exercises
Exercises increase joint flexibility and muscle strength.  Your physical therapist may show you exercises.


For pain that doesn't respond to conventional treatment and physical therapy, surgery may be the answer.  With the development of new synthetic materials, total joint replacement surgery has become a practical solution to advanced osteoarthritis.  Although the majority of today's replacements are for the hip and knee, replacements for other joints, such as the fingers, toes, wrists, elbows, shoulders, and ankles, are currently being developed.  But don't expect the new joint to perform as well as the one Mother Nature provided.

Total Hip Replacement
The ball and socket joint in the hip, which carries most of the body weight and is essential for walking can be replaced with a duplicate made of plastic and stainless steel.  After recovery, your doctor will determine when it's safe to resume normal activity.  However, active sports such as tennis or skiing may not be recommended.

Total Knee Replacement
The entire knee joint can be replaced with a mechanical implant.  After recovery, your doctor will tell you when it's safe to resume your normal lifestyle and if you will be restricted to certain activities.  In most cases, pain is relieved and joint function returns.

Your OA Team
Controlling osteoarthritis takes team effort.  The doctor who made the initial diagnosis may refer you to a rheumatologist, a physician specializing in the treatment of arthritic conditions.  Physical therapists are specially trained in techniques that can reduce the pain and stiffness of osteoarthritic joints.  An orthopedic surgeon may provide general medical treatment for osteoarthritis and, if necessary, perform joint replacement surgery on the affected joint.


Many people with osteoarthritis lead normal and active lives.  Medication and physical therapy can help reduce pain and restore movement to stiff joints.  If necessary, joints can be replaced surgically.  Although osteoarthritis can't be cured, it can be managed, allowing you to enjoy a more active and useful life.

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