Osteo arthritis is a condition that affects the joints, or specifically the cartilage that cushions two bones within the joints. The cartilage breaks down and provides less cushion, resulting in pain, swelling and deformity. Osteoarthritis is also known as degenerative arthritis because of the nature of the disease.
The wear and tear on the cartilage is degeneration and increases with frequency as people age. In fact, there are now over 27 million people in the United States alone who suffer from degenerative arthritis. Individuals who have suffered an injury to a joint will often find as they age these joints are at greater risk for developing wear and tear arthritis.
The joints which are typically affected are the knees, hips, big toe, finger and spine. When a joint is affected, not only does the cartilage disintegrate but bone spurs can also develop. The combination of these two factors are what contribute to the development of pain.
Osteoarthritis is most common in individuals who are over age 40, even more common over age 60. People who develop degenerative arthritis at a young age or in unusual joints, such as the shoulder, without history of an injury, should be screened for hemochromatosis. This is a condition in which the body has too much iron that is deposited in the joints and organ systems. When found the early, further damage to both joints and organ systems can be prevented.
People can suffer from secondary osteoarthritis, meaning it is caused by another condition. Individuals who are obese, have repeated trauma or surgery, abnormal joints from birth, chronic gout, diabetes or other hormonal disorders are at higher risk for developing secondary osteoarthritis.
Obesity causes mechanical stress on the cartilage and, next to aging, is the most powerful risk factor for developing degenerative arthritis of the knees. Repeated trauma to joint tissue will lead to early degenerative arthritis, such as soccer players and baseball players. However, recent studies have not found an increased risk of osteoarthritis in long distance runners.
Individuals who are born with abnormally formed joints are more vulnerable to wear and tear, causing early degeneration. Hormonal disturbances such as diabetes or growth hormone disorders are also associated with the early damage and secondary osteoarthritis.
At this time there is no treatment that will prevent the progression or cure the disease. However, there is conflicting evidence about using glucosamine, chondroitin, vitamin D and vitamin C in combination to reduce the damage to the joints and deformity. (1,2,3)
Treatment protocols will include rest, ice, elevation and specific exercises designed to improve the strength of the muscles which support the damaged joints. Physicians will refer patients to a physical therapist who will initially provide an exercise program to help reduce the stress on the joints. Weight loss is another significant treatment option to help reduce the stress on the cartilage, especially in the knees and hips.
Osteoarthritis causes enlargement of the small joints of the fingers. Classic bone changes at the end of the fingers are called Heberden\’s nodes, named after a British physician. The deformity is the result of bone spurs. Another common bone deformity is a Bouchard node. While these deformities are not usually painful they are associated with a limitation in motion, and therefore function.
Osteo arthritis that develops at the base of the big toe will lead to the formation of a bunion because it alters the function of the bones of the feet during ambulation, or walking. Degenerative arthritis in this location is often a result of damage done to the cartilage from repeated gout flareups. At other times there is a genetic basis found in those who suffer from degenerative arthritis, specifically in the toes and fingers.
There are no current blood tests which are definitive so physicians rely on a thorough medical history, physical examination and imaging studies which allow them to see the damage done in the joints. Arthrocentesis may be performed in the office to remove fluid for analysis. All of this information in combination with the character of the symptoms, the appearance of the joints and the results of the studies give physicians the information they need to accurately diagnose degenerative arthritis.
Unfortunately, there is no specific treatment protocol which has found to reduce the progression and decrease the pain. Physicians rely on pain medications, physical therapy, icing or heat, reduced damaging physical activity, increased strength of the muscles that support the joint and emotional support for the patients in order to help them manage sufficiently. Surgery is reserved for those individuals who have been unresponsive to conservative treatment or who have lost significant function.
(1) DukeHealth: Vitamin C Worsens Knee Osteoarthritis in Animal Study
http://www.dukehealth.org/health_library/news/7640
(2) American College of Rheumatology: Low Vitamin D Levels May Worsen Osteoarthritis of the Knee
http://www.sciencedaily.com/releases/2007/11/071109202444.htm
(3) British Medical Journal: Effects of Glucosamine, Chondroitin or Placebo in Patients with Osteoarthritis of Hip or Knee: Network Meta-analysis
http://www.bmj.com/content/341/bmj.c4675.full