Osteoarthritis 101: The Basics

Adapted from the Spring 2011 issue of HealthConnection


Mary K. Crow, MD

Physician-in-Chief, Hospital for Special Surgery
Chair, Department of Medicine, Hospital for Special Surgery
Chief, Division of Rheumatology, Hospital for Special Surgery, New York Presbyterian Hospital and Weill Cornell Medical College
Senior Research Scientist, Hospital for Special Surgery
Professor of Medicine, Weill Cornell Medical College
Attending Physician, Hospital for Special Surgery and New York Presbyterian Hospital

Osteoarthritis is a disorder that affects the lives of 27 million Americans. It triggers pain in the joints that limits mobility and daily activities, potentially turning mundane tasks such as buttoning a shirt or walking the dog into an endurance test. The disease is the nationís number one musculoskeletal disorder. Many impacted by it suffer because they are unaware of the broad range of innovative treatment options available to help them.    

There are steps you can take, even starting today, to reduce your risk of developing the condition if you donít have it, and to live with less pain if you do. Incorporating physical activity into your daily routine and adopting healthy eating habits to achieve a healthy weight are excellent first steps. Hospital for Special Surgery offers guidance and treatment to get you on your way.

What Is Osteoarthritis?
In its simplest terms, osteoarthritis involves the breakdown of cartilage in your joints ó most commonly in the knees, hips and hands. This spongy tissue normally acts as a shock absorber between the bones in each joint. But over time, and particularly with age or injury, the cartilage breaks down due to normal wear and tear. In early-stage osteoarthritis, the cartilage has started to deteriorate, but the bones are unaffected.

As years pass, the bones lose this protective cushion, and they can rub against each other, causing the pain that characterizes osteoarthritis. This progression marks the later stage of the disease.

Arthritis specialists are increasingly learning that thereís more to the story than wear and tear: inflammation appears to play a role as well. Studies have shown that many people with osteoarthritis have inflammatory cells in their joints, especially among those who have suffered an injury (such as a torn meniscus or anterior cruciate ligament [ACL] in the knee) that puts them at an increased risk for developing osteoarthritis.

Research is demonstrating that in addition to mechanical damage to a joint, an individualís response to that damage may influence the onset of osteoarthritis. And if doctors can understand what factors promote arthritis progression, they might be able to intervene earlier ó such as by guiding patients to help them lose weight. With more research, we might even be able to define medical approaches that would prevent progression of joint damage.

Who Is at Risk?
While osteoarthritis can affect anyone, there are some risk factors that can increase your chance of developing the condition:

  • Being obese: Obesity is the leading cause of osteoarthritis development and makes pain worse in those who already have the disorder. The increased stress on your joints increases wear and tear. In addition, the proteins produced by fat cells might contribute to the development of inflammation in the joints. Losing just 10 pounds not only helps ease osteoarthritis pain, but can also help slow the rate of cartilage degeneration.
  • Being over age 65: The inevitable changes in tissue that accompany the aging process promote the development of arthritis. Symptoms may begin in the 40ís and 50ís.
  • Prior musculoskeletal injury: Any kind of injury to the bones, joints, and tendons can raise your risk of osteoarthritis. Young athletes who sustain a sports injury may develop osteoarthritis earlier as adults. People who have been injured need to have regular check-ups and Xrays to keep a watchful eye on their joints. (See page 3 for more information about athletes and osteoarthritis.)
  • Being female: About twice as many women as men suffer from osteoarthritis. While it is not completely clear why there is this disparity, there are some theories that exist.
  • Family history: If you have family members with osteoarthritis, you might, too; however, research to study genetic factors related to osteoarthritis risk has not yet identified specific mutations that commonly predispose individuals to the disease. You can assess your risk of osteoarthritis using the online Risk Assessment Tool located at http://www.fightarthritispain.org/, in the ďResourcesĒ section. This web site, created by the Arthritis Foundation, also provides guidance on how you can manage your arthritis risk.

What Are the Symptoms?
By far the most common symptom of osteoarthritis is recurring joint pain. This pain may present in the following ways:

  • Pain when you move the joint. The same joint hurts, especially during weight-bearing activities, and lessens when you stop moving. Some people also hear a crackling sound that occurs when the joint moves.
  • Pain and stiffness may be worse at certain times of day. Some people experience their worst joint pain when they first wake up, while others experience more discomfort at the end of the day.
  • Limited range of motion. As osteoarthritis progresses, the affected joints may lose their range of motion. Inflammation and swelling may develop, causing more pain.
  • Osteoarthritis symptoms may also differ depending on which joints are affected. People with arthritis in the hips may feel pain in the groin, inner thigh and buttock, which may extend to the knee and cause limping. Knee arthritis may cause pain and a grating or a catching feeling with movement. Osteoarthritis in the fingers can cause pain, redness and swelling in the joints which make it difficult to pick things up. Some people with arthritis in the fingers develop bony growth spurs in the joints at the middle or ends of the fingers.
  • Joint pain can be caused by a number of diseases. If you have experienced any of these symptoms, it is important to see a doctor to determine what is causing your symptoms, so you can take measures to start managing them as early as possible.

Making the Diagnosis
If you have joint pain, your doctor will do a series of examinations to determine the cause. The first is a physical examination to look for any swelling and to assess your level of pain, range of motion, and muscle strength. If your pain is in your knees or hips, your doctor may also look at how it is affecting your walking (gait). It is important to tell your doctor about your medical history, such as prior injuries and the nature of your pain.

X-rays can help visualize what is happening inside a joint, particularly if any wearing-down of the bone has begun. They can also be used to show cartilage deterioration, because the bones of a joint will move closer together when this happens. Magnetic resonance imaging (MRI) is very helpful for demonstrating bone and soft-tissue changes in arthritis at an earlier stage, while computed tomography (CT) scanning is valuable for assessing early bony changes, including bone spurs.

In some patients with suspected osteoarthritis, ultrasound is useful for imaging cysts. Your doctor may also do blood tests or withdraw some synovial fluid from a joint for analysis to rule out other causes of joint pain and to confirm a diagnosis of osteoarthritis.

What You Can Do
If you are at risk for developing osteoarthritis or are diagnosed with this condition, your doctor will discuss ways you can reduce your risk or slow its progression. By far the most effective and tangible way is to achieve and maintain a healthy weight, as well as strengthen your joints and maintain flexibility.

The management of osteoarthritis may require a team approach, bringing together your primary care physician, a rheumatologist (joint specialist), sports medicine doctor, physiatrist (rehabilitation medicine specialist), orthopedic surgeon, dietitian, and/or physical therapist as needed.

Your healthcare team may recommend anti-inflammatory drugs such as ibuprofen or naproxen to manage your symptoms, or prescription drugs such as celecoxib. Some patients benefit from joint injections or mechanical adjustments that shift the pressure being put on a joint, such as custom orthotics to be worn in your shoes to relieve hip or knee pain.

If, despite these measures, joint damage and pain in the knees or hips become so severe that they significantly interfere with your daily activities, your health care team may recommend joint replacement to get you back to your normal routine as quickly and comfortably as possible.

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