OSTEOARTHRITIS
A CONDITION OF WEAR AND TEAR

Osteoarthritis (OA) is the most common form of arthritis. More than 23 million Americans have OA. Over one-third are women. The vast majority are 45 years or older. Most people believe that OA is a natural consequence of aging, but heredity and injury are equally strong risk factors.

Osteoarthritis occurs when the protective cartilage that covers the joint wears away. The joint space narrows, bone spurs form, the joint becomes inflamed, and the nerve endings become irritated.

People with osteoarthritis usually complain of joint pain after any activity involving that joint. Morning pain and stiffness are also common, but usually resolve after 15 to 30 minutes. Over time, as the cartilage continues to wear, pain often increases.

The hands, feet, knees, hips and spine (cervical spine/neck and lumbar spine/low back) are the most common areas affected by OA. Osteoarthritis of the hands often strikes the base of the thumb, at the end and middle joints. It is also common in the base of the big toe, and foot pain is worsened by tight shoes and heels. People with OA of the hips feel pain in their groin and thighs, which sometimes travels or “refers” to the knee. People with OA of the knee complain of pain and stiffness around the joint.

Osteoarthritis can severely restrict mobility and movement. Osteoarthritis of the hip and knee can cause pain with even simple weight-bearing activities, such as walking. Osteoarthritis of the hands impairs activities that require dexterity and hand strength. Pain due to OA of the spine often increases when rising from a sitting or lying position, and worsens with prolonged standing or walking.

A diagnosis of osteoarthritis is based on patient history, a physical exam, and x-rays. X-rays show narrowed joint spaces (due to loss of cartilage) and spur formation. Laboratory studies may also be performed, and results will be normal if it truly is OA. (An abnormal lab result may suggest that there is another cause of the pain, or may indicate that two types of arthritis are present.)

There is no cure for osteoarthritis. Treatment focuses on relieving pain, reducing inflammation and improving joint motion. Common medications used to treat OA include both prescription drugs and over-the-counter medications, including acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, and COX-2 inhibitors2 like Celebrex®. Glucosamine is another treatment that some patients find helpful with the pain of OA, and is available over the counter. A large clinical trial at the National Institutes of Health (NIH) is underway to determine the safety and effectiveness of glucosamine in OA. In addition to drug therapy, people with osteoarthritis are usually encouraged to exercise, which increases flexibility and builds muscle strength. Controlling body weight is another good strategy because it helps to lessen stress on weight-bearing joints. Surgery is also sometimes recommended to relieve pain in damaged joints, or to replace joints that are severely damaged.)

The above information about osteoarthritis is from Dr. Zashin's book, Arthritis Without Pain, a comprehensive guide for patients considering or undergoing treatment with the TNF blockers Enbrel®, Remicade®, or Humira®. All rights reserved.

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