Osteoarthritis (Degenerative Joint Disease)

Definition
Osteoarthritis is the breakdown of cartilage in the joints and the  subsequent growth of bone spurs that become inflamed. Healthy cartilage serves as a cushion between the bones in a joint. Osteoarthritis usually affects the hands, feet, spine, hips and knees. People with osteoarthritis usually have joint pain and limited movement.

Causes
Osteoarthritis is usually a condition of aging. The exact cause is  unclear, but it appears to be related to:

• Degeneration of cartilage, which can lead to a total loss of the
  cartilage cushion between the joints
• Bone spurs that form around the joints
• Muscle weakness
• Trauma to or near a joint

Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.

• Obesity
• Genetic factors (osteoarthritis often runs in the family)
• Injury to the joint lining
• Occupations that put stress on joints

Symptoms
Symptoms include:

• Mild to severe pain in a joint, especially after overuse or long periods of inactivity, such as sitting for a long time
• Creaking or grating sound in the joint
• Swelling, stiffness, limited movement of the joint, especially in the mornings
• Weakness in muscles around the sore joint
• Deformity of the joint

Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may include:

• X-rays of the affected joints - to look for cartilage loss, bone damage, or bone spurs
• Blood tests - to rule out other medical conditions
• Arthrocentesis - removal of fluid from the joint for testing

Treatment
There is no treatment to stop the degeneration of cartilage or repair cartilage that is already damaged. The goal of treatment is to reduce joint pain and inflammation and to improve joint function.
 
Treatments may include:
Medications

• Over-the-counter pain medication - acetaminophen (Tylenol) and
  nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen (Advil, Aleve)
• Prescription pain relief medications -
•    Cox-2 inhibitors -  celecoxib (Celebrex) and rofecoxib (Vioxx)
•    Arthrotec - a new NSAID that may reduce the risk for gastrointestinal bleeding
• Viscosupplementation - injection of a substance called hyaluronan into the joint
• Pain relief creams - capsaicin, methyl salicylate, and menthol

Dietary Supplements

• There is some evidence that glucosamine and chondroitin may relieve pain.
• Fish oils have also been noted to reduce inflammation. Increasing the intake of omega?3 fatty acids may reduce osteoarthritis pain and inflammation.

Alternative Treatments
  Some clinicians report that acupuncture has been successful in reducing the pain of osteoarthritis.Hydrotherapy, or spa therapy, is an ancient therapy that uses mineral baths to relieve pain.

Mechanical Aids - Shoes with shock-absorbing soles can provide relief while you are doing daily activities or exercising. Splints or braces help to properly align joints and distribute weight. Knee and wrist joints may benefit from elastic supports. A neck brace or corset can relieve back pain, as can a firm mattress. Canes, crutches, walkers, and orthopedic shoes also can be of benefit to patients with advanced osteoarthritis.

Weight Reduction -  Losing weight can lessen the stress on joints affected by osteoarthritis.  A modest loss of five pounds can eliminate at least 15 pounds of stressful impact on an affected joint. The more weight lost, the greater the benefit.

Exercise and Physical Therapy - Strengthening the muscles supporting an arthritic joint (particularly the knee, lower back and neck) may decrease pain. Swimming and water aerobics are particularly good, because they don't put stress on the joint.

Assist Devices
If you are having difficulty getting around due to arthritis pain, your  doctor might recommend that you install handrails and grips throughout  your home. These are especially useful in the bathroom and shower. You may  need elevated seats (including the toilet seats) if you're having difficulty rising after sitting.

Heat and Ice -Applying heat (with hot water bottles, heating pads, hot paraffin) or  using ice packs can decrease pain.

Steroids -When less potent pain relievers are ineffective, corticosteroid injections to the inflamed joint may be given. Because repeated cortisone injections can be harmful to the tissue and bones, they are reserved for patients with more pronounced symptoms.

Surgery
Surgery can:

• Resurface and smooth out bones
• Reposition bones
• Replace joints
• Remove loose pieces of bone or cartilage from joints

Prevention
To reduce your chance of getting osteoarthritis:

• Maintain a healthy weight.
• Do regular, gentle exercise, including walking, stretching, and yoga.
• Avoid repetitive motions and risky activities that may contribute to joint injury, especially after age 40.

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