By Qaiser Rehman, M.D., Internist and Rheumatologist, South Central Kansas Bone & Joint Center

Osteoarthritis (OA) is the oldest and most common type of joint disease. It affects almost 21 million Americans. It is also known as degenerative joint disease, osteoarthroses and hypertrophic arthritis. Pain and loss of joint motion are the cardinal manifestations of this disease and can result in significant disability. In fact, OA is the second most common cause of long-term disability among adults in the United States. The prevalence and severity of OA increases with increasing age. More than 50% of patients over the age of 65 have X-ray evidence of OA in their knees and these findings are universal in at least one joint among people aged 75 and over. The knee is the most common joint affected and it correlates with obesity. The frequency of OA is similar among men and women aged 45 to 55. However, after 55, the incidence is much more common in women. Fortunately, osteoarthritis is a treatable disease and most patients do very well with the available therapy.

What is Osteoarthritis?

OA is a disease of the joint cartilage. Normally the bones that touch each other in our joints are covered by a thin layer of cartilage that provides smooth gliding and cushioning of the joint. Several risk factors predispose to cartilage loss and arthritis including trauma, other bone and joint diseases, aging, repetitive injury and some metabolic diseases. It is characterized by gradual or insidious onset of pain and stiffness in and around the joint associated with limitation of function. The pain, initially mild in intensity is worsened by activity and relieved with rest. Over the years, as the joint tries to repair the cartilage damage, there is bony swelling and spur formation in and around the joint that further limits functional range of joint motion. Small joints of the fingers and the weight bearing joints are the most common sites for OA. Spine, hips, knees and the base of the big toe (the bunion joint) are frequently involved in OA.

What are the treatment options?

Treatment for OA begins with patient education. Therapeutic interventions can be pharmacologic and non-pharmacologic. A comprehensive treatment plans includes both of these modalities simultaneously. The goals of therapy are to relieve symptoms, maintain or improve function, limit physical disability and to avoid drug toxicity.

Non-Pharmacologic: Physical therapy is an essential part of treatment. Range of motion and muscle strengthening exercises are helpful in maintaining joint function and improving pain and disability. Occupational therapists can provide assistive devices and teach joint protection and energy conservation skills. Orthotics such as a cane can help take the load off of a painful hip or knee joint. Regular exercises can keep the muscle and joints healthy and improve balance and well-being.

Pharmacologic: Analgesics such as acetaminophen form the first line therapy for OA. They help control the pain of OA and allow patients to continue their daily activities. Non steroidal anti inflammatory drugs, such as Naproxen, Ibuprofen and Piroxicam, can help decrease the pain and inflammation of OA. A recently approved group of medicines called the Cyclo-oxygenase 2 (COX-2) inhibitors including celecoxib and rofecoxib can be helpful for patients with a history of peptic ulcer disease or significant risk of bleeding in the stomach. If there are signs of inflammation (i.e. redness, swelling, and pain), local joint injection with a corticosteroid may help decrease pain and inflammation significantly and can be repeated up to four times a year in a weight bearing joint. For patients with knee OA who cannot pills, joint injections with hyaluronic acid may be the safest and most effective treatment option. There is some evidence that glucosamine and chondroitin sulfate help decrease the pain and swelling associated with osteoarthritis. Currently a large study sponsored by the National Institute of Health is looking into the efficacy and toxicity of these drugs and results from this study will help define a place for these agents in OA therapy. At this time, these agents are available as nutritional supplements in the United States.

Surgical: The definite cure of osteoarthritis, at present, is possible only using surgical joint replacement. Excellent long-term results have been obtained with knee, hip and even shoulder joint replacement. There is a significant improvement in pain, disability, and quality of life following these procedures.

As our nation ages, we will be seeing many more patients with osteoarthritis. Fortunately we have good treatments available to keep our patients pain-free and able to perform activities of daily living. Current research is focusing on ways to prevent cartilage damage and loss, halt the disease progression and regenerate of joint cartilage.