Osteoarthritis: Symptoms, Diagnosis and Treatment

Osteoarthritis (OA) is a disease affecting more than 12% of the elderly in the USA. Being the most common form of arthritis it is also one of the leading causes of disability in the elderly. It has been projected that the prevalence of osteoarthritis will rise by 66-100% by 2020.

Symptoms of Osteoarthritis

You might have OA if you experience activity-related joint pain. The pain usually starts during or just after the activity and resolves on rest. If your disease has progressed then you might also experience continuous pain throughout the day and sometimes at night too. You might also experience tenderness in the joints i.e. pain on touching the joint in question. Another common symptom of OA is the stiffness of the joints.

Causes of Osteoarthritis

The bones in our many of our joints are surrounded by a joint capsule. Inside it is the bone, a layer of cartilage covering the bone surface and the synovial fluid. The components of the joint capsule along with the supporting structure of a joint, the muscle and ligaments and the tendons, ensure that the joint works smoothly with the least wear and tear.

OA is a degenerative disease that causes degeneration of the cartilage covering the bone surface leading to erosion of the bony surface during movement. This is accompanied by the formation of an outgrowth of the bone by the margin of the joint which might irritate the joint capsule leading to inflammation.

OA affects specific joints in the body, they include : knee joint, hip joint, joint in the lower back, joint in the neck, joints in the fingers of the hands.

The risk of getting OA increases with age. Females are more prone to get OA compared to males. One of the major risk factors for OA is obesity, which is on a rise in the US. OA is a heritable disease and heritability is joint-specific. Previous history to a joint may increase the chances of developing OA.

Diagnosis of Osteoarthritis

Your doctor would like to obtain an adequate medical history followed by an examination of the joint involved to consider OA as a possible diagnosis. To confirm this, your doctor would like to order some tests like:

• Blood test: although there are no blood tests for osteoarthritis the blood tests help in ruling out other forms of arthritis.
• Joint Fluid analysis: by analyzing the fluid present in the affected joint your doctor would like to know if there are any crystals or blood cells present, to rule out other forms of arthritis.
• X-ray: the loss of cartilage which is one of the identifying features of OA cannot be directly seen on an X-ray, but can be deduced by the reduced space between the bones in a joint. The growth of the bone near the margins of the joint can also be visualized on an X-ray

Treatment of Osteoarthritis

Treatment of OA aims at alleviating the pain and reducing the rate of degeneration of the bones in the joint involved.

• Acetaminophen: the first line of treatment for OA.
• NSAIDs: Non-steroidal anti-inflammatory drugs like ibuprofen and naproxen help in reducing the pain. These drugs, when taken orally for a long time, may cause stomach problems hence topical application of NSAIDs is suggested. These help in relieving the pain the in joint involved without causing major side effects.
• Topical lidocaine and capsaicin may also help in reducing pain.
• Duloxetine
• Gabapentin
• Intraarticular injection of glucosamine sulphate and chondroitin sulphate:  these two glycoproteins are a part of the fluid present in the joint capsule that reduces friction between the joint surfaces. Injecting them into the joint surface helps reduce symptoms in some patients.
• Cortisone injections: injecting steroid-like cortisone into the joint capsule reduces inflammation and hence reduces pain.
• Physical therapy: regular gentle exercise will help in strengthening the muscles around the joints. This will reduce the pain and rate of wear and tear.
• Joint replacement surgery: your surgeon will remove the affected joint surface and replace it with a metal or plastic part.

Resources:

• Clinical Practice Guidelines – American College of Rheumatology
• NICE guidelines for OA.