Osteoarthritis – Diagnosis, Symptoms, and Treatment

What is Osteoarthritis?

Osteoarthritis is a degenerative joint disease that typically affects the weight-bearing joints and produces pain.  The joints in the knees, hips, back, and hands are most commonly affected. Unlike other forms of arthritis, osteoarthritis is almost always seen in the elderly. 

Osteoarthritis is one of the most commonly diagnosed joint diseases.  Although it is not a life-threatening condition, it can lead to severely impaired mobility and decreased quality of life.  Some patients with osteoarthritis may even require surgery to continue with normal daily activities around the home.

What Causes Osteoarthritis?

Osteoarthritis is caused by repetitive stress and injury to the joints.  This leads to episodes of joint inflammation and gradual destruction of the cartilage between the joints.  As a result, the joints become stiff, painful, and have reduced mobility. There are multiple factors that increase the risk of developing osteoarthritis:

• Advanced age
• Being overweight or obese
• Prior injury or trauma to joint
• History of joint surgery
• Repetitive joint use

How Common is Osteoarthritis?

 

Osteoarthritis is the most common joint condition in the United States.  The condition occurs in approximately 10% of men and 13% of women age 60 years or older. The number of patients with osteoarthritis in the United States is increasing significantly due to the aging population and increasing rates of obesity.

Signs and Symptoms

The most common symptom of osteoarthritis is pain in the affected joints.  The pain may be mild to very severe and debilitating depending on the severity of joint disease.  Osteoarthritis can theoretically affect any joint, but the most commonly involved joints include those in the:

• Back
• Hip
• Knee
• Hands 
• Shoulders

The pain of osteoarthritis tends to increase in severity as the joint is used. For this reason patients will have pain that is most severe in the evenings following a day of walking, moving objects, or otherwise using the affected joints. Pain, stiffness, and reduced mobility that is most severe in the mornings upon awakening is less likely to be due to osteoarthritis.

Besides pain, more severe symptoms such as swelling, stiffness, and reduced mobility of the affected joints may appear in patients with severe osteoarthritis. Underuse of the affected joints can lead to the muscles surrounding the joint appearing atrophied or “shrunken.”

Diagnosis

The diagnosis of osteoarthritis will begin with reviewing the history of your symptoms, the joints affected, and other symptoms that are associated with your pain. This diagnosis will be strengthened by a physical examination of the affected joints. Signs such as severe pain with movement, grinding in the joint, and a reduced range of motion, and deformity of the joints will suggest osteoarthritis as a diagnosis. 

 Joint x-ray is typically used to confirm the diagnosis and evaluate the severity of joint disease.  X-rays often show reduced joint space and degeneration of the surrounding bones with bone spurs.

If your doctor is worried about other types of arthritis such as joint infection or rheumatoid arthritis, they may obtain blood tests evaluating for inflammation such as ESR(erythrocyte sedimentation rate), CRP (C-reactive protein), WBC (white blood count).  They may also test for rheumatoid arthritis with an ANA (anti-neutrophil antibody) and RF(rheumatoid factor). These tests are likely to be ordered if you have fever, sudden and severe pain, or pain that is worse in the morning or associated with a recent injury.

Osteoarthritis Treatment

Osteoarthritis is a difficult condition to treat given the significant damage to the joints that is generally present by the time the diagnosis is made. The first step is to reduce the severity of symptoms and the progression of the disease with weight loss, activity modification, and medications to reduce pain and occasional swelling.  

Treatment is focused around allowing the individual to continue using the affected joint through physical therapy and pain control. Inability to use the joint can result in weakness of the surrounding muscles and can increase the severity of pain and rate of disease progression.

Some patients may benefit from certain types of joint braces and may even require the use of mobility aids such as canes, walkers, and wheelchairs.  Very severe cases can necessitate the use of motorized wheelchairs.

Medications that are commonly used to reduce the pain and inflammation seen in osteoarthritis include:

• Tylenol (acetaminophen)
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Advil (Ibuprofen)
• Naprosyn (naproxen)
• Celebrex (celecoxib)
• Mobic (meloxicam)

NSAIDS should generally be avoided in people with high blood pressure, stomach or intestinal ulcers, prior history of gastrointestinal bleeding, the elderly, or people with kidney disease.

Sometimes, your doctor may recommend a corticosteroid injection (eg. Kenalog - triamcinolone) into the joint – this is particularly common in the knee, shoulder, and back osteoarthritis. These treatments can result in a reduction of the inflammation that causes most of the pain in arthritis but are only effective for 1 to 3 months at a time.

Your doctor may prescribe opiates for severe cases or osteoarthritis that are not responsive to the above measures.  This can include medications such as:

• Codeine
• Vicodin
• Tramadol
• Oxycodone

Opiate pain medications should be used at the lowest possible dose and for the shortest duration of time – these medications can be highly addictive and result in drug dependence if misused.  They should especially be avoided in the elderly, as their use is associated with increased risk for fall and hip fracture.

Very severe cases of osteoarthritis that do not respond to weight reduction, activity modification, physical therapy, and medications may require back or joint surgery.  Surgery is usually indicated as a last resort in patients with minimal joint function that impairs their quality of life and ability to perform their daily activities. In patients that are otherwise healthy and are able to participate in post-surgery physical therapy, joint replacement surgeries are extremely successful and can result in a total resolution of osteoarthritis symptoms.