Osteoarthritis Treatment

What is Osteoarthritis?

Osteoarthritis is a type of degenerative joint disease that typically affects the weight-bearing joints and produces pain.  The common joints that are affected include the knees, hips, back, and hands.  This condition is most commonly seen in individuals with advanced age.

Osteoarthritis is one of the most commonly diagnosed joint diseases seen in primary care clinic.  Although it is not a fatal condition, it can lead to impaired mobility and decreased quality of life.  Some patients with severe osteoarthritis may even require surgery to improve their functionality and pain levels.

Since this is such a common condition and may affect the quality of life, it is important to become educated about its causes, diagnosis, and treatment.  By the end of this article, you will be able to answer the following important questions:

What causes Osteoarthritis?

Osteoarthritis is caused by repetitive stress and injury to the joints.  This leads to episodes of joint inflammation and eventually degeneration of the cartilage between the joints.  As a result, the joint becomes stiff and painful with reduced mobility.  Certain factors increase the risk of developing osteoarthritis such as:

  • 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 that is present to the primary care clinic in the United States– it is also a frequent reason patients are referred to orthopedic surgeons.  The condition occurs in 10% of men and 13% of women age 60 years or older.  This condition is very prevalent in the United States due to the increasing elderly population and rise in obesity.

What are the symptoms and signs of Osteoarthritis?

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.  Osteoarthiritis can theoretically affect any joint, but the most commonly involved joints include:

  • Back
  • Hip
  • Knee
  • Hands
  • Shoulders

 On physical examination, your doctor will evaluate for swelling, stiffness, and reduced mobility of the joint.  Some of the muscles around the joint may appear atrophied or “shrunken” as they have not been used as a result of joint pain.

Your doctor will also likely evaluate for signs of joint infection such as fever, significant swelling, warmth, or redness in the joint.  People with arthritis of the hand can develop enlargement of the joints in the fingers.  Severe cases are associated with disfiguring shapes and basically no joint function at all.

How is Osteoarthritis diagnosed?

Osteoarthritis may be suggested based on the person’s age, medical history, symptoms and signs on examination.  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).

How is Osteoarthritis treated?

Osteoarthritis is treated with weight loss, activity modification, and medications to reduce pain and occasional swelling.  Patients are usually encouraged to not stop using the joint or resting it completely because this may result in increased pain and worsening joint mobility over time.  Complete rest can also cause the muscles around the joint to weaken and atrophy, which also contributes to impaired mobility and joint function.  Some patients may benefit from certain types of joint braces and physical therapy – they 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 treat 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.

Your doctor may prescribe opiates in cases 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.

Osteoarthritis Patient Summary:

  • Osteoarthritis is an extremely prevalent degenerative joint condition that frequently affects the weight-bearing joints such as the back, hips, and knees.
  • The condition is most commonly seen in the elderly, overweight/obese individuals, people with a previous history of joint injury or surgery, and smokers.
  • The most common symptoms include joint pain, swelling, and mobility.
  • In severe cases, the muscles around the joint shrink due to underuse.
  • The diagnosis of osteoarthritis is typically confirmed with joint x-ray.
  • Treatment includes weight loss, smoking cessation, activity modification, and sometimes physical therapy.
  • Occasionally, your doctor will recommend joint braces or mobility devices such as canes, walkers, and wheelchairs.
  • Medical treatment includes the use of medications such as Tylenol, Advil, Aleve, Naprosyn, Celebrex, and Mobic.
  • Some patients may benefit from corticosteroid injections into the joint – Kenalog.
  • In severe cases, your doctor may prescribe opiates such Codeine, Norco, Tramadol, Oxycodone, or Percocet – this should be used at the lowest dose and for the least amount of time possible.
  • NSAIDs and opiates should generally be avoided in the elderly.
  • Surgery may be recommended for patients with severe osteoarthritis that does not respond to medications and interferes with the quality of life and the ability to perform daily activities.

References:

  1. Sinusas K1. Osteoarthritis: diagnosis and treatment. Am Fam Physician. 2012 Jan 1;85(1):49-56.
  2. Seed SM, Dunican KC, Lynch AM. Osteoarthritis: a review of treatment options. Geriatrics. 2009 Oct;64(10):20-9.
  3. Zhang Y, Jordan. Epidemiology of Osteoarthritis. Clin Geriatr Med. 2010 Aug; 26(3): 355–369.

Popular Osteoarthritis Medications

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.