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Osteoarthritis: Ways to Cope with a Common Disability

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Osteoarthritis

This short video illustrates how Osteoarthritis causes the cartilage with a joint to deteriorate as a person ages.

Osteoarthritis -- It's the most common form of arthritis, affecting more than 21 million people in the U.S., and it's one of the most frequent causes of disability among adults.

By age 65, more than half of the population has X-ray evidence of osteoarthritis (OA) in at least one joint, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. In addition, OA accounts for most hip and knee replacements.

"Osteoarthritis is a highly debilitating and painful condition suffered by millions of people," states Marc C. Hochberg, M.D., M.P.H., head of the Division of Rheumatology and Clinical Immunology at the University of Maryland Medical Center and a professor of medicine at the University of Maryland School of Medicine.

OA, or degenerative joint disease, is characterized by the breakdown of the joint's cartilage. Cartilage is the slippery tissue that covers the ends of bones in a joint. When the cartilage breaks down, it causes bones to rub against each other, resulting in pain and loss of movement. Over time, the joint may lose its normal shape. In addition, bone spurs may grow on the edges of the joint. Pieces of bone or cartilage can break off and float inside the joint space, causing more pain and damage.

OA most often occurs in people over 45, but some younger people get it from a joint injury. Both men and women get the disease, but after age 50, women are more commonly affected. OA most often occurs in the hands, hips, knees, neck and spine.

Causes/Risk Factors

Many factors can cause or lead to osteoarthritis including heredity, obesity, joint injury, and overuse of certain joints.

Genetics often play a key role. According to Hochberg, genetic factors account for about half of OA in the hands and hips and a smaller percentage of OA in the knees.

So who is most likely to get OA? Hochberg says higher-risk groups would include those with a parent or older sibling affected by OA, or a person with a congenital or developmental disease of the hip, knee or lower limb.

"Frequently OA runs in families and affects multiple family members," said Danuta. Bujak, Ph.D., FNP, instructor of medicine at the University of Maryland School of Medicine (Division of Rheumatology and Clinical Immunology).

In fact, The University of Maryland Medical Center is part of an international research network that has launched the largest study ever to find the genetic susceptibility for OA.

"Finding a genetic basis for the disease will open up whole new possibilities for finding effective treatments and even preventive measures for this condition," said Hochberg, who is the principal investigator of the study.

Besides genetics there are other risk factors, such as participation in sports such as football, baseball and soccer.

Hochberg says that people involved in sports that involve high-intensity, acute, direct joint impact from contact with other players, playing surfaces or equipment do have an increased risk of OA. Football is a good example.

"Sports that involve both repetitive joint impact and twisting also have an increased risk of OA, such as soccer and baseball pitching," he said.

Much of OA in men can also be attributed to occupational activities, particularly jobs requiring kneeling or squatting, along with heavy lifting.

In addition, Bujak points out that people often sustain injuries in the course of regular exercise because they are not using the proper techniques and are not warming up. "Imagine all those people who are constantly exercising, running on cement and pavement, not wearing proper shoes. They are getting injured. Once you have a torn cartilage it precipitates the process of OA," she said.

Weight also plays an important role. "People who are obese (overweight) have great problems with weight-bearing joints (hips and knees). If they lose weight and can control it, they will have a lesser degree of OA then people who do not," said Bujak.

OA Treatments

Usually, doctors will try to use non-medication treatments first, and then progress to drugs if necessary. It all depends on the severity of the disease, said Bujak.

"If someone has a mild form of OA, first we use heat, ice and rest," said Bujak. "Then we start them on physical therapy because what really accelerates the destruction of the joint (like the knee) is poor muscle tone. We can also use Tylenol, some acupuncture and myofacial release. When the pain becomes more severe, we go to medication."

Hochberg said non-drug therapies are fundamental to the overall treatment approach, and should focus on:

Patient education (self-management programs, i.e., arthritis self-help courses, home exercise routines, telephone support by health professionals)
Physical/occupational therapy (range-of-motion exercises, quadriceps strengthening exercise, elastic support bandages). Make sure footwear gives proper support.
Weight loss/control to prevent extra stress on weight-bearing joints.
Exercise programs that include training for strength and endurance. Exercise can help patients regain or maintain motion and flexibility through low-intensity movements that don't increase pain.
Ice or heat treatments for temporary pain relief.
Supportive devices such as canes, crutches walkers or splints.
Shock absorbing footwear and other devices can help OA of the knee. Studies suggest that heel wedges in the shoes can be an alternative to knee replacements in certain cases of OA of the knee.
Complementary and alternative therapies, including nutritional supplements such as glucosamine and chondroitin sulfate and acupuncture. See related article.
Surgery, which involves replacing the damaged joint with an artificial one, may be considered when OA pain can't be controlled by other methods.

OA Medications

There are many different medications used to treat OA, including:

Various forms of acetaminophen (such as Tylenol) are typical over-the-counter examples. Doctors recommend them for initial treatment because they are safe and work as well as ibuprofen andnaproxen.
Topical analgesics (pain-killing preparations put on the skin). These are used with oral medications when only one or two joints are involved.
Nonsteroidal anti-inflammatory drugs (NSAIDs). These are used to treat pain and swelling. However, traditional NSAIDs pose a significant risk of gastrointestinal (GI) side effects such as ulcers and bleeding. Examples of NSAIDs are:
- Over-the-counter preparations. These include ibuprofen and naproxen.
- Prescription preparations.
- COX-2 inhibitors. These new drugs inhibit inflammation-related enzymes and are good painkillers. "Their biggest advantage is their low risk of GI side effects," says Hochberg. "Recent studies show COX-2 inhibitors are significantly safer than traditional NSAIDs. COX-2 inhibitors are as effective as other NSAID drugs." Hochberg advises patients who are over 60 or have other risk factors of upper GI problems to take COX-2 instead of other NSAIDs.

Steroid injections into the joint. Steroids are used to treat local inflammations (swelling, warmth and redness).
Opioid analgesics (narcotic painkillers). Opioids are suggested for older patients with OA who cannot have surgery and for those who decide against having surgery.

Reduce Your Risk of OA

Hochberg says several steps can be taken to prevent or delay the onset of OA:

Maintain ideal body weight. Losing weight can reduce the risk of OA. It is estimated that eliminating obesity could lead to the prevention of 25 to 50 percent of cases of OA in adults. "It's important to maintain normal weight in adolescence, young adulthood and middle-age," says Hochberg.
Strengthening the quadriceps muscles can help maintain or increase stability of the knee joint. Hochberg says a relatively small increase in strength can lead to a 20-30 percent decrease in risk of OA.
Use appropriate sports equipment and physical training to stabilize joints. Hochberg suggests that individual counseling, rule changes, changes in equipment and playing surfaces and training can help reduce injuries.
Exercise properly and use proper techniques to avoid injuries. "We need to train people who are exercising in proper techniques so they don't get injured, especially now that everybody is so health conscious," Bujak said. "Everyone wants to be physically fit. We have to know how to do it. Exercising in a healthy way will prevent injury and strengthen the muscles."
Maintain good posture. Good posture protects the joints in your neck, back, hips and knees.
Avoid excessive physical activity if there is a history of joint injury.
Be careful when lifting heavy objects. When lifting or carrying, use your largest and strongest joints and muscles. This will help you avoid injury and strain on your smaller joints.
Get your daily requirements of vitamins C, D and E. According to some studies, antioxidants, both natural and supplemental, may protect against knee osetoarthritis progression. This is particularly true for vitamin C and may be for E and D. So be sure to consume the recommended daily requirements of vitamins, including C, D and E.

Looking for more information?

For more information on arthritis disease, research, and treatment, visit the Arthritis Foundation
The National Institute of Arthritis and Musculoskeletal and Skin Diseases is a service of the National Institutes of Health. Its mission is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases.

By Michelle W. Murray
University of Maryland Medical System Web Site Writer

This page was last updated on: July 22, 2008.

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