Osteoarthritis is the most common cause of disability in the United States. Osteoarthritis affects an estimated 27 million Americans. This painful condition develops when there is a breakdown of cartilage in the joints (Shaw, 2012, p.1). Osteoarthritis can occur with age, or it can be caused by a joint injury or stress on the joints from a specific job, sport or being overweight. Over time, some people experience extreme inflammation and permanent damage to the joint. The joint may even need to be surgically replaced. The chance of developing the disease increases with age. Most people over age 60 have osteoarthritis to some degree, but its severity varies. Even people in their 20s and 30s can get osteoarthritis. In people over 50, more women than men get osteoarthritis (Gazella, 2009).
Bone ends are covered with a layer of cartilage and lubricated by a synovial fluid to provide less friction and a smooth surface for the bones to move over each other. The whole joint is enclosed by the synovial sac (Gazella, 2009). In osteoarthritis, the cartilage becomes thinner and rougher while the bone underneath thickens. The ends of the bones start to rub against each other which causes pain and even more damage. The bones try to repair themselves, but this is not very successful, so it results in a more uneven surface of spurs and cracks. The synovium also produces extra fluid, which results in swelling, and there are changes to the ligaments, which cause movement restriction. Muscles may also become weaker Progression is slow and many patients diagnosed with OA will not suffer a great degree of deterioration (Gazella, 2009).
The most common other form of arthritis is rheumatoid arthritis (RA), which has a different pattern of signs and symptoms, although some of the symptoms may overlap. Symptoms of OA can also vary, with flares and remission, which can make diagnosis more difficult. Other factors such as the cold and damp weather often can increase pain. One complication which can occur is calcification, which is when deposits of calcium crystals form in the cartilage to cause further swelling and the joint can become hot and red.
Pain and stiffness in the joints are the most common symptom. The pain is often worse after exercise and when you put weight or pressure on the joint. Your joints may ache, or the pain may feel burning or sharp. For some people, the pain may come and go. Constant pain or pain while you sleep may be a sign that your arthritis is getting worse. When you have arthritis, getting up in the morning can be hard. Your joints may feel stiff and creaky for a short period of time, until you get moving. You may also get stiff from sitting. The muscles around the joint may get weaker. This happens a lot with arthritis in the knee. Arthritis can cause swelling in joints, making them feel tender and sore. Joints can start to look like they are the wrong shape, especially as arthritis gets worse. As it gets worse, you may not be able to fully bend, flex, or extend your joints. Or you may not be able to use them at all. Your joints may make crunching, creaking sounds. This creaking may also occur in a normal joint. But in most cases, it doesn’t hurt and doesn’t mean that there is anything wrong with the joint. The phrase morning stiffness refers to the pain and stiffness you may feel when you first wake up in the morning. Stiffness usually lasts for 30 minutes or less. It can be improved by mild activity that “warms up” the joint (Shaw, 2012).
There are several factors that can increase the risk for developing osteoarthritis, including heredity, obesity, injury, or overuse of certain joints. People born with abnormalities are more likely to develop osteoarthritis. Some people have an inherited defect in one of the genes responsible for making collagen a major component of cartilage; this causes defective cartilage, which leads to more rapid deterioration of joints (Gazella, 2009). Obesity increases the risk of osteoarthritis. Maintaing ideal weight or losing excess weight may help prevent osteoarthritis, or decrease the rate of progression once osteoarthritis is established.
Injuries contribute to the development of osteoarthritis. For example, athletes who have knee-related injuries may be at higher risk of developing osteoarthritis of the knee. In addition, people who have had a severe back injury may be predisposed to develop osteoarthritis of the spine. People who have had a broken bone extending into the joint margin are prone to develop osteoarthritis in that joint (Osteoarthritis, 2009). Overuse of certain joints increases the risk of developing osteoarthritis. Osteoarthritis is not associated with fever, weight loss, or anemia.
As of now there is no known cure for osteoarthritis, but treatments can help to reduce pain and maintain joint movement. Acetaminophen (Tylenol) can relieve pain, but doesn’t reduce inflammation. It has been shown to be effective for people with osteoarthritis who have mild pain to moderate pain. Taking more than the recommended dose can cause liver damage (Mayo Clinic, 2012).
Non-steroidal anti-inflammatory drugs (NSAIDs reduce inflammation and reduce pain. Over-the-counter NSAIDs can cause stomach upset, ringing in your ears, cardiovascular problems, bleeding problems, and liver and kidney damage. Narcotics typically contain ingredients similar to codeine and may provide relief from more severe osteoarthritis pain. These stronger medications carry a risk of dependence, though that risk is thought to be small in people who have severe pain. Side effects include nausea, constipation, and sleepiness (Researchers from National Research Center Describe Findings in Osteoarthritis, 2012).
Working with a physical therapist can help. The physical therapist can work with you to create an individualized exercise regimen that will strengthen the muscles around your joint, increase the range of motion in your joint and reduce your pain. Find ways to go about your day without stressing your joints. Consider trying splints, braces, shoe inserts or other medical devices that can help reduce your pain. These devices can immobilize or support your joint to help you keep pressure off it (Gazelle, 2009). The Arthritis Foundation and some medical centers have classes for people with osteoarthritis or chronic pain. These classes teach skills that help manage osteoarthritis pain. Injections of corticosteroid medications may relieve pain in the joint. During this procedure the doctor numbs the area around the joint, and then inserts a needle in the space within the joint and injects medication. The number of cortisone shots you can receive each year is limited, because the medication can cause joint damage (Mayo Clinic, 2012). Injections of hyaluronic acid derivatives may offer pain relief by providing some cushioning in your knee. These treatments are made of rooster combs and are similar to a component normally found in your joint fluid (Mayo Clinic, 2012).
In joint replacement surgery (arthoplasty), the surgeon removes the damaged joint surfaces and replaces them with plastic and metal devices called prostheses. The hip and knee joints are the most commonly replaced joints. Surgical risks include infections and blood clots. Artificial joints can wear out or come loose and may need to eventually be replaced (Shaw,2012).
Medications and other treatments are key to managing pain and disability, but another major component to treatment is your own attitude. Your ability to cope despite pain and disability caused by osteoarthritis often determines how much of an impact osteoarthritis will have on your everyday life. Make a plan with your doctor for managing your arthritis. This will help make you feel that you’re in charge of your disease rather than vice versa. Studies show that people who take control of their treatment and actively manage their arthritis experience less pain and function better (Mayo Clinic, 2012). It is also important that you know your limits. Rest when you think it might be needed. Arthritis can make a person feel fatigued and makes that person prone to muscle weakness, a deep exhaustion that makes everything you do a great effort. Resting or taking a short nap that doesn’t interfere with nighttime sleep may help a great deal.