|By Rachel Kaiser, MD, MPH, FACP, FACR, CCD
Arthritis and Rheumatism Associates, P.C.
Osteoarthritis (OA) is one of the most common causes of disability worldwide. OA can involve any joint but most commonly affects the hands, knees, hips and spine. Symptoms include pain in one or more joints with motion that worsens with activity (e.g., knee pain after walking). OA can lead to deformity of the joints (see hands in Figure 1) as well as decreased function and quality of life.
Risk factors for developing this painful degenerative form of arthritis include being female, prior joint injuries, aging and obesity. Historically thought of as a “wear and tear” type of arthritis (e.g., wearing out of the cartilage or joint cushion), the causes now are thought to be more complex and remain under investigation to find better targeted treatments for this disease. There is no cure for OA but it can be managed well.
In most situations, your doctor can make the diagnosis of Osteoarthritis by talking with you and conducting a physical exam. Sometimes x-rays can be helpful when establishing the diagnosis but they are not always necessary. The x-ray images on page 2 illustrate joint space narrowing of the knee over time as the cartilage wears out. There are no lab tests that can make this diagnosis but some tests can help rule out other forms of arthritis.
There is no medication that prevents or slows down the progression of Osteoarthritis. Weight loss is the only intervention clinically proven to slow progression of OA in the lower extremities. While running and other highimpact activities do not seem to cause arthritis, once you have it, it is best to abstain from such high-impact activities to avoid accelerating the progression of OA.
Exercise is important to maintain joint health. Both aerobic and aquatic exercise can be helpful. Reaching and maintaining your ideal weight is very important. Studies have shown that even a small amount of weight loss can improve pain and function significantly. Physical therapy can help str engthen muscles around the joints and reduce pain, increase flexibility and improve function. For some patients, physical therapists may recommend an assistive device, such as a cane.
Pain medications used to treat osteoarthritis include topical pain applications (e.g., Voltaren Gel) for hand and knee arthritis. Acetaminophen is the first-line choice of oral medication followed by anti-inflammatories, which have a higher side-effect profile. For some patients, Duloxetine, a chronic pain medication also approved for treating the pain of OA, can help, especially if other medications are contraindicated.
Narcotics rarely are indicated in the management of Osteoarthritis. In certain patients, injections (steroids or hyaluronic acid) into a joint can provide several months of pain relief.
Finally, if unacceptable pain and lifestyle limitations continue once conservative management is exhausted, a joint replacement may be indicated, especially for hip and knee OA.
Some studies have suggested that the supplements Glucosamine and Chondroitin can help with pain, but most did not confirm this finding. As a result, the American College of Rheumatology does not recommend using this combination of supplements to treat OA. Some studies have shown that acupuncture can be useful, especially for Osteoarthritis of the knee. Knee braces may be helpful when managing Osteoarthritis of the knee, but studies have been inconclusive.
Finally, changes in diet (e.g., gluten-free diets) have not been shown to affect pain or progression of osteoarthritis.