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Osteoarthritis
April 15, 2008
by Rick C. Chatwell M.D.

Osteoarthritis is the most common form of arthritis worldwide, and is one of the leading causes of disability and pain.  Over 30 million people in the United States have osteoarthritis; however, not everyone has joint symptoms because of it.  The presence of osteoarthritis correlates strongly with age, although that is not the only risk factor.  One third of people aged 65 years and older have knee osteoarthritis that is evident by x-ray, but not all of these people will develop symptoms.  Although the cause of osteoarthritis is not known, risk factors include age, heredity, obesity, joint injury, repeated overuse of certain joints, muscle weakness, and nerve injury.

 

In osteoarthritis, changes occur in the cartilage and bone of the joints. In normal joints, the cartilage provides a smooth gliding surface for joint motion.  In osteoarthritis, the cartilage covering the ends of the bones breaks down, resulting in such symptoms as pain, stiffness, swelling and problems with joint motion.  Osteoarthritis can affect any joint, but most typically the weight-bearing joints of the legs and feet, lower back, neck and hands.  Most people with osteoarthritis describe the onset of their pain as gradual.  Osteoarthritis pain worsens by using the involved joints, and lessens, or is relieved, with rest.  Most patients experience morning stiffness of the involved joints, often less than 30 minutes.  Gel phenomenon, or stiffness after a period of rest or inactivity, is common with osteoarthritis and resolves within several minutes.  Most osteoarthritis patients experience worsening symptoms with changes in the weather.  Characteristically, their symptoms are worse in damp, cool, and rainy weather.  Changes in barometric pressure may also create discomfort.

 

On examination, the findings of osteoarthritis vary with disease severity and are localized to the involved joints.  Bony enlargement is common and limitation of motion increases with arthritis severity.  Malalignment of the joint, crepitus (gravelly noise on joint motion), joint warmth, and joint swelling may also occur.

 

The diagnosis of osteoarthritis can be made by clinical history and physical examination, and confirmed by plain x-rays.  Additionally, routine laboratory tests are helpful in screening for associated conditions and for establishing a baseline for monitoring therapy.  Since osteoarthritis is so common, it may be present simultaneously with other types of arthritis.  There are more than 100 diseases that cause arthritis and other potentially disabling disorders of the joints, muscles, and bones.  Appropriate therapy requires an accurate diagnosis.  A rheumatologist is an internal medicine specialist, who is qualified by additional training and experience in the diagnosis and treatment of arthritis and related disabling disorders.

 

Because of the variable nature of this serious and often disabling disease, the treatment of osteoarthritis must be individualized.  Selecting the best treatment requires a mutual effort by the patient and the physician.  The underlying principles of managing osteoarthritis include relieving symptoms, maintaining and/or improving function, limiting physical disability, and avoiding drug toxicity.  A good treatment program includes patient education, physical and/or occupational therapy, exercise, weight control, and medication.