Arthritis comes in many different forms. But the most common form of the condition is called osteoarthritis (OA), also referred to as degenerative arthritis. It is commonly referred to as “wear and tear” of the joints, but it is not considered to be an inflammatory arthritis. One in seven US adults (over 32 million Americans) suffer from OA. Therapies and medications for osteoarthritis exist, but if the disease goes untreated, it can progress to a more severe type called advanced osteoarthritis.
What causes osteoarthritis?
OA is a slowly progressive disease that causes breakdown of cartilage in between the joints. Cartilage functions as a cushion in between the bones, and without the cushion, bone and bone come together–leading to pain, stiffness, and swelling of the joints. This is because OA usually affects the hand joints, spine, great toe and weight-bearing joints like the (hips and knees). While getting older is one of the biggest risk factors for OA (half of all people over 65 suffer from the disease), other factors can increase your risk as well. Some of these include:
- Joint injury
- Excessive strain on your joints possibly through sports or manual labor
- Being female
- Genetic predisposition
- Lack of exercise
How does OA affect the body?
Patients who have OA are at higher risk of death due to increased cardiovascular disease. This is likely due to decreased activity because of joint pain as well as increased use of medications such as non-steroidal anti-inflammatories (ibuprofen, naproxen, diclofenac, etc.). Other risks that increase with OA include the following complications:
- Risk of joint infection
- Joint deformities
- Trouble sleeping (due to pain)
How is OA treated?
OA is not a curable disease. But the symptoms of OA can be effectively managed to improve the quality of life. The basic principles of OA management include:
Exercise. OA leads to weakness in the muscles surrounding the affected joint. With effective exercise, strengthening of these muscles could help decrease the pain and improve quality of life.
Weight reduction. Obesity is an important risk factor for OA. Maintaining a healthy weight could help reduce the risk of OA and could also help reduce the pain.
Self management and education
Use of safe medications to manage the pain:
- Pain relievers such as acetaminophen
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen
- Duloxetine and pregabalin
- Topical gels
- Narcotics for severe pain
Medication Choices for OA
The choice of medications depends on the severity of the pain. Acetaminophen is a relatively safe option to treat mild pain, but it is not effective for more severe pain. NSAIDs are more effective to control the pain but have more side effects, in particular the risk of bleeding, kidney and liver problems, and increased cardiovascular disease with prolonged use. Duloxetine and pregabalin are two drugs used to treat seizures and depression that could be helpful for some patients with OA. Injections into the joint may also be used to control the pain of OA temporarily. Narcotics can be used for severe OA pain.
Treatments for advanced OA
In case of advanced OA, medical therapy is not usually effective. At this point, you may need to see an orthopedic surgeon to discuss the surgical options.
- Joint replacement. If a joint is severely damaged, replacing it entirely can help reduce the pain and even restore some normal function.
- Bone realignment / osteotomy. If OA affects one of your knees, you can undergo an osteotomy to correct the mal-alignment of the joint. This could help reduce the pain in the joint.
OA can be a painful disease, but it can be managed to improve your life. Consult with your doctor to find the treatment that will work best for you.
Written by Natan Rosenfeld