Osteoarthritis, frequently referred to as OA, is the most common form of arthritis that predominantly impacts the joints, particularly those located in the hands, knees, hips, neck, and lower back.
It is a degenerative joint disease where the cartilage that cushions the joints breaks down, causing the bones to rub against each other. As the cartilage deteriorates, it leads to inflammation and pain.
According to the Centers for Disease Control and Prevention (CDC), OA affects over 30 million adults in the US. Among those aged 60 and older, the prevalence of symptomatic knee OA is roughly 13% in women and 10% in men. As the U.S. population ages and obesity rates increase, the number of Americans with symptomatic OA is projected to rise substantially. Without intervention, OA threatens to become a national public health crisis.
What are The Symptoms of Osteoarthritis?
Osteoarthritis causes a variety of symptoms that can range from mild to severe, depending on the joint affected and severity of the disease. The most common symptoms are:
Pain
OA leads to pain in the affected joint. The pain can be mild and sporadic or severe and constant. It typically worsens with physical activity or at the end of the day. For example, if your knees are affected by OA, you may experience pain when walking, climbing stairs, or standing for long periods. The pain associated with OA can significantly impact mobility and daily activities.
Stiffness
It is common to feel stiffness in the affected joint, especially after periods of inactivity. For example, if you have OA in your hips or knees, you may feel very stiff when you first wake up in the morning or after sitting for a long time. Moving around and stretching usually helps improve the stiffness, although it may return after prolonged activity or inactivity.
Swelling
The inflamed joint tissue can lead to swelling around the affected joint. The area may look visibly puffy or swollen, and feel warm to the touch. The swelling can come and go, and may be worse after increased activity or at the end of the day.
Reduced range of motion
As OA progresses, the joint cartilage continues to break down and the joint space narrows. This leads to a decreased range of motion in the joint, making it difficult to move freely and easily. Simple daily tasks can become more challenging and painful.
Crepitus
You may hear or feel a grinding, cracking, or popping sensation in the affected joint when moving it. This is known as crepitus, and is caused by the rough, worn down joint surfaces rubbing against each other.
Joint deformity
In severe, long-standing cases of osteoarthritis, the joint can become deformed. Extra bone growths known as bone spurs can form around the joint, and the joint can become misaligned or unstable. This can significantly impact mobility and independence.
What Are The Causes and Risk Factors of OA?
The development of osteoarthritis is complex, involving a combination of mechanical, biological, and genetic factors. At the cellular level, osteoarthritis occurs when the synthesis of cartilage components is outpaced by the degradation of cartilage in the joints. Inflammatory substances called cytokines and enzymes known as matrix metalloproteinases contribute to the breakdown of cartilage tissue.
The exact underlying cause of this imbalance is not fully understood. However, several risk factors are known to increase the likelihood of osteoarthritis development:
Age - As people get older, the cartilage in their joints naturally begins to break down. This aging-related deterioration of joint cartilage is why osteoarthritis becomes more common and severe with advancing age.
Genetics - Having family members with osteoarthritis increases your genetic risk of developing the condition. Certain gene variations appear to contribute to the processes that lead to osteoarthritis.
Obesity - Excess weight puts additional stress and strain on weight-bearing joints like knees and hips. This added stress accelerates the breakdown of cartilage, increasing the risk of osteoarthritis. Losing weight can help reduce the risk.
Joint injuries - Previous injuries to a joint, such as fractures or torn ligaments, can damage the cartilage and lead to osteoarthritis in the future. The risk is higher for severe or repeated joint injuries.
Occupation - Jobs that require repetitive motions or frequent heavy lifting, twisting, and bending can put extra stress on joints and contribute to the development of osteoarthritis.
Gender - Women are at higher risk of developing osteoarthritis, especially after menopause. The loss of estrogen's protective effects on joints may play a role in the increased risk for women.
How is Osteoarthritis Diagnosed?
Getting a diagnosis of osteoarthritis typically involves several steps to thoroughly evaluate the condition.
Medical history
First, the rheumatologist will have an in-depth discussion with you about your medical history and current symptoms. They will ask questions about pain, swelling or stiffness in the joints, how long symptoms have been present, how severe they are, and what makes them better or worse. This helps the rheumatologist understand the impact the symptoms are having on your daily life and activities.
Physical exam
Your rheumatologist will perform a physical examination of the joints, assessing range of motion, tenderness, swelling or warmth. They will move the joints in different directions to determine where pain or limited mobility may occur.
Imaging tests
Additional tests are often needed to visualize the joints and confirm an OA diagnosis. These may include:
X-ray can show loss of joint space, bone spurs, and other changes consistent with OA. X-rays may be slightly uncomfortable but are not painful.
MRI can provide a very clear view of the cartilage, tendons, ligaments, and bone. MRI is often done if the diagnosis is unclear or before surgical procedures.
Ultrasound can detect inflammation, bone spurs, and other joint abnormalities. An ultrasound is non-invasive but may cause slight discomfort.
What Are The Treatments for Osteoarthritis?
OA itself cannot be cured, as the damage to cartilage is permanent. However, treatment focuses on alleviating pain, improving joint mobility, and slowing further joint damage. Options include the following.
Lifestyle changes and home remedies
Losing excess weight
Exercise
Hot/cold therapy
Assistive devices like canes, walkers, shoe inserts, etc.
Medications
Over-the-counter pain relievers, such as acetaminophen, ibuprofen and naproxen to ease pain and discomfort.
Steroid injections directly into joints can reduce inflammation and relieve pain for weeks or months.
Hyaluronic acid injections lubricate and cushion joints to provide pain relief for some people.
Braces and sleeves
Knee braces, ankles braces, elbow sleeves, etc. provide external support and stability while reducing pain. They do not stop joint damage progression.
Surgery
For severe and debilitating joint damage, surgery may be recommended to repair or replace joints.
Procedures like arthroscopy can trim torn cartilage, remove loose bone fragments and repair other joint damage. This reduces pain and improves mobility.
Total knee replacement or hip replacement can be done when joints are severely damaged. Artificial joints help relieve pain and improve function and mobility when other treatments have not helped sufficiently.
What Are The Complications and Prognosis of OA?
As the disease progresses, the breakdown of joint cartilage and other tissue can lead to chronic pain, reduced joint flexibility and range of motion, joint instability and deformity, muscle weakness, impaired mobility and physical function, and an increased risk of falls.
These effects can make even simple physical tasks challenging, limit independence, and isolate individuals from social activities, thereby diminishing quality of life.
The rate of OA progression can differ for each person. Effective treatment approaches may help slow the progression of osteoarthritis and minimize joint damage, especially when implemented early.
Osteoarthritis Care in Orange County
While OA is a progressive disease, the outlook is not bleak. With commitment to self-care and working closely with a rheumatologist, most people with osteoarthritis can significantly improve their quality of life and stay active for years to come.
There are still many enjoyable moments ahead! The dedicated rheumatologists at OC Rheumatology & Arthritis in Orange County are here to help you regain control of your life. Benefit from the latest advancements in osteoarthritis management, including cutting-edge therapies and minimally invasive procedures. Schedule your appointment today and call us at 714-825-0891.
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