All About Osteoarthritis

The Facts about Osteoarthritis (OA) Most common form of arthritis Approximately 20.7 million Americans suffer form the disease. 3 times as many women suffer from the disease than men. Form of arthritis from wear and tear Source “Osteoarthritis ”. Arthritis Foundation. 2 April, 2003. http://www.arthritis.org Notes Who Is At Risk? Osteoarthritis affects an estimated 20.7 million Americans, mostly after age 45 Women are more commonly affected than men Other Information OA is responsible for more than 7 million physician visits per year Eighty percent of people with OA report some form of limitation in movement or activities Knee OA can be as disabling as any cardiovascular disease except stroke As many as half the people who have OA do not know what type of arthritis they have and cannot make informed decisions about their care because treatment options vary among the more that 100 forms of arthritis Musculoskeletal conditions such as OA cost the U.S. economy nearly $125 billion per year in direct expenses and lost wages and production Dynomed, Inc. “Osteoarthritis: Know the Risk Factors, Symptoms, Medications and Other Available Treatments”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.AllAboutArthritis.com Osteoarthritis is the most common form of arthritis affecting one out of eight people between the ages of 18 and 79. According to the Arthritis Foundation, approximately three times as many women than men suffer from osteoarthritis. Source: www.AllAboutArthritis.com, 2003 www.arthritis.org, 2003 V112

What is Osteoarthritis? The covering on the ends of bones gradually wear away, becoming frayed and rough. Known as “wear and tear” arthritis Usually develops due to many years of use and affects people middle-age and older. Targets hands and weight-bearing joints, such as knees, hips, feet and back. Source “Osteoarthritis”. American Academy of Orthopaedic Surgeons. 2 April, 2003. http://orthoinfo.aaos.org. Notes In the progressive disease osteoarthritis (OA), the covering on the ends of bones gradually wears away, becoming frayed and rough, like sandpaper. This can make it painful to move the joint. Also known as "wear and tear" arthritis, OA usually develops after many years of use and affects people who are middle aged or older. Other risk factors for OA include obesity, injury to a joint and family history of osteoarthritis. Source: www.aaos.org , 2003 V113

Warning Signs of Osteoarthritis Signs include: Steady or intermittent pain Stiffness Joint swelling or tenderness Crunching sound when moving Source National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases. “Warning Signs of Osteoarthritis”. About, Inc. 2 April, 2003. http://www.physicaltherapy.about.com Notes The Warning Signs of Osteoarthritis Steady or intermittent pain in a joint Stiffness after getting out of bed Joint swelling or tenderness in one or more joints A crunching feeling or sound of bone rubbing on bone Hot, red, or tender? Probably not osteoarthritis. Check with your doctor about other causes, such as rheumatoid arthritis. Not always pain. Not everyone with osteoarthritis feels pain. In fact, only a third of people with osteoarthritis in their x rays report pain or other symptoms. Osteoarthritis Source: www.physicaltherapy.about.com , 2003 V114

Risk Factors for Osteoarthritis Age- 45 yrs or older Gender- majority of sufferers are women Certain hereditary conditions, including defective cartilage and malformed joints Joint Injuries caused by physical labor or sports Obesity Diseases that change the normal structure and function of cartilage, such as rheumatoid arthritis, Paget’s disease, gout or pseudogout Source Mayo Clinic. “Osteoarthritis: Risk Factors”. Mayo Clinic. 2 April, 2003. http://www.mayoclinic.com Notes The exact causes of osteoarthritis are unclear, but these factors increase your risk: Being 45 years old or older Being female Having certain hereditary conditions, including defective cartilage and malformed joints Having joint injuries caused by physical labor or sports Being obese Having diseases that change the normal structure and function of cartilage, such as rheumatoid arthritis, hemochromatosis, Paget’s disease, gout or pseudogout. Source: www.mayoclinic.com , 2003 V115

Symptoms of Osteoarthritis Symptoms usually come on slowly. Pain and inflammation Pain may develop gradually and feel like a deep ache. Swelling and stiffness May be worse in the morning and feel better with activity. Loss of range of motion “Sticking” and weakness Loose fragments of cartilage and other tissue can cause locking or “sticking”. Joint may also lose strength and buckle or lock. Source “Osteoarthritis”. American Academy of Orthopaedic Surgeons. 2 April, 2003. http://orthoinfo.aaos.org. Notes Symptoms Osteoarthritis can affect any joint in the body, with symptoms ranging from mild to disabling. A joint affected by OA may have pain and inflammation, swelling and stiffness, loss of range of motion, "sticking" and weakness. Pain and inflammation. Without cartilage, bones rub directly against each other when you move, causing pain and inflammation. Joint pain usually develops gradually and may feel dull or aching. Pain may be worse in the morning and feel better with activity. Vigorous activity may cause pain to flare up. Swelling and stiffness. The joint may stiffen and look swollen, enlarged or "out of joint." A bump may develop over the joint. Loss of range of motion. Motion may be limited if bending the joint becomes difficult. "Sticking" and weakness. Loose fragments of cartilage and other tissue can cause locking or "sticking" when you use the joint—it may creak, click, snap, or make a grinding noise (crepitus). The joint may lose its strength (atrophy) and buckle or lock. See a doctor right away if you have symptoms of osteoarthritis. Although osteoarthritis cannot be cured, early identification and treatment can slow progression of the disease, relieve pain and restore function. Source: www.aaos.org , 2003 V116

Diagnosis of Osteoarthritis Medical history To prepare for your exam, be sure to have all the information including: Chief complaint (Where it is hurting the most?) Chronology of illness Functional Impact (What effect does the pain have on your life?) Family history Be sure to mention any previous joint damage Physical examination X-rays Lab tests Joint Aspiration Source “Osteoarthritis”. American Academy of Orthopaedic Surgeons. 2 April, 2003. http://orthoinfo.aaos.org. Notes Doctor's exam To diagnose osteoarthritis and determine the extent to which it has progressed, a doctor relies upon your complete medical history, physical examination, X-rays and possibly lab tests. Medical history. Tell the doctor everything in your medical history, including current symptoms. When did joint pain begin? Is pain continuous, or does it come and go? Is it worse at night? When you walk or run? Be sure to mention if you ever injured the joint, or if you also have pain in other parts of the body. Physical examination. The doctor will look at the affected joint, and may ask you to move it into various positions. He or she may check for pain and restricted motion, crepitus, muscle atrophy, involvement of other joints or signs of injury to muscles, tendons and ligaments. X-rays. X-rays can show the extent of joint deterioration, including narrowing of joint space, thinning or erosion of bone, excess fluid in the joint, bone spurs or other abnormalities. This may help the doctor distinguish various forms of arthritis. Lab tests. Sometimes laboratory tests can help rule out other diseases that cause symptoms similar to OA. Source: www.aaos.org , 2003 V117

Prognosis of Osteoarthritis Generally gets worse over time and cannot be cured. However, pain and stiffness symptoms frequently responds to medical treatment. Progression of disease varies from one person to another. Does not always become disabling. Source “Osteoarthritis”. Best Practice of Medicine. 2 April, 2003. http://praxis.md. Notes Osteoarthritis is a disease that generally gets worse over time and it cannot be cured. However, the pain and stiffness associated with the disease frequently responds to medical treatment and self-care techniques. Unlike other forms of arthritis, osteoarthritis does not spread throughout the body. It can, however, affect more than one joint. The progression of the disease varies from one person to another. Osteoarthritis does not always become disabling. Some people whose disease shows up on x-rays never experience noticeable symptoms. Source: www.praxis.md , 2003 V118

Non-Surgical Treatment Options of Osteoarthritis Lifestyle modifications Change activities that cause pain, including job or sports activities. If osteoarthritis affects weight-bearing joints (hip, knee, ankle, spine) and you are overweight, a weight loss program may need to be started. Exercise with range-of-motion (flexibility), aerobic conditioning and targeted muscle-strengthening exercises. Source “Osteoarthritis”. American Academy of Orthopaedic Surgeons. 2 April, 2003. http://orthoinfo.aaos.org. Notes Early treatment Early, non-surgical treatment can slow progression of OA, increase motion and improve strength. Most treatment programs combine lifestyle modifications, medications and physical therapies. Lifestyle modifications. The doctor may recommend that you rest or change activities to avoid provoking osteoarthritis pain. You may need to modify job or sports activities. This could mean switching from high impact activities (such as aerobics, running, jumping or competitive sports) to low impact exercises (such as stretching, walking, swimming or cycling). If osteoarthritis affects weight-bearing joints (such as the knee, hip, spine or ankle) and you are overweight, you may also need to start a weight loss program. Source: www.aaos.org , 2003 V119

Non-Surgical Treatment Options of Osteoarthritis Medications Anti-inflammatory medication to reduce swelling and inflammation. Corticosteroids, which are injected directly into the joint for temporary relief of pain and swelling. Dietary supplements Glucosamine Chondroitin Calcium Source “Osteoarthritis”. American Academy of Orthopaedic Surgeons. 2 April, 2003. http://orthoinfo.aaos.org. Notes Early treatment Early, non-surgical treatment can slow progression of OA, increase motion and improve strength. Most treatment programs combine lifestyle modifications, medications and physical therapies. Medications. Non-steroidal anti-inflammatory medications can help reduce inflammation. Sometimes the doctor may recommend strong anti-inflammatory agents called corticosteroids, which are injected directly into the joint for temporary relief of pain and swelling. Dietary supplements called glucosamine and chondroitin sulfate may also help relieve osteoarthritis pain. (Glucosamine stimulates formation and repair of articular cartilage. Chondroitin sulfate prevents cartilage from degrading. Caution: The U.S. Food and Drug Administration does not test or analyze dietary supplements. These compounds may also cause negative interactions with other medications or cause excessive bleeding during surgical procedures. Always consult your doctor before taking dietary supplements.) Source: www.aaos.org , 2003 V120

Non-Surgical Treatment Options of Osteoarthritis Physical Therapy A fitness program and physical therapy to improve joint flexibility, increased range of motion, strengthen muscle, bone and cartilage tissues and reduce pain. May use assistive devices (crutches, walker, brace) Apply ice or heat to affected joint for short periods, several times a day. Source “Osteoarthritis”. American Academy of Orthopaedic Surgeons. 2 April, 2003. http://orthoinfo.aaos.org. Notes Physical therapy. The doctor may prescribe a balanced fitness program, physical therapy and/or occupational therapy to improve joint flexibility, increase range of motion, strengthen muscle, bone and cartilage tissues and reduce pain. You may need to use supportive or assistive devices (i.e., brace, splint, elastic bandage, cane, crutches or walker) and/or apply ice or heat to the affected joint for short periods, several times a day. Source: www.aaos.org , 2003 V121

Surgical Treatment Options for Osteoarthritis May consider surgery if non-surgical options do not offer relief to pain. Surgery is dependent on several factors: Age Activity level Condition of affected joint Extent to which the disease has progressed Surgical options include arthroscopy, arthroplasty, joint fusion, debridement and joint replacement. Source “Osteoarthritis”. American Academy of Orthopaedic Surgeons. 2 April, 2003. http://orthoinfo.aaos.org. Notes Surgery If early treatments do not stop the pain, the doctor may consider surgery to treat advanced osteoarthritis. It depends upon your age and activity level, the condition of the affected joint, and the extent to which osteoarthritis has progressed. Surgical options for osteoarthritis include arthroscopy, joint fusion and joint replacement. Arthroscopy. A surgeon uses a pencil-sized instrument (arthroscope) and two or three small incisions to remove bone spurs, cysts, damaged lining or loose fragments in the joint. Joint fusion. A surgeon eliminates the joint by binding together the ends of bone (fusion). Pins, plates, screws or rods may hold bones in place while they heal. This procedure eliminates the joint’s flexibility. Joint replacement. A surgeon removes parts of the bones and creates an artificial joint with metal or plastic components (total joint replacement or arthroplasty). Source: www.aaos.org , 2003 V122

Surgical Treatment Options for Osteoarthritis Fascial reconstruction. Placed between the rubbing bone surfaces, creating a tough connection of scar tissue, cushioning the ends of the bones. Osteotomy. Cuts the bone to re-align the joint to a better position. Often used for younger people, when the limb is clearly not straight and the cartilage wear is confined to one part of the joint. Source “Surgical Procedures for Arthritis Pain”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.jointreplacement.com. Notes Fascial reconstruction. Before artificial joints, surgeons tried many things to keep the worn-out bone surfaces of arthritic joints from rubbing against each other. Surgeons found that fascia - the connective tissue that makes up the covering of muscles - could be placed between the rubbing bone surfaces to create a tough connection of scar tissue that cushioned the ends of the bones. This approach is still used in some cases. Osteotomy. Osteotomy is an operation that cuts the bone, either above or below the joint, and re-aligns the joint to a better position. An osteotomy is often used for younger people where the limb is clearly not straight and the cartilage wear is confined to one part of the joint. Unfortunately, the success of this operation decreases as the degree of arthritis increases. Source: www.jointreplacement.com, 2003 V123

Surgical Treatment Options for Osteoarthritis Arthroscopy Doctor uses a small instrument to remove bone spurs, cysts, damaged lining or loose fragments in the joint. Joint Fusion (applies to hand and ankle) Eliminates the joint by binding together the ends of the bones, which limits movement of the joints. Source “Osteoarthritis”. American Academy of Orthopaedic Surgeons. 2 April, 2003. http://orthoinfo.aaos.org. Notes Arthroscopy. A surgeon uses a pencil-sized instrument (arthroscope) and two or three small incisions to remove bone spurs, cysts, damaged lining or loose fragments in the joint. Joint fusion. A surgeon eliminates the joint by binding together the ends of bone (fusion). Pins, plates, screws or rods may hold bones in place while they heal. This procedure eliminates the joint’s flexibility. Source: www.aaos.org , 2003 V124

Surgical Treatment Options for Osteoarthritis Joint Replacement (Total Joint Replacement, Arthroplasty, Minimally Invasive techniques) Resurfacing parts of the bones with implants creating an artificial joint. Cartilage transplant Healthy cartilage transplanted to another area where cartilage has been damaged. Not always viable, dependant on the condition of the cartilage and bone. Source “Surgical Procedures for Arthritis Pain”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.jointreplacement.com. Notes If and when you can no longer manage the pain or deal with the loss of mobility caused by your severe arthritis through non-surgical treatments, surgery may offer some relief. Your physician or surgeon can discuss with you in-depth your surgical options. Below we've listed the most common surgical interventions recommended to arthritis sufferers.  Total joint replacement. People with advanced symptoms of arthritis that cannot be managed with medications or physical therapy are often candidates for total joint replacement surgery. With total joint replacement, the old, worn out surface of the joint is surgically removed and a new synthetic surface is put in place. (Use the links to the left to find out more about joint replacement surgery for a specific part of the body.) Cartilage transplant. It is now possible to transplant cartilage from one location to another. Healthy cartilage from an area of the joint that does not bear weight, can be transplanted to another area where weight-bearing cartilage has been damaged. Unfortunately, in most cases of advanced arthritis, the degeneration and wear of cartilage involves the majority of the joint surface, and cartilage transplant is not always a viable treatment option. Source: www.jointreplacement.com, 2003 V125

How Treatment Can Help! Having osteoarthritis does not mean an end to your active lifestyle. There are many options to help relieve pain and regain your former lifestyle. Restore the joy of motion V126

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