Osteoarthritis (also called degenerative joint disease or osteoarthrosis) is the a progressive disease of the cartilage and most common form of arthritis.

Cartilage is the tissue that cover the surface of bones in a joint. It allows bones to glide smoothly over each other for smooth joint movement and acts as a cushion that absorbs energy from physical movement. In osteoarthritis, this cartilage wears away, thus allowing the exposed bone to grind and rub against each other. This causes pain and swelling, as well as loss of motion of the joint.

X-ray of osteoarthritis in the hand X-ray of osteoarthritis in the knee
Hand affected by osteoarthritis. Notice the deformity of the finger bones.   Knee affected by osteoarthritis. Notice the narrowed space in the joint between the bones.

Over time, small abnormal bone growth in the edge of the joints called bone spurs or osteophytes can add to the loss of joint motion. These spurs can even break off and jam the joint space between the bones, causing even more pain and damage.

Unlike other forms of arthritis (there are about 100 distinct types), osteoarthritis does not affect internal organs.

Healthy Joint
Healthy joint
In a healthy jonit, the ends of the bones are covered by smooth cartilage tissue. The joint capsule is lined with synovial membrane and filled with synovial fluid that protect and lubricates the joint.
Osteoarthritic Joint
Joint with osteoarthritis
In osteoarthritis, the cartilage is worn away and bone spurs may grow from the edge of the bones. Bone spur and cartilage fragments are often found in the synovial fluid. In some cases, the space between the bones in the joint narrows.

Symptoms of Osteoarthritis

The symptoms of osteoarthritis include:

  • Pain in 1 or more joints
    In some people, the pain is more frequently felt in the morning when getting out of bed. The pain tends to be sporadic and temporary in early cases of osteoarthritis, and can develop to become persistent in advanced cases.

  • Stiffness in a joint
  • Difficulty in moving the joint
  • Limited range of motion in a joint

The symptoms of osteoarthritis may worsen with physical activity.

In osteoarthritis affecting specific joints, the following symptoms are often seen:

  • In finger osteoarthritis, Heberden's nodes or enlargement in the end joints of the fingers and Bouchard's nodes or enlargement in the middle joints are seen. Although in most cases they are not painful, they can develop suddenly and become inflamed, swollen, red, and painful in a condition called nodal osteoarthritis.

Heberden and Bouchard nodes in an arthritic hand.
Heberden's nodes and Bouchard's nodes

  • Bone spurs in osteoarthritis of the spine can pinch or crowd spinal nerves that cause pain as well as weakness in the arms and legs.

Osteoarthritis often affect the joints in the fingers and thumbs, neck and spine, as well as weight-bearing joints such as the hips, knees, and feet. In rare cases, it can also affect the elbow.

How is it Diagnosed?

Your doctor would perform the following tests to diagnose osteoarthritis:

  • Physical examination
    Your doctor would check the patient's reflexes and muscle strength, and observe the affected joint. Physical tests such as the ability to walk and bend can also be done.

  • X-Ray
    X-rays can show the narrowing of the space between the bones in a joint, the presence of bone spurs, and hardening of the bones.

  • MRI and CT Scan
    Magnetic Resonance Imaging (MRI) and Computed Tomography (CT or CAT) Scan are non-invasive imaging techniques that can visualize the structures within the joint.

  • Joint fluid analysis and blood test
    These tests are done not to diagnose osteoarthritis, rather to disprove infection as the underlying cause of the symptoms.

Causes of Osteoarthritis

The following factors can increase the risk of developing this condition:

  • Age
    Bone becomes more brittle, more prone to damage and less able to heal with age. As people grow older, they are more likely to develop osteoarthritis.

  • Gender
    Women are more prone to developing osteoarthritis than men.

  • Genetics
    Although not well understood, it is thought that the tendency to develop osteoarthritis may be genetically inherited.

  • Obesity
    Because stress of the bone is increases with heavier body weight, obesity can contribute to the development of osteoarthritis, especially in weight-bearing joints such as the hips and knees.

  • Joint Injury
    Major traumatic injury to the bone, such as a bone break can cause damage to the cartilage as well as improper alignment of bones in the joint. Microtrauma, such as repetitive motion of the fingers of a typist, can occur over a long time.

  • Diseases
    These include: diabetes and endocrine disorders, metabolic diseases such as Paget disease and Wilson disease, congenital musculoskeletal abnormalities such as unequal leg length, as well as inflammatory diseases such as gout, rheumatic arthritis, and joint infection.

Treatment of Osteoarthritis

For early cases of osteoarthritis, lifestyle changes and exercise may help limit the progression of the disease. These include:

  • Losing weight
  • Low-impact exercise to strengthen the muscle and potentially stimulate cartilage growth
  • Adding vitamins C, D, and E, as well as calcium
  • Using orthoses or corrective devices, such as splints and braces to help correct joint alignments and provide more support to the body.

The pain of osteoarthritis can be managed by using:

  • Heat from hot soaks or warm wax (paraffin) application.

  • Over-the-counter analgesic creams, such as those containing capsaicin, menthol and camphor.

  • Over-the-counter medications, such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen.

  • Prescription medications, including COX-2 inhibitors. Note that recently, COX-2 inhibitors have been shown to increase the risk of heart attack and stroke.

  • Injection of corticosteroids.

For severe cases of osteoarthritis, surgery maybe the only treatment option. There different types of surgeries include:

  • Arthroplasty
    Replacement of the joint surface with metal or plastic.

  • Arthrodesis
    Fusion of the bony ends of the joint to prevent joint movement, and thus end the pain associated with motion.

  • Chondroplasty
    This surgery repairs the cartilage of the bone.

  • Joint replacement
    In this surgery, the damaged knee or hip joints are replaced with an artificial joints.
Partial and total knee joint replacement
Partial and total joint replacement of the knee.

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