By Gilda Morales, ANP, DC
Today’s column deals with a condition that will affect every person in his or her lifetime—osteoarthritis. This column will address the other well know type, rheumatoid arthritis next week.
Osteoarthritis is a result of wear and tear of joints or discs, and affects everyone starting at about age 35. It is a slow process, which is accelerated by trauma or by occupations that put greater stress on the joints, and by the age of 65, greater than 90% of patients will show radiographic signs of the disease.
The cause of OA is a failure of cartilage or disc material to repair itself as we age, resulting in degeneration and loss of the protective material and proliferation of bone spurs to replace previous cartilage formation
OA is an equal opportunity disease affecting men and women equally, but arthritis of the hip appears to affect whites more than others, with blacks, Chinese, and Native Americans also being affected in smaller numbers. There are also several risk factors for developing the disease including age greater than 50, with hip and knee arthritis more commonly affected after the age of 70 and OA of the hand more commonly affecting postmenopausal women. Athletes are also more prone to develop arthritis at an earlier age than others, and trauma also plays a large part in the development of OA.
The diagnosis of OA is made through the evaluation of clinical symptoms and x-rays taken later in the disease. Common complaints are joint pain that is described as an ache, and which is worse with changes in weather. There is usually temporary stiffness, especially in the mornings, that improves after several minutes of moving around. OA more commonly affects the hands, spine, and large joints such as the hips and knees.
There may be some deformity in the fingers and decreased range of motion. In later stages, patients may describe a grinding sound, usually in the knee, that is present with bending the knee. In severe cases, there may even be some deformity in the knee causing a “knock-kneed” appearance.
Treatment includes weight loss, with the loss of one pound translating to a three-pound equivalent off the joints. Heat or cold will provide temporary relief and physical therapy is considered first line treatment and the most effective, especially if patients continue a home exercise program after completing their therapy.
Medication therapy usually consists of Acetaminophen or Tylenol, 1000 mg, three times daily for knee and hip pain, but it is not effective for back pain. If there is no relief, your provider may prescribe an NSAID, such as Ibuprofen or Naproxen (Motrin or Aleve), or a COX-2 inhibitor like Celebrex. However, because of potentially dangerous side effects such as increasing blood pressure, swelling and stomach irritation, these medications should be used for short periods of time. NSAIDS should be avoided in patients that have kidney problems, high blood pressure, ulcers, heart disease, or are allergic to aspirin.