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Osteoarthritis

Osteoarthritis

OA is the most common type of arthritis. It tends to occur in middle age or due to an injury or obesity.

Sometimes called wear and tear arthritis, osteoarthritis (OA) is the most common type of arthritis. When the smooth cushion between bones (cartilage) breaks down, joints can get painful, swollen and hard to move.  OA can affect any joint, but it occurs most often in hands, knees, hips, lower back and neck.  OA can happen at any age, but it commonly starts in the 50s and affects women more than men. This disease starts gradually and worsens over time. But there are ways to manage OA to prevent or minimize pain and keep mobile. Some people never develop OA.

Causes

Osteoarthritis was long believed to be caused by the wearing down of joints over time. But scientists now see it as a disease of the joint. 

Here are some things that may contribute to OA: 

  • Age. The risk of developing OA increases someone gets older because bones, muscles and joints are also aging. 
  • Joint injury. A break or tear, can lead to OA after years.
  • Overuse. Using the same joints over and over in a job or sport can result in OA.
  • Obesity. Extra weight puts more stress on a joint and fats cells promote inflammation.
  • Weak muscles. Joints can get out of the right position when there’s not enough support.
  • Genes. People with family members who have OA are more likely to develop OA.
  • Sex. Women are more likely to develop OA than men.

Symptoms

Symptoms tend to build over time rather than show up suddenly. They include:

  • Pain or aching in the joint during activity, after long activity or at the end of the day.
  • Joint stiffness usually occurs first thing in the morning or after resting.
  • Limited range of motion that may go away after movement.
  • Clicking or cracking sound when a joint bends.
  • Swelling around a joint.
  • Muscle weakness around the joint.
  • Joint instability or buckling  (knee gives out).

Here are ways that OA may affect different parts of the body:

  • Hips. Pain is felt in the groin area or buttocks and sometimes on the inside of the knee or thigh.
  • Knees. A “grating” or “scraping” feeling when moving the knee. 
  • Fingers. Bony growths (spurs) at the edge of joints can cause fingers to become swollen, tender and red. There may be pain at the base of the thumb.
  • Feet. The big toe feels painful and tender. Ankles or toes may swell.

As OA gets worse, cartilage may get uneven edges and cracks. Bones may harden, change shape and get bumpy. Once cartilage breaks down, it doesn’t grow back on its own.

Health Effects

Pain, reduced mobility, side effects from medications and other factors associated with osteoarthritis can lead to negative health effects not directly related to the joint disease.

Obesity, Diabetes and Heart Disease
Knee or hip pain may make it harder to exercise. That can cause or worsen weight gain and lead to obesity. Being overweight or obese can lead to the development of high cholesterol, diabetes, heart disease and high blood pressure. 

Falls
People with osteoarthritis experience as much as 30 percent more falls and have a 20 percent greater risk of facture than those without OA. Having OA can decrease function, weaken muscles and make it more likely that someone has a fall. Side effects from pain medications, such as dizziness, can also contribute to falls. 

Diagnosis

Medical history, a physical examination and lab tests help to make an OA diagnosis. 

A primary care doctor may be the first person you talk to about joint pain. The doctor will go over medical history information, symptoms, how the pain affects activities, as well as medical problems and medication use. The doctor will look at and move the joints. These tests help to make the diagnosis:

  • Joint aspiration. After numbing the area, a needle is inserted into the joint to pull out fluid. This test will look for infection or crystals in the fluid . The results can help rule out other medical conditions or other forms of arthritis.
  • X-rayX-rays can show joint or bone damage or changes related to osteoarthritis.
  • MRIMagnetic resonance imaging (MRI) gives a better view of cartilage and other parts of the joint.

Treatment

There is no cure for OA, but medication, nondrug methods and assistive devices can help to ease pain. As a last resort, a damaged joint can be surgically replaced with a metal, plastic or ceramic one. 

Medications

Pain and anti-inflammatory medicines for osteoarthritis are available as pills, syrups, patches and creams, or they are injected into a joint. They include:  

  • AnalgesicsThese are pain relievers and include acetaminophen and opioids. Acetaminophen is available over-the-counter (OTC), and opioids must be prescribed by a doctor.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)These are the most commonly used drugs to ease inflammation and pain. They include aspirinibuprofennaproxencelecoxib. They are available OTC or by prescription, but the OTC versions only help the pain.
  • Counterirritants. These OTC products have ingredients like capsaicin, menthol and lidocaine. They irritate nerve endings, so the painful area feels cold, warm or itchy to take focus away from the actual pain. 
  • Corticosteroids –These prescription anti-inflammatory medicines work in a similar way to a hormone called cortisol. The medicine is taken by mouth or injected into the joint at a doctor’s office.
  • Platelet-rich plasma (PRP). Available from a doctor by injection, this product has proteins that help ease pain and inflammation.
  • Other drugs. The anti-depressant duloxetine (Cymbalta) and the anti-seizure drug pregabalin (Lyrica) are oral medicines that are FDA-approved to treat OA pain.

Nondrug Therapies

Exercise

Movement is an essential part of an OA treatment plan. Getting 150 minutes of moderate-to-vigorous exercise per week should be the goal according to the U.S. Department of Health and Human Services. A good exercise program to fight OA pain and stiffness has four parts:

  • Strengthening exercises build muscles around painful joints and helps to ease the stress on them. 
  • Range-of-motion exercise or stretching helps to reduce stiffness and keep joints moving.
  • Aerobic or cardio exercises help improve stamina and energy levels and reduce excess weight.
  • Balance exercises help strengthen small muscles around the knees and ankles and help prevent falls.

Talk to a doctor or physical therapist before starting a new exercise program.

Weight Loss

Weighing more than what’s healthy puts extra stress on the hips, knees, feet and back. Losing weight helps to reduce pain and stop or slow down joint damage. Every pound of weight lost removes four pounds of pressure on lower-body joints.

Physical Therapies and Assistive Devices
Physical therapists, occupational therapists and chiropractors can provide:

  • Specific exercises to help stabilize your joints and ease pain.
  • Information about natural treatments and products that can ease pain.
  • Instruction to make movement easier and to protect joints. 
  • Braces, shoe inserts or other assistive devices.

Surgery

Joint surgery can improve function or replace damaged joints to restore mobility and relieve pain. Hips and knees are the joints most commonly replaced. An orthopedic surgeon can determine the best procedure based on how badly damaged the joint is.

Self Care

Practicing these habits can slow down OA, keep  you healthy and put off surgery as long as possible.

Maintain a Healthy Weight

Excess weight worsens OA. Combine healthy eating with regular exercise to maintain a healthy weight.

Control Blood Sugar

Many people have diabetes and OA. Having high glucose levels can make cartilage stiffer and more likely to break down. Having diabetes causes inflammation, which also weakens cartilage.

Maintain Range of Motion

Movement is medicine for joints. Make a habit of putting your joints through their full range of motion, but only up to the point where it doesn’t cause more pain. Gentle stretching, raising and lowering legs from a standing or seated position, daily walks and hobbies such as gardening can help.  But listen to your body and never push too hard.

Protect Joints

Make sure to warm up and cool down when doing exercise. If you play sports, protects joints with the right gear. Use your largest, strongest joints for lifting, pushing, pulling and carrying. Watch your step to prevent falls. Balance rest and activity throughout the day.  

Relax

Find ways to reduce or avoid stress through meditation, listening to music, connecting with friends and family, doing fun activities, and finding ways to relax and recharge.

Choose a Healthy Lifestyle

Eating healthy food, not smoking, drinking in moderation and getting good sleep will help you to feel your best.

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