Alan C. Jacobson, M.D.

Rheumatologist at Dreyer Medical Clinic - West Aurora

Osteoarthritis is the most common form of arthritis, and occurs more frequently as people age due to, primarily, wear and tear on joints. Before age 50, men are more affected than women, but after age 50, women are more affected than men. Young people can also develop osteoarthritis. Certain diseases that can lead to premature osteoarthritis include hemochromatosis (iron overload), hyperparathyroidism (excessive activity of the parathyroid glands), and gout (a condition involving recurrent inflammatory arthritis, usually affecting a single joint).

Because of the stress on joints from increased weight, obesity can increase the risk of osteoarthritis of the knee and hip. Osteoarthritis also tends to run in families, with genetic factors contributing.

A number of conditions occur in osteoarthritis. There is a loss of cartilage, and bony protrusions develop, called spurs. There may be narrowing of the joint and eventually bone-on-bone contact. This can lead to symptoms, such as pain and stiffness developing in the affected joints. A person with osteoarthritis can sometimes see and feel bony nodules in the fingers. Swelling of the knee may also develop, but since this form of arthritis is considered a non-inflammatory disease, the swelling does not feel warm. The pain that occurs is not sudden, but usually occurs over time. You could feel stiff in the morning, but usually for less than 30 minutes.

Like most diseases a physician treats, the diagnosis usually can be made through taking a medical history and performing a physical exam. X-rays can help confirm the diagnosis and evaluate the degree of the arthritis. Fluid may be removed from the knee to test that the fluid is non-inflammatory, meaning very few white blood cells are present.

Once the diagnosis is made, the next step is to reduce any pain. Without pain, no additional treatment is necessary. Exercises that include muscle strengthening and range of motion are very important if you have osteoarthritis. One of the best exercises for osteoarthritis is swimming because it allows mobility of the joints and strengthens muscles around the joints. Weight loss may help reduce knee pain and hip pain. Physical therapy may be necessary to strengthen muscles, and occupational therapy may help with activities of daily living. Occasionally, splints are needed. If there is continued pain, medication may be necessary.

Medications for pain relief may include nonsteroidal anti-inflammatory drugs (NSAIDs), which are designed to reduce pain and local inflammation. Examples of these medications include ibuprofen, naproxen, and many others. However, these medications can cause gastritis, ulcers, and may affect the kidneys and liver. Laboratory tests are often ordered to evaluate these possible side effects, and there are medications available to be taken with the NSAIDs to help reduce ulcer risks. There are questions whether NSAIDs may increase the risk of myocardial infarcts (heart attacks) and strokes. Acetaminophen could be just as an effective pain reliever as an NSAID, but without the risks of ulcers and bleeding. Stronger pain medications, such as tramadol, are available if they are needed.

Other options for control of pain, which limit side effects to the joint, include local intra-articular corticosteroid injections. Viscosupplementation, hyaluronan injections for the knee, may also reduce osteoarthritis knee pain, and may involve either three or five weekly knee injections.

Studies vary on their effectiveness, but some people have found that glucosamine and chondroitin supplements reduce osteoarthritic pain. Eventually, a total joint replacement may be necessary if other less invasive treatments do not control pain or if the condition leads to severe limitation in daily activities.