Osteoarthritis

Osteoarthritis is the most common form of arthritis.
It is caused by the breakdown of cartilage. Cartilage is the tough elastic material that covers and protects the ends of bones. Bits of cartilage may break off and cause pain and swelling in the joint between bones. This pain and swelling is called inflammation.
Over time the cartilage may wear away entirely, and the bones will rub together.
Osteoarthritis can affect any joint but usually affects hips, knees, hands and spine.

Osteoarthritis is a disease that affects joints in the body. It can involve any joint, but usually concerns hands and weight-bearing joints such as hips, knees, feet and spine.
Cartilage is the tough elastic material that covers and protects the ends of bones. In healthy joints cartilage acts as a shock absorber when you put weight on the joint. The slippery surface of the cartilage allows the bones to move smoothly. When a joint develops osteoarthritis the cartilage gradually becomes rough and thin, and the bone underneath thickens.
Osteoarthritis is classified as non-inflammatory arthritis. This suggests that there is no inflammation (swelling), but recent research shows that this is not true. Although there is usually no swelling in the early stage of the disease, as the arthritis progresses there can be inflammation. Bits of cartilage may break off and float around inside the joint. This disturbs other soft tissues inside the joint and can cause pain and swelling between bones. The result is you may have trouble moving the joint.
Over time as the cartilage wears down, the bones may form bumps on their ends. These bumps are called spurs. Or, the cartilage may wear away entirely, and your bones may rub together.

OA may lead to other problems such as:
• The muscles that hold the joint in place weaken because they are not being used.
• Over time, the joint looses its shape and does not work at all.

How common is osteoarthritis?
There are many kinds of arthritis. The most common kind is called osteoarthritis
It affects 3,000,000 (1 in 10)
It affects men and women in equal numbers.
Most people develop osteoarthritis after the age of 45, but it can occur at any age.

What are the warning signs of osteoarthritis?
Pain, stiffness and swelling around a joint that lasts longer than two weeks.
The joints that are usually affected are the hips, knees, feet and spine. Finger and thumb joints might also be affected.
If you are experiencing persistent joint pain, visit your family doctor.

Symptoms of OA usually come on slowly, and involve the area around the joints. If you have joint pain, stiffness, or swelling for more than two weeks, see the doctor at A+ clinic.
Damage due to OA progresses slowly over time and may result in several problems. You may have pain, especially when moving a joint. Sometimes, you may hear a grating sound when the roughened cartilage on the surface of the bones rubs together. Bumps or swelling may appear, especially on the fingers and feet. A joint may feel sore and stiff, and the joint won't move as easily or as far as it once did. All these changes can make it hard to move around and to do everyday tasks, such as opening a jar or walking up stairs.

Joints Affected

OA commonly affects weight-bearing joints such as hips, knees, feet and spine. However, non-weight bearing joints such as finger joints and the joint at the base of the thumb may be affected as well. It usually does not affect other joints, except when they have been injured or been put under unusual stress.

How does the doctor diagnose osteoarthritis?

If you are experiencing persistent joint pain, visit your family doctor at A+ clinic. Describe the pain in detail including where the pain occurs and when. The x-ray is the most useful test to confirm osteoarthritis.

What causes osteoarthritis?

The exact cause is unknown.
The chances of getting osteoarthritis seem to increase with age.
Some people with osteoarthritis have other family members with it.
Being overweight can increase your risk of getting osteoarthritis.
Excess weight puts stress on joints such as hips and knees.
Injury to a joint or repeated overuse of it can also damage the cartilage and lead to osteoarthritis.
Other types of arthritis can also damage joints and lead to osteoarthritis.

No one knows for sure what causes OA, although scientists are well on their way to understanding the events that lead to the breakdown of cartilage. Researchers now think that there are several factors that may increase your risk for getting OA. Key risk factors include: heredity; excess weight; injury; joint damage from another type of arthritis.
  Hallux valgus deformity of big toe
 Heredity

The way your bones fit together may have been passed on to you from your parents. Sometimes joints don’t fit right or the cushion between your bones is not normal. You may not have problems until you are older.

Excess Weight

Excess weight puts extra stress on the weight-bearing joints, especially the knees and hips. The good news is losing weight, even just 10 pounds (4.5 kilograms), can help prevent osteoarthritis in your knees. Even if you have osteoarthritis in your knees, losing weight can make you feel better. Less body weight means less stress on your knees.

Joint Injury

If you damaged a joint and it did not heal completely, you may end up with osteoarthritis in that joint later in life. Certain occupations may predispose you to osteoarthritis. For example, people that must work in a squat position over many years may be more susceptible to osteoarthritis of the knees.

Complications of Another Type of Arthritis
Sometimes osteoarthritis is caused by damage from a different kind of joint disease that occurred years before. For example, people with rheumatoid arthritis can develop osteoarthritis in those joints in which the rheumatoid inflammation has largely burnt out.

Wear and Tear?
Osteoarthritis used to be thought of as the inevitable result of “wear and tear” on the joints. Research now shows that normal wear does not actually cause “tear.” Normal activity and exercise is good rather than bad for joints and does not cause osteoarthritis.

We do not yet know the causes or the cure for osteoarthritis, but researchers in Canada and around the world are trying to learn why cartilage starts to wear away. In fact, The Arthritis Society funds many leading edge research projects that bring vital new insights and lead to new and better treatments for osteoarthritis.

What can you do about osteoarthritis?
If the doctor at A+ clinic thinks you have osteoarthritis, he or she may perform a physical examination and order tests such as x-rays.
Although there is no cure for osteoarthritis, there are a number of steps you can take to manage your pain and lead an active life.

Establishing the correct diagnosis is very important, because something can be done to manage most forms of arthritis, and most therapies work best when started early in the disease.

Your doctor may be able to diagnose OA based on your medical history and a physical examination. Sometimes, your doctor may order certain tests to help confirm the diagnosis, to determine how much joint damage exists, or to distinguish among different types of arthritis. These tests may include x-rays, blood tests or joint fluid tests.
 
X-ray of finger showing nodal arthritis

Although there is no cure for OA, a lot can be done to help manage the condition. A variety of treatments can help to lessen pain and stiffness and to make movement easier. Your active involvement in developing your prescribed treatment plan is essential.

Medicine: Analgesics
Acetaminophen is often the first medication chosen to treat osteoarthritis. It can relieve pain but does not reduce inflammation.

Creams and Gel
Nonsteroidal anti-inflammatory drugs (NSAIDs)
First line management
Fomentation
Local gel
Physiotherapy
Modification of activities

Non steroidal anti-inflammatory drugs (NSAIDs) are a type of medication that helps reduce the pain and swelling of the joints and decrease stiffness. However, they do not prevent further joint damage.

Exercise

Exercise helps reduce pain and prevents further joint damage. It can also help you maintain a healthy weight, which puts less strain on your joints.
Not using a sore joint will cause the muscles around it to become weak, resulting in pain.
A physiotherapist can teach you correct exercises such as:
Strengthening exercises improve muscle strength and tone, which will help to stabilize and protect osteoarthritis joints and reduce the pain.
Range of motion exercises help maintain or restore normal joint movement and relieve stiffness.
Low impact exercises such as walking and swimming, which do not put unnecessary strain on joints.

Muscles and the other tissues that hold joints together weaken when they aren't moved enough, so the joint loses its shape and function. Exercise helps lessen the symptoms of OA and can help make you feel better overall. Moderate stretching exercises will help relieve the pain and keep the muscles and tendons around the affected joint more flexible and strong. Low-impact exercises like swimming, walking, water aerobics and stationary bicycling can all reduce pain while maintaining strength and flexibility.

Protect Your Joints

Avoid excess strain on joints
Maintain a healthy weight to avoid putting extra stress on your joints
Warm-up/cool-down before and after exercising
Apply ice after injuries
Wearing proper shoes and using aids such as canes or walkers can also take off some of the strain

Positioning joints wisely helps you use them in ways that avoid extra stress. Use larger, stronger joints to carry loads. For example, use a shoulder bag instead of a hand-held one. Also, avoid keeping the same position for a long period of time.

Heat/Cold

Applying heat helps relax aching muscles, and reduces joint pain and soreness.
Applying cold helps to lessen the pain and swelling in a joint.

Heat applied to an arthritic area can reduce pain, stiffness and muscle spasm. It promotes blood circulation, which nourishes and detoxifies muscle fibers. Having a hot shower before exercise may help you get ready for the workout. You should not apply heat to an inflamed joint. Cold applied to inflamed joints reduces pain and swelling by constricting blood flow.

Viscosupplementation

Another treatment is viscosupplementation, in which a clear gel-like substance is injected into the knee. This substance lubricates the cartilage (much like oil lubricates an engine), reducing pain and allowing greater movement of the knee.
Visco supplementation restores frictionless movement within the joint, thus reducing pain and allowing greater mobility.

Surgery

If one of your joints becomes badly damaged, or if the pain is too strong, your doctor may recommend surgery.
There are different kinds of surgery for OA. With some surgery, bits of cartilage are removed from the joint. Other kinds of surgery repair or rebuild parts of the bone, or replace a joint with an artificial or a man-made joint.(see total knee replacement surgery)

Osteoarthritis may progress to the point where surgery is necessary. Minor surgery can be performed to clean out cartilage debris from the joints, particularly the knee. This is called arthroscopic surgery. It is performed as outpatient surgery and does not usually require an overnight stay in hospital. Severely damaged joints can be reconstructed or surgically replaced with artificial ones called as Joint replacement surgery, and is most often performed to replace hip and knee joints. Artificial joints can last 10-20 years before they require replacement, this is why this type of surgery is delayed until it is clearly necessary.

Supplements

Chondroitin Sulfate
Glucosamine
MSM (Methylsulfonylmethane)
What it's suppose to do
Reduce pain and inflammation, improve joint function and slow disease progression. Slow deterioration of cartilage, relieve osteoarthritis pain and improve joint mobility. Reduce pain and inflammation.

Massage is widely used for pain relief, but its results are open to question. At best, massage may relieve muscle ache or tension by increasing blood flow, but benefit is relatively short-lived. Massage should be avoided when joints are especially tender or inflamed, since it can actually worsen your condition at such times. If you’re having a massage done by a professional, make sure he or she understands that, because of your arthritis, you want only the gentlest procedure.

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