Osteoarthritis

February 8, 2017

Osteoarthritis (OA) is the most common form of arthritis. It causes joint pain and stiffness. It usually develops gradually, over time. Several different joints can be affected, but osteoarthritis is most frequently seen in the hands, knees, hips, feet and spine.

Normal joints are hinges at the ends of bones usually covered by cartilage and lubricated inside a closed sack by synovial fluid.

Normally, joints have remarkably little friction and move easily. With degeneration of the joint, the cartilage becomes rough and worn out, causing the joint halves to rub against each other, creating inflammation with pain and the formation of bone spurs. The fluid lubricant may become thin and the joint lining swollen and inflamed.

Osteoarthritis is also known as degenerative joint disease and affects up to 30 million Americans, mostly women and usually those over 45 or 50 years of age. All races in the U.S. appear to be equally affected. This article focuses on osteoarthritis of the spine, particularly on facet joint arthritis.

OA affects people of all races and both sexes. Most often, it occurs in patients age 40 and above. However, it can occur sooner if you have other risk factors (things that raise the risk of getting OA). Risk factors include –

Older age
Having family members with OA
Obesity
Previous traumatic Joint injury or repetitive use (overuse) of joints
Joint deformity such as unequal leg length, bowlegs or knocked knees

Causes

Genes – Various genetic traits can make a person more likely to develop OA. One possibility is a rare defect in the body’s production of collagen, the protein that makes up cartilage. This abnormality can cause osteoarthritis to occur as early as age 20. Other inherited traits may result in slight defects in the way the bones fit together so that cartilage wears away faster than usual. Researchers have found that a gene called FAAH, previously linked to increased pain sensitivity, is higher in people with knee OA than in people who don’t have the disease.

Weight – Being overweight puts additional pressure on hips and knees. Many years of carrying extra pounds can cause the cartilage that cushions joints to break down faster. Research has shown there is a link between being overweight and having an increased risk of osteoarthritis in the hands. These studies suggest that excess fat tissue produces inflammatory chemicals (cytokines) that can damage the joints.

Injury and overuse – Repetitive movements or injuries to joints (such as a fracture, surgery or ligament tears) can lead to osteoarthritis. Some athletes, for example, repeatedly damage joints, tendons and ligaments, which can speed cartilage breakdown. Certain careers that require standing for long periods of time, repetitive bending, heavy lifting or other movements can also make cartilage wear away more quickly. An imbalance or weakness of the muscles supporting a joint can also lead to altered movement and eventual cartilage breakdown in joints.

Others – Several other factors may contribute to osteoarthritis. These factors include bone and joint disorders like rheumatoid arthritis, certain metabolic disorders such as hemochromatosis, which causes the body to absorb too much iron, or acromegaly, which causes the body to make too much growth hormone.

Symptoms

The main symptoms of osteoarthritis are –

Pain – The pain tends to be worse when you move your joint or at the end of the day. If you have severe osteoarthritis, you may feel pain more often.

Stiffness – Your joints may feel stiff after rest, but this usually wears off as you get moving. A grating or grinding sensation (crepitus) – Your joint may creak or crunch as you move.

Swelling – The swelling may be hard (caused by osteophytes) or soft (caused by synovial thickening and extra fluid), and the muscles around your joint may look thin or wasted.

Not being able to use your joint normally – Your joint may not move as freely or as far as normal. Sometimes it may give way because your muscles have weakened or your joint has become less stable. Exercises to strengthen your muscles can help to prevent this.

Treatment

Pain and Anti-inflammatory Medications

Medicines for osteoarthritis are available as pills, syrups, creams or lotions, or they are injected into a joint. They include –

Analgesics – These are pain relievers and include acetaminophen, opioids (narcotics) and an atypical opioid called tramadol. They are available over-the-counter or by prescription.
Nonsteroidal anti-inflammatory drugs (NSAIDs) – These are the most commonly used drugs to ease inflammation and related pain. NSAIDs include aspirin, ibuprofen, naproxen and celecoxib. They are available over-the-counter or by prescription.
Corticosteroids – Corticosteroids are powerful anti-inflammatory medicines. They are taken by mouth or injected directly into a joint at a doctor’s office.
Hyaluronic acid – Hyaluronic acid occurs naturally in joint fluid, acting as a shock absorber and lubricant. However, the acid appears to break down in people with osteoarthritis. The injections are done in a doctor’s office.

Assistive Devices – Assistive devices can help with function and mobility. These include items, such as like scooters, canes, walkers, splints, shoe orthotics or helpful tools, such as jar openers, long-handled shoe horns or steering wheel grips. Many devices can be found at pharmacies and medical supply stores.

Surgery – Joint surgery can repair or replace severely damaged joints, especially hips or knees. A doctor will refer an eligible patient to an orthopaedic surgeon to perform the procedure.

Alternative Treatment

Glucosamine and chondroitin are the building blocks of cartilage. Cartilage is the substance that covers and protects joints. In people with OA, cartilage becomes damaged and degraded with use and time.

Omega 3 fatty acids EPA and DHA can be helpful for inflammatory arthritis including OS.

Vitamin E – Studies suggest that vitamin E can play a key role in treating OS by preventing damage to the cells of the bones and joints.

Selenium – Mild selenium deficiency is common in OS patients. It helps in slowing down the rapid progression of the disease.

SAM-e, pronounced “sammy”, is a naturally occurring compound produced from the amino acid methionine and adenosine triphosphate (ATP), a compound responsible for producing energy within the body. SAM-e is believed to improve joint mobility and relieve pain by raising levels of ATP and stimulating the production of cartilage within the joints. Getting sufficient folic acid in your diet (e.g. dark leafy green vegetables, fortified cereals) may help your body with natural SAM-e production.

Chondroitin sulfate, found naturally in cartilage, is believed to protect articular cartilage from deterioration caused by enzymes that destroy cartilage. It may also help to prevent the formation of microscopic blood clots leading to improvement of circulation to joint tissues.

Flax Seed Oil – Flax seed oil is an anti-inflammatory.

Avocado soybean unsaponifiables (ASUs) – A few preliminary studies suggest that this natural vegetable extract may help reduce the symptoms of OA and maybe even slow progression of the disease. More research is needed to know whether ASUs can actually stop joint damage.

Bromelain – This enzyme that comes from pineapples reduces inflammation. Bromelain increases the risk of bleeding, especially if you also take blood thinners, such as clopidogrel (Plavix), warfarin (Coumadin), or aspirin.

Turmeric – Turmeric is sometimes combined with bromelain, because it makes the effects of bromelain stronger. Turmeric can increase the risk of bleeding, especially for people who take blood thinning medications or NSAIDs.

Cat’s claw – It is useful for OA pain.

Devil’s claw – One study found that more than 50% of people with OA of the knee or hip or low back pain who took devil’s claw reported less pain and better mobility after 8 weeks. Devil’s claw may increase the risk of bleeding, especially if you also take blood thinners

Ginger – One study found that ginger extract blocked COX-2, a chemical in the body that causes pain. Ginger may increase the risk of bleeding, especially if you also take blood thinners such as clopidogrel (Plavix), warfarin (Coumadin), or aspirin.

Capsaicin – Capsaicin is the main component in hot chili peppers (also known as cayenne). Applied to the skin, it is believed to temporarily reduce amounts of “substance P,” a chemical that contributes to inflammation and pain in arthritis.

Acupuncture – Several controlled clinical trials suggest that the ancient Chinese practice of acupuncture works to treat OA pain. It may also help improve joint function. A few clinical studies have found that people with OA experience better pain relief and improvement in function from acupuncture than from NSAIDs, such as aspiroxicam.

Chiropractic – Although there is no evidence that chiropractic care can stop joint damage from OA, some studies indicate that spinal manipulation may: