Arthur–itis that is.  Osteoarthritis (OA) is probably about as old as humans and, even more likely, as old as moveable joints. Other animals do develop osteoarthritis but humans are the only ones that can really express the misery that comes with it. There are several other forms of arthritis but they tend to look and behave differently from one another. Osteo means bone and arthritis means deterioration in a moveable (diarthroidal) joint. Just about everybody will get it if they live long enough but there are certain risk factors that make it more likely for some than for others. Even though the word ends in -itis which we tend to associate with inflammation, it is not an inflammatory condition. It is mostly a disease of wear and tear on the cartilage between the joints and may ultimately erode into bone. Being overweight can certainly increase the incidence of osteoarthritis but not everyone who is overweight has it. And even if one knee or hip is affected, the other might not necessarily be involved.  Many people who are not overweight also have osteoarthritis. It can also be brought on my an injury to the joint and is then known as traumatic arthritis. Symptoms include joint pain and stiffness after the joint has been at rest; a crunching feeling or sound in the joint with movement and, at times, swelling/redness around the joint. Even though I said it is not an inflammatory condition, pieces of cartilage can break off or protrude into the joint causing irritation, inflammation and swelling. That is the exception to the rule however. I have provided some illustrations of how it affects various joints.

Your doctor diagnoses it by conducting a medical history and physical exam of the joint.  At times the doctor may want to draw some blood to check if something besides osteoarthritis might be causing similar symptoms.  It's also possible if swelling is present that the doctor may want to draw out some of the fluid around the joint and look at it under a microscope. Part of what your doctor learns by taking your history is when the joint you're having trouble with causes problems. As noted above the pain and stiffness associated with osteoarthritis usually occurs after a joint has been at rest and then you move it. You will notice it when you stand up after you have been sitting for awhile, when you turn over in bed at night after lying still and other times when you're just minding your own business and it strikes as you take a step or reach for something. It tends to “pick on” one joint at a time and then move on to another for no apparent reason.  It is also affected by weather fronts and the changing of seasons. Typically it is more of a nuisance than a debilitating illness but in some cases it reaches advanced stages and can hamper your daily activity and ability to participate in exercise. It is chronic, annoying and progressive and not a very proper thank you for a long life well lived. There are many theories about its cause but no one has been able to pinpoint the reason it develops or to find a cure. 

One reason that arthritis is so painful is that the muscles that are attached to the joints pull on the thin membranes that lie on the outer surface of your bones called the periosteum. The periosteum is richly supplied with nerve endings. As pain sets into a joint, people tend to favor the joint and the muscles that are attached to it. The muscles grow weaker and the joint starts to lose its functional capacity. A vicious cycle can become established that leads to unnecessary debility. Routine exercise keeps muscles strong and toned.  How much and what kind of exercise is a question that each individual with osteoarthritis has to answer for him or herself. With OA of the lower extremities one must find a balance between weight bearing and non-weight bearing activity. With OA in general, individuals must find the balance between being sedentary and being active. Stretching, toning and engaging in joint range of motion activity are the key to keeping a joint useful.

   Treatment consists of the use of analgesics (pain relievers) with a broad group of drugs called non-steroidal anti-inflammatories. These would include acetaminophen, aspirin, naproxen and other brand-name products that have come along in recent years. All have the potential to be effective pain relievers and all also have potential side effects as well.  Because of the severe side effects of steroids such as prednisone and similar preparations, those medications are rarely used to treat osteoarthritis. Some topical preparations are also available that cause a sensation of heat and may be comforting to some people. In advanced cases where pain is ever present and surgery is not an option, opioids (hydrocodone, oxycodone, morphine) may be used judiciously. 

   Physical Therapy and Occupational Therapy may be useful to improve joint function and help with pain management.

In addition to exercise, therapists may use ultrasound, hot/cold applications and pool therapy.  It is easier and less painful to move joints in the water. Many facilities will have “walking pools” that are the same depth throughout their length so no one has to worry about staying afloat while exercising. Typically the water is warm so stiff joints get a double treat. Arthritis sufferers may also benefit from gentle osteopathic or chiropractic treatment, from yoga, acupuncture, meditation and other modalities that relieve physical and psychological stress. If weight is an issue in your arthritis pain you need to consider losing weight to reduce some of the stress on the joints. You also need to make sure you are eating a well balanced, portion controlled diet and not following a fad diet that may otherwise harm your health.

   But what of dietary supplements such as glucosamine sulfate and other joint health products on the market.  Scientifically controlled studies show mixed results. In some instances the results of the treatment studied show improved pain, function and slowed progression of the disease. In other cases where the placebo effect of various treatments were studied, the same results could be seen. One study shows liver damage in a small percentage of those taking glucosamine.  

   Joint replacement/repair is also an option for those with advanced osteoarthritis that have not been able to obtain relief by any other method. It is a significant step to be carefully considered and will require some post operative rehabilitation. It can be a true “miracle” for some OA sufferers.  

   Lastly, there are many websites and organizations that provide information and support for those with osteoarthritis. Some organizations sponsor support groups to encourage and inform people with OA so that they are not fighting the battle alone. You may want to contact the Arthritis Foundation for help or go to their website www.arthritis.org to learn more about services that are available. There is also a lot of good unbiased, non-commercial information available through government entities such as the Centers for Disease Control. Their website is www.cdc.gov/arthritis.