Osteoarthritis: Degenerative Spinal Joint Disease

Osteoarthritis is a disease of the joints. Also know as degenerative joint disease, it is the most common form of arthritis, affecting more than 20 million American adults. It should not be confused with rheumatoid arthritis, which is not the same as osteoarthritis. Osteoarthritis is caused by a breakdown of cartilage, the substance that provides a cushion between the bones of the joints. Healthy cartilage allows bones to glide over one another and acts as a shock absorber during physical movement. In osteoarthritis, the cartilage breaks down and wears away. This causes the bones under the cartilage to rub together, causing pain, swelling and loss of motion of the joint.

What Causes Osteoarthritis?
Most cases of osteoarthritis have no known cause. Risk factors include:

• Age – osteoarthritis affects more people over the age of 45
• Female – osteoarthritis is more common in women than in men
• Certain hereditary conditions such as defective cartilage and joint deformity
• Joint injuries caused by sports, work-related activity or accidents
• Obesity
• Diseases that affect the structure and function of cartilage, such as rheumatoid arthritis, hemochromatosis (a metabolic disorder), Paget's disease and gout

Signs and Symptoms of Osteoarthritis
Osteoarthritis usually begins slowly. Early in the disease, joints may ache after physical work or exercise. Often the pain of early osteoarthritis fades and then returns over time, especially if the affected joint is overused. Other symptoms may include:

• Swelling or tenderness in one or more joints, especially before or during a change in the weather
• Loss of flexibility of a joint
• Stiffness after getting out of bed
• A crunching feeling or sound of bone rubbing on bone
• Bony lumps on the joints of the fingers or the base of the thumb
• Steady or intermittent pain in a joint (although not everyone with osteoarthritis has pain)

Which joints are affected by Osteoarthritis?
Osteoarthritis can occur in any joint but most often occurs in the spine, hips, knees or hands.

Spine. Stiffness and pain in the neck or in the lower back can result from osteoarthritis of the spine. Weakness or numbness of the arms or legs can also result. Some people feel better when they sleep on a firm mattress or sit using back support pillows. Others find help from heat treatment or an exercise program to strengthen the back and abdominal muscles. In severe cases, surgery to reduce pain and help restore function may be necessary.

Hips. Osteoarthritis in the hip can cause pain, stiffness and severe disability. People may feel the pain in their hips, groin, inner thigh or knees. Osteoarthritis in the hip may limit moving and bending. This can make daily activities such as dressing and foot care difficult. Walking aids (such as canes and walkers), medication, and exercise can help relieve pain and improve motion. If the pain is severe and not helped by other methods, hip replacement surgery may be necessary.

Knees. The knees are the body's primary weight-bearing joints. For this reason, they are among the joints most commonly affected by osteoarthritis. They may be stiff, swollen, and painful, making it hard to walk, climb, get in and out of chairs and use bathtubs. If not treated, osteoarthritis in the knees can lead to disability. Medications, losing weight, exercise, and walking aids can reduce pain and disability. In severe cases, knee replacement surgery may be necessary.

Hands. In osteoarthritis of the hands, small, bony knobs appear on the end joints of the fingers. They are called Heberden's nodes. Similar knobs, called Bouchard's nodes, can appear on the middle joints of the fingers. Fingers can become enlarged and gnarled, and may ache or be stiff and numb. The base of the thumb joint is also commonly affected by osteoarthritis. Medications, splints or heat treatment can usually help osteoarthritis in the hands.

How do I know if I have Osteoarthritis?
No single test can diagnose osteoarthritis. However, if you are experiencing any of the symptoms listed above, see your doctor. Most doctors use a combination of tools to determine if you have osteoarthritis, including:

History: Your doctor will begin by asking you to describe any symptoms you are having and how they have changed over time. Tell your doctor about any pain, stiffness, or decreased joint function you are experiencing and how it is affecting your daily life. Also talk to your doctor about how you have been treating these symptoms. Be sure to also tell your doctor about any other medical problems you have and if you are taking any medications.

Physical Examination: After talking with you about your symptoms, your doctor will examine you by checking your reflexes and muscle strength. Your doctor may also ask you to walk and bend to observe your flexibility.
Tests: Since there is no single test for osteoarthritis, your doctor may need to do a variety of tests including x-rays of your joints to see if there has been any cartilage loss, bone damage or bone spurs. Other tests may include blood tests and a test called “joint aspiration” where fluid is drawn from the joint to be examined.

It is usually not difficult to tell if a patient has osteoarthritis. It is more difficult to tell if the disease is causing the symptoms. Osteoarthritis is so common, especially in older people, that other conditions may play a role in the symptoms. Your doctor will try to find out what is causing the symptoms and rule out any other health problems you may have.

Treatment of Osteoarthritis
Even though there is no cure for osteoarthritis, its symptoms can be treated. Osteoarthritis treatment generally includes the following:

Pain control. Many different medications can be used to control pain, including corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs). If NSAIDs do not provide relief to inflamed joints, glucocorticoids (an injection) may be used. For mild pain without inflammation, acetaminophen or aspirin may be used. Non-drug treatments may provide temporary pain relief and include hot/cold therapy, acupuncture and herbal remedies.

Exercise. Regular exercise will help to improve flexibility and improve muscle strength and can also improve your mood and outlook, decrease pain, improve your heart and blood flow and maintain your weight.

Weight control. Maintaining an acceptable body weight will help prevent extra stress on weight-bearing joints.

Spine surgery (in severe cases) may be necessary to relieve chronic pain in damaged joints.

One of the most important things you can do is to take care of yourself and adopt healthy lifestyle habits. People with osteoarthritis can enjoy good health despite having this disease. Research shows that patients who take part in their own care report less pain and make fewer doctor visits. They also enjoy a better quality of life. The best way to start is what you are doing right now – learning as much as you can about osteoarthritis. Talk to your doctor about programs that you can join that are designed to help you manage your condition and develop a healthy lifestyle.