By: Gregory Raab
It is believed that as many as 30 million Americans suffer from osteoarthritis — characterized by a breakdown of cartilage, specifically at the ends of the bones. This is the cartilage that normally protects the joint, allowing for smooth movement and a cushioned surfaced. As the normal cartilage layer wears, the bones gets closer together, in some cases actually rubbing, causing pain, swelling and stiffness. Osteoarthritis most commonly occurs in the hips, knees, and hands, but other joints, particularly the shoulders and ankles, also can be affected. Most osteoarthritis comes from the general “wear and tear” associated with the aging process. However, other types may have injury or obesity as predisposing factors.
The pain, stiffness and swelling of osteoarthritis can make it difficult to perform normal activities of daily living. It also can affect many forms of employment as well as recreational activities. Usually affected joints can ache or be stiff first thing in the morning or after periods of use.They often get stiff after periods of inactivity, too, such as sitting in a car or at a desk. Despite the apparent paradox, one of the best things you can do is remain physically active, despite some discomfort you might experience. This helps build strength in the muscles around the joint, helps lubricate the joint and assists with general fitness to keep your body weight down. Losing extra weight also has a big effect on maintaining a healthy cartilage surface.
Osteoarthritis is a chronic condition, so most treatment regimens focus around pain relief. Lifestyle modification may be all that’s necessary for some patients early on. Braces, canes and walkers also can provide some relief for some patients. However, the mainstay of early treatment for most people revolves around nonsteroidal anti-inflammatory drugs. This can help with pain and swelling but patients need to be monitored for stomach distress, ulcers and heart disease. Acetaminophen also can be helpful in some patients.
As the disease progresses, injections of a steroid into the affected joint may be recommended by your physician. While not reversing the cartilage wear, injections can be helpful for pain relief. In some cases, when the disease is advanced and is unresponsive to other conservative means, surgery may be recommended. A joint replacement, like a hip or knee, can be a tremendously beneficial surgery to help maintain or restore quality of life.
Gregory Raab is an assistant professor of orthopaedics at Penn State Hershey Bone and Joint Institute, Penn State Milton S. Hershey Medical Center.
