What is Arthritis?
The term arthritis is a generic term defined as inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis. The Arthritis Foundation, the premiere advocacy and educational organization for arthritis identifies 100 different forms of the condition, most characterized by inflammation.
By far the most common form of arthritis is osteoarthritis (OA), also known as degenerative joint disease or degenerative arthritis. Approximately 27 million suffer from osteoarthritis. This condition is characterized by breakdown of the cartilage in the joints so that the underlying bone is thickened and may form spurs. These changes can cause bits of bone or cartilage to float in the joint space. The joint lining or synovium becomes inflamed due to cartilage breakdown and the inflammatory process causes further damage to the cartilage. All of these changes can lead to irritation, stiffness and pain in the joint.
Primary osteoarthritis does not have a known cause and is often referred to as “wear and tear” arthritis. The older we get the more likely we are to develop it. Secondary osteoarthritis occurs when the breakdown of cartilage can be associated with injury, heredity, obesity or something else.
Risk Factors
There are several risk factors for osteoarthritis which are listed below:
Age. Incidences of OA increase as you age. Since “wear and tear” does play a part in the development of OA, the older you are, the more you have used your joints. Although age is an important risk factor, it doesn’t mean that OA is inevitable.
Obesity. Obesity is a nationwide epidemic and you hear about the danger from it every day on the news. Increased body weight is a serious factor in the development of OA, particularly in your knees, which carry the brunt of your weight day in and day out. For every pound you gain, you add 3 pounds of pressure on your knees and six times the pressure on your hips. Since weight gain gradually increases the stress on joints, the weight you gain the decade before you have OA symptoms, particularly in middle age, plays a big role in determining if you will have OA.
Injury or Overuse. Athletes and people who have jobs that require doing repetitive motion, such as landscaping, typing or machine operating, have a higher risk of developing OA due to injury and increased stress on certain joints. OA also develops in later years in joints where bones have been fractured or surgery has occurred. It is important for athletes to learn to take precautions to avoid injury and for people in repetitive jobs to modify their movements to lessen this stress. Note: Avoiding repetitive movement should not be interpreted as not exercising. Regular moderate exercise strengthens the joint causing it to be more stable, thereby, reducing the risk of OA in that joint.
Genetics or Heredity. It is becoming clearer that genetics play a role in the development of OA, particularly in the hands. This occurs in many ways. Inherited abnormalities of the bones that affect the shape or stability of the joints can lead to OA. It is also more common in joints that don’t fit together smoothly. For example, a bowlegged person is more likely to develop OA.
Increased laxity or being double jointed also increases the risk of OA. Recently, researchers have been looking at a defect in the gene responsible for manufacturing cartilage as a risk factor. Just because you have one of these inherited traits, doesn’t mean that you are going to develop OA. It just means that your health care provider should check you more closely and more frequently for signs and symptoms of the disease.
Muscle Weakness. Studies of the knee muscles show not only that weakness of the muscles surrounding the knee can lead to OA, but that strengthening exercises for thigh muscles are important in reducing the risk.
Signs and Symptoms of Osteoarthritis
Most often, OA develops slowly, beginning with stiffness and aching in the effected joints. Pain may be moderate and intermittent and may not interfere with daily activities. Some people may stay in this mild phase while others will progress to more severe pain that impacts their daily functioning. Osteoarthritis most commonly occurs in the weight-bearing joints of the hips, knees and lower back.
It also affects the neck, small finger joints, the base of the thumb and the big toe. OA rarely affects other joints except when injury or stress is involved. It is crucial that a doctor be consulted if signs of arthritis occur and that it be properly diagnosed as other conditions can mimic OA.
Below are some more specific signs and symptoms of OA.
• Joint soreness after periods of overuse or inactivity.
• Stiffness after periods of rest that goes away quickly when activity resumes.
• Morning stiffness, which usually lasts no more than 30 minutes.
• Pain caused by the weakening of muscles surrounding the joint due to inactivity.
• Joint pain is usually less in the morning and worse in the evening after a day’s activity.
• Deterioration of coordination, posture and walking due to pain and stiffness.
If OA is in the hips, you may experience:
• Pain in groin, inner thigh and buttock
• Referred pain in knee and side of thigh
• Limping when walking
If OA is in the knees, you may experience:
• Pain when moving the knee
• Grating or catching when moving the knee
• Pain when walking up and down stairs or getting up from a chair
• Pain that prevents you from exercising your leg
• Weakened large thigh muscles
If OA is in the fingers, you may experience:
• Pain and swelling of the finger joints
• Bony growth spurs at the joint at the end of the finger, called Heberden’s nodes, or at the middle joint,
called Bouchard’s nodes.
• Redness, tenderness and swelling in the affected joints, especially early on when the nodes are forming
• Enlarged joints
• Difficulty with pinching movements, such as picking an item up from a table or grasping a pencil or pen.
If OA is in the feet, you may experience:
• Pain and tenderness in the large joint at the base of the big toe
• Pain when wearing tight shoes or high heels
If OA is in the spine, you may experience:
• A breakdown of the spinal discs resulting in bony overgrowth
• Stiffness and pain in the neck and lower back
• Pressure on the nerves in the spinal cord (pinched nerves)
• Pain in the neck, shoulder, arm, lower back and legs
• Weakness or numbness in arms and legs due to pinched nerves result in inflammation.
Diagnosis and Treatment
Your health care provider will diagnose OA by using a combination of history, physical examination and lab/x-ray tests.
Treatment goals include:
• Management of pain
• Managing ability to function in daily life
• Slowing the disease’s progress
The treatment plan will be made together with your health care provider and may include the following:
• Pain control-this may include medication, relaxation, application of heat or cold, and other lifestyle choices
that serve to reduce stress, tension and therefore break the pain cycle.
• Exercise-the importance of this intervention can not be over emphasized. Aqua or water aerobics in a warm
water pool is suggested to protect further stress on joints. The Arthritis Foundation has trained instructors
and programs in many communities.
• Weight control-excess weight causes undue stress on the joints and can make OA worse or even be the
main cause. Weight reduction can result in improvement of symptoms, especially in the knee joints.
• Joint protection -through building in rest periods and avoiding high impact activities. Use of assistive
devices and braces can also help to prevent further joint damage.
• Physical and Occupational therapy- therapists can assist with strengthening muscles that surround affected
joints as well as helping you make a personalized activity plan. In addition, they can assist you with
modifications to your environment and with adaptive equipment.
• Surgery-in severe cases joint replacement surgery may be recommended; your health care provider will be
your guide for when it is time to consider surgery.
It is very important that you take an active role in the management of OA. Become educated about your condition and get involved with the Arthritis Foundation to keep informed about research, new developments and ongoing educational opportunities.
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