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Osteoarthritis

Osteoarthritis (OA) is the primary example of degenerative arthritis. It affects approximately 20 million people in the United States. The condition affects both men and women the same and occurs primarily in individuals over 40 years of age. OA predominantly affects joint cartilage. This is the smooth surface that covers the end of bones. The purpose of this cartilage is to provide shock absorbency and to reduce friction as movement occurs. Overtime, wear and tear takes place, which erodes and roughens the cartilage.

Ultimately, bines rub together, inflammation results, and bony spurs may develop. This produces more joint breakdown leading to decreased range of motion (ROM) and pain. OA affects the knees, hips, ankles and even the hands. Genetics may also play a role in the development of OA, particularly in the hands. Some can actually be born with defective cartilage or with slight defects in the way that joints fit together. As a person ages, these defects may cause early cartilage breakdown.

There is no blood test for the diagnosis of osteoarthritis. Blood tests are performed to exclude diseases that can cause secondary osteoarthritis, as well as to exclude other arthritis conditions that can mimic OA. X-rays of the affected joints can suggest osteoarthritis. The common x-ray findings of osteoarthritis include loss of joint cartilage, narrowing of the joint space between adjacent bones, and bone spur formation.

Simple x-ray testing can be very helpful to exclude other causes of pain in a particular joint as well as assist the decision-making as to when surgical intervention should be considered. Arthrocentesis is often performed in the doctor’s office. During arthrocentesis, a sterile needle is used to remove joint fluid for analysis. Joint fluid analysis is useful in excluding gout, infection, and other causes of arthritis.

Removal of joint fluid and injection of corticosteroids into the joints during arthrocentesis can help relieve pain, swelling, and inflammation. Arthroscopy is a surgical technique whereby a doctor inserts a viewing tube into the joint space. Abnormalities of and damage to the cartilage and ligaments can be detected and sometimes repaired through the arthroscope. If successful, patients can recover from the arthroscopic surgery much more quickly than from open joint surgery.

Finally, a careful analysis of the location, duration, and character of the joint symptoms and the appearance of the joints helps the doctor in diagnosing osteoarthritis. Bony enlargement of the joints from spur formations is characteristic of osteoarthritis. Therefore, Heberden’s nodes, Bouchard’s nodes, and bunions the feet can help the doctor make a diagnosis of osteoarthritis.

Aside from weight reduction and avoiding activities that exert excessive stress on the joint cartilage, there is no specific treatment to halt cartilage degeneration or to repair damaged cartilage in osteoarthritis. The goal of treatment in osteoarthritis is to reduce joint pain and inflammation while improving and maintaining joint health & function.

Some patients with osteoarthritis have minimal or no pain, and may not need treatment. Others may benefit from conservative measures such as rest, exercise, weight reduction, physical therapy, and mechanical support devices. These measures are particularly important when large, weight-bearing joints are involved, such as the hips or knees. Medication may be taken orally or injected into the joints to decrease joint inflammation and pain.

When conservative measures fail to control pain and improve joint function, surgery to replace a joint can be considered. Resting sore joints decreases stress on the joints, and relieves pain and swelling. Patients are asked to simply decrease the intensity and/or frequency of the activities that consistently cause joint pain. Exercise usually does not aggravate osteoarthritis when performed at levels that do not cause joint pain.

Exercise is helpful in osteoarthritis in several ways. First, it strengthens the muscular support around the joints. It also prevents the joints from getting stiff and improves and maintains joint mobility. Finally, it helps with weight reduction and promotes endurance. Applying local heat before and cold packs after exercise can help relieve pain and inflammation.

Swimming is particularly suited for patients with osteoarthritis because it allows patients to exercise with minimal impact stress to the joints. Other popular exercises include walking, stationary cycling, and light weight training and tai chi. With regards to weigh training, it is imperative to start with small ranges of motion and to avoid the full range of the movement at the onset of your training.

Further down the line, under the guise of a trained professional, you can begin full ROM training. If constant crepitus ensues during weight training, cease the activity and explore multirange isometric training. Exercise for arthritic joints can reduce stiffness, improve motion, prevent further damage and increase your functional capacity. Massage also aids in circulation and the ultimate health of a joint.

Here are some reminders that you should consider when exercising

-Start slowly. If you are out of shape, walk for no more than five minutes and do this several times throughout the day.

-Use supportive sneakers or rubber soled shoes while walking.

-Build up your duration gradually. Increase your walking by 10% a day (if you walk for 10 minutes today, try 11 minutes tomorrow).

-During your walking program, focus on time goals rather than distance. This will help you keep a controlled pace.

-It is O.K. to push yourself a little when exercising and even break a sweat, but you should always be able to carry on a conversation comfortably during your walking exercise program.

-Watch your weight. The more weight you have, the more compression on your cartilage.

-A gentle stretching & ROM program before and after is paramount to your function. Think about the muscles needed for your activity and stretch them!

-Moist heat before exercise and Ice applied to the affected joint after exercise can be very soothing and will aid in the preparation and recovery of exercise.

-Gentle exercise should be done daily even when the joint is flared up and activity is undesirable.

-Never exercise for greater then one hour at a time. This can be too vigorous.

-Avoid over stretching.

-Remember that low impact activities like walking and dancing are the best exercises while high impact exercises are not recommended.