Overview of Osteoarthritis

 In beginning this discussion, let me first review the pathology associated with osteoarthritis. Osteoarthritis (OA) is a chronic disease of the joints, especially the weight-bearing joints (knees, hips, and lower back). It develops when the linings of joints degenerate, leading to the breakdown of bone, and results in pain and decreased mobility/joint function. Although the true cause of OA is unknown, it is widely agreed upon that it is a disease primarily associated with aging and injury. When cartilage becomes worn, exposed bones can rub together and the painful symptoms of osteoarthritis may appear.

 The onset of OA is gradual and most often affects the hips, knees, fingers, and spine, although other joints also may be involved. Morning stiffness is also common and diminishes with movement. Pain is the main symptom, which usually worsens with exercise and is relieved by rest. As OA progresses, joint motion is lost, and tenderness and grating sensations may develop. OA of the spine may lead to shooting pains down the arms or legs.

 The treatment of OA is usually based on the severity of the pain and limitation of mobility/function. First-line treatment of mild cases commonly involves the use of over the counter aspirin and/or nonsteroidal anti-inflammatory drugs (NSAIDs). This is often augmented with use of topical creams, hot soaks, heating pads, and joint-support devices to manage localized pain. Most health care practitioners also incorporate changes in dietary and lifestyle habits when appropriate. Obesity significantly increases the risk of OA developing in weight-bearing joints. Studies have shown that even a moderate 10% drop in body weight is commonly associated with reduced incidence of developing OA, as well as reduction in the pain secondary to existing OA. Second-line treatment of moderate OA symptoms is usually restricted to prescription strength NSAIDs, corticosteroid injections, narcotic analgesics, and physical therapy. In most cases, when the pain becomes severe and refractory to treatment, surgical intervention is the last treatment option available.