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Osteoarthritis

Background:

Osteoarthritis (OA) – or degenerative joint disease – is characterized by the breakdown of the joint cartilage, which causes sensitive bone exposed and vulnerable to abrasion and destruction as the bones rub against each other. The most common type of arthritis, OA leads to joint pain, deformity and loss of movement. Osteoarthritis most commonly affects the knee, hip and hand, but can also involve the shoulder, spine, knee, foot and ankle.

Statistics:

  • are many forms of arthritis, afflicting 43 million people – 20.8 percent of American adults – and is the leading form of disability in the U.S.
  • is the most common type of arthritis, especially among older people, and is suffered by nearly 21 million Americans.
  • risk of developing OA increases with age, and disproportionately affects women.
  • all Americans aged 65 or older were x-rayed, more than half of this population would show evidence of osteoarthritis in at least one joint.
  • 2030, 20 percent of Americans – about 70 million people – will be at risk for osteoarthritis.
  • of the knee is one of the five leading causes of physical disability in non-institutionalized men and women.
  • of the hip is considered the most debilitating form of OA: one in 4-5 people hospitalized for OA of the hip is released to a long-term care facility or nursing home.

Talking Points:

Recommendations for patients with OA:

  • shows that exercise is one of the best treatments for osteoarthritis. Exercise helps keep the joints flexible, the muscles around the joints strong, bone and cartilage tissue strong and healthy; and reduces pain.
  • with osteoarthritis should: engage in a balanced fitness program that includes walking, swimming, cycling and stretching exercises avoid exercises that place excessive stress on the joints like aerobic workouts, running or competitive sports activities.
  • non-surgical treatment can slow progression of OA, increase motion and improve strength. Most treatment programs combine lifestyle modifications, medications and physical therapies.
  • study commissioned by the National Institutes of Health showed that acupuncture provides pain relief and improves function for people with osteoarthritis of the knee, when complemented with proper medical care.
  • is a risk factor for both the development and progression of knee and hip osteoarthritis.
  • of the 500,000 U.S. patients with osteoarthritis who undergo total hip or total knee replacements as a surgical means of relieving OA pain are overweight or obese. Not only does extra body weight adversely affect the patients’ overall health, it may also compromise the lifespan of the prosthesis.

Potential Media Questions:

Q: What are some symptoms of OA?

A: Osteoarthritis can affect any joint in the body, with symptoms ranging from mild to disabling. A joint affected by OA may have pain and inflammation, swelling and stiffness, loss of range of motion, "sticking" and weakness. Joint pain usually develops gradually and may feel dull or aching. Pain may be worse in the morning and feel better with activity. Vigorous activity may cause pain to flare up. Joints may stiffen and look swollen, enlarged or "out of joint." Loose fragments of cartilage and other tissue can cause locking or "sticking" when you use the joint, it may creak, click, snap, or make a grinding noise.

Q: How does osteoarthritis develop?

A: Osteoarthritis usually develops after many years of use (it’s often referred to as “wear and tear” arthritis), affecting people who are middle aged or older. However, OA affects each person differently. In some people, it progresses quickly; in others, the symptoms are more serious.

Q: Is osteoarthritis preventable?

A: Unfortunately, OA is not preventable, as you can develop osteoarthritis even if you don't have any “risk factors.” However, you are more susceptible to developing OA if you have any risk factors, which include the following:

  • generally, the more weight a person carries, the greater the pressure on weight-bearing joints of the body
  • as people age, cartilage normally is less able to repair itself
  • calcium and vitamins C and D are needed to build strong bones, and investigators are researching whether an insufficiency of these vitamins may contribute to developing OA in later life
  • or deformity in a joint: there is an increased risk of developing OA in a joint that is not properly aligned or one that has been injured
  • factors: repetitive tasks, overworking the joints and overtiring muscles that protect a joint increase the risk for OA in that joint

Q: How influential is hereditary in developing OA?

A: Osteoarthritis in all its various forms appears to have a strong genetic connection. Gene mutations may be a factor in predisposing individuals to develop OA. However, there are other risk factors (refer to question immediately above) as well that can increase a person's risk of developing OA.

Q: How is osteoarthritis diagnosed?

A: While there is currently no single test to diagnose osteoarthritis, most physicians rely on a combination of methods to diagnose OA and to determine the extent to which it has progressed. Diagnosis will likely require a review of your complete medical history, physical examination, X-rays and possibly lab tests to rule out any other diseases with similar symptoms.

Q: How does osteoarthritis differ from rheumatoid arthritis?

A: OA and RA both affect joints one or many, but RA is also a systemic (autoimmune) disease which often affects multiple joints or systems. Some individuals may have both OA and RA occurring simultaneously.

Q: What are some non-surgical treatment options?

A: Early, non-surgical treatment can slow the progression of OA, increase motion and improve strength. Most treatment programs combine lifestyle modifications, medications and physical therapies all tailored to each patient's needs, lifestyle, and health.

  • modifications: The doctor may recommend that you rest or change activities to avoid provoking osteoarthritis pain. You may need to modify job or sports activities. This could mean switching from high impact activities (such as aerobics, running, jumping or competitive sports) to low impact exercises (such as stretching, walking, swimming or cycling). If osteoarthritis affects weight-bearing joints (such as the knee, hip, spine or ankle) and you are overweight, you may also need to start a weight loss program.
  • Non-steroidal anti-inflammatory medications (NSAIDs) can help reduce inflammation and pain. Also, Tylenol can be used for pain relief. Dietary supplements called glucosamine and chondroitin sulfate may also help relieve osteoarthritis pain. Care should be taken in selecting a brand, and always consult your doctor before taking any dietary supplements
  • Sometimes doctors may recommend strong anti-inflammatory agents called corticosteroids, which are injected directly into the joint for temporary relief of pain and swelling. Cortisone or steroid injections can give temporary relief of osteoarthritis pain. Also, there are newer injectable gels (viscosupplementation) that can act as a lubricant and also provide relief for osteoarthritis of the knee.
  • therapy: The doctor may prescribe a balanced fitness program, physical therapy and/or occupational therapy to improve joint flexibility, increase range of motion, strengthen muscle, bone and cartilage tissues and reduce pain. You may need to use supportive or assistive devices (i.e., brace, splint, elastic bandage, cane, crutches or walker) and/or apply ice or heat to the affected joint for short periods, several times a day.

Q: What types of surgical treatments are available?

A: If early non-surgical treatments do not stop the pain, the doctor may consider surgery to treat advanced osteoarthritis. It depends upon your age and activity level, the condition of the affected joint, and the extent to which osteoarthritis has progressed. Surgical options for osteoarthritis can include arthroscopy (debridement), osteotomy, joint fusion and joint replacement (partial or total).

Q: What are some exercises that can help manage OA?

A: Exercise is very important to help keep the joints flexible, the muscles around the joints strong, bone and cartilage tissue strong and healthy, and reduce pain. People with osteoarthritis should check with their physician before starting an exercise program. The amount and form of exercise will depend on which joints are affected, how stable the joints are, and whether or not a joint replacement has already been performed. Individuals with osteoarthritis should engage in a balanced fitness program that includes walking, swimming, cycling and stretching exercises. They should avoid exercises that place excessive stress on the joints like aerobic workouts, running or competitive sports activities. Pain medications and applying ice after exercising may make exercising easier.

Q: Are there exciting developments in the horizon for treating OA?

A: The U.S. Bone and Joint Decade is committed to researching new ways to treat OA, such as via gene therapy, tissue engineering, early preventative surgery and osteochondral transplants. Is it not just a matter of treating pain, but helping prevent and hopefully even reverse arthritic genes with new developments not yet available at this time, but hopefully in the near future.

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