Pain in the neck? A crick in the old hip? You may be one of the 20 to 40 million Americans who have osteoarthritis, one of the most common forms of arthritis. Also known as "degenerative" or "wear and tear" arthritis, it is a breakdown of protective joint cartilage, leaving the ends of bone to rub painfully against each other.

  Osteoarthritis is most common after age 45, but can affect people in their 30s and 40s as well. Most often it affects the weight-bearing joints (hip, knee, spine) and the fingers, including the base of the thumb. Involvement of the hip is more common in men, and involvement of the fingers is more common in women.

  Primary osteoarthritis occurs independently; secondary osteoarthritis develops after a traumatic injury to a joint, as a result of a congenital defect, from increased stress on joints due to obesity, or from a metabolic disorder such as gout.

Symptoms and Diagnosis

   The symptoms of osteoarthritis vary greatly from person to person; it can be mild, moderate or quite severe. Most of the time, however, osteoarthritis can be very successfully managed.

  The primary symptoms are pain, stiffness and restricted movement caused by joint degeneration. Unlike rheumatoid arthritis, which is a systemic immune disorder, osteoarthritis does not usually exhibit inflammation (redness, tenderness and swelling), although it is possible. If inflammation is present, it's a result of the joint damage and not due to the same underlying process as rheumatoid arthritis.

The following symptoms are characteristic of osteoarthritis:

• Joint pain, particularly after overuse
• Pain that eases after a period of rest
• Stiffness and (sometimes) swelling
• Loss of joint motion
• Achiness when weather changes
• Pain on standing or walking
• Crepitus, or the sound of "snap, crackle and pop" when moving the joint

  Bony bumps in the finger joints, at the base of the thumb and in the joints of the spine are also part of the degenerative process of osteoarthritis. When the cartilage in the joint breaks down, the body attempts to repair the damage. Because there is no blood supply in cartilage, cartilage can not heal itself. As a result, extra bone grows, forming osteophytes ("spurs," or calcium deposits) around the joint, restricting its motion and causing pain. Sometimes, these spurs will impinge on or interfere with nerves. When this occurs in the spine, it's called spinal stenosis, resulting in leg pain. When the sciatic nerve is affected, the symptom is called sciatica.

  Particularly characteristic of osteoarthritis are bony changes that increase the size or width of the finger joints. In the mid-finger joints they're called Bouchard's nodes, and the ones at the ends of the fingers are called Heberden's nodes.

  To diagnose osteoarthritis, your physician will conduct a physical exam, take your medical history, and possibly order x-rays and other tests. X-rays will reveal narrowing of the joint space and bone spur formation. Blood tests may be done to rule out other types of arthritis, such as rheumatoid arthritis, or to obtain baseline information prior to treating you with medications. Generally, inflammation that is commonly identified in the blood of people with rheumatoid arthritis will not be present in osteoarthritis.

Treatment Options

   Once the diagnosis of osteoarthritis is certain, the goal is to decrease pain and increase activity and strength. With your doctor, possibly a rheumatologist, you will need to develop an effective treatment plan that will manage pain, prevent disability and keep you as independent as possible in your daily activities. The plan will be different for everyone, because it depends on the severity of the disease, the joint damage that has already occurred, and which joints are affected. A typical treatment plan will combine short- and long-term approaches and can include medication, joint protection, exercise, massage, heat and cold, weight control, surgery and more.

Passive vs. Active Approaches

   Passive approaches like analgesic or NSAID therapy, massage, heat, cold, ultrasound and neoprene sleeves can be useful in relieving the pain of OA. Since these approaches can ease pain, they are many times a first step to becoming more active.

  However, none of these therapies, including medications, will control the disease process or improve the damage that is already done. It's important to realize that both passive and active approaches must be part of your treatment plan to get the most from what you can do to help yourself.

  Passive Approaches. Over-the-counter pain relievers such as acetaminophen (i.e. Tylenol) may be used to relieve mild osteoarthritis pain. If there is some inflammation, a non-steroidal anti-inflammatory drug (NSAID) may be the better choice. Over-the-counter NSAIDs include aspirin, ibuprofen (Advil, Nuprin) and naproxen (Aleve). If necessary, your doctor can select the appropriate medication from a whole array of prescription NSAIDs. Always make sure your medication, whether prescription or over-the-counter, is supervised by your physician. NSAIDs can cause stomach problems, such as ulcers and bleeding, when used over long periods.

  As a result of the problem many people have experienced with NSAID therapy, a new class of NSAIDs called COX-2 inhibitors has recently been FDA approved, designed to provide relief of osteoarthritis symptoms with much less risk of stomach problems. Additionally, COX-2 inhibitor NSAIDs can be taken with blood thinners, something not available before this new class of NSAIDs became available. Celebrex, Mobic and Vioxx are the most frequently prescribed. If medication is needed, work with your doctor to determine the smallest dose that is effective for you.

  Injecting steroid preparations (cortisone) into the joint can ease pain and inflammation. Cortisone preparations are kept at a minimum due to side effects. If a cortisone injection is ineffective in relieving pain, it may be due to the joint losing all its cartilage surface. Cortisone will rarely help a joint that is already severely degenerated. Another injectable preparation is now available to treat osteoarthritis of the knee. It mimics hyaluronic acid, the natural "lubricating oil" of the joint, and goes by the brand names Hyalgan and Synvisc. Again, although proven to be very helpful, these injectables work best when there is some cartilage remaining in the knee joint.

  Active Approaches. These include joint protection and other modalities that help you to become more functional and active--something that passive approaches won't do in the long run. Through appropriate exercise, assistive devices, activity modification and, sometimes, surgery, one will be able to achieve much more in controlling pain and loss of independence.

  It's very important to remain active with osteoarthritis. That's hard, because when our joints hurt we tend not to use them. After years of extra stress caused by a joint that has degenerated and doesn't move the way it was meant to, your muscles can weaken. As a result, they won't be able to support your joint as well, which increases pain and leads to even more joint damage.

  Exercise and a program for strengthening muscles help break this cycle. Remember, the goal is to reduce pain and increase strength. Strength is obtained through exercise. Strength added to your joints diminishes pain and reduces actual stress to the joint. If you do not consciously do something to increase strength, chances are you will lose ground over the years simply because we weaken with age. Arthritis pain worsens with weakness.

  Whether it's a series of range-of-motion exercises provided by a physical therapist, or swimming, walking or bike riding, always be gentle on your joints when exercising. Start slowly, and build repetitions gradually. Don't use weights unless you know it won't cause further damage to your joints. Proper instruction is important. Swimming or water aerobics are excellent for people with osteoarthritis, because the water supports your body weight. Once you get going, you'll find exercise helps you feel better and function better overall.

  Inasmuch as we may not want to undergo surgery, surgery can play an important role in the treatment of osteoarthritis. Different joints can benefit differently from the various types of surgery. Total joint replacement is the most popular and generally the most successful in the long term. People with knee problems caused by torn or damaged cartilage may find that arthroscopic procedures can provide some relief. If osteoarthritis has caused severe joint damage, the only way to regain that lost function and put an end to the pain may be joint replacement surgery.

  Total joint replacement, especially of the hip and knee, has an excellent track record. It has relieved pain and restored joint function in 95 percent of patients for 15, 20, 25 years--and even longer.

  Always remember that you are the most important member of your treatment team, working with your primary care physician, rheumatologist, orthopaedic surgeon, physical therapist and others. To enjoy the best quality of life possible with osteoarthritis, you must take an active role from the beginning--don't let it control you! The more you know, the more successful your arthritis management will be.

Managing Osteoarthritis: Short-Term and Long-Term Approaches

  Effective management of osteoarthritis--or any type of arthritis, for that matter--requires a treatment plan that balances both "short-term" and "long-term" approaches. A short-term approach helps make today better, such as using an ice pack on a sore joint or taking some medication for pain or inflammation. A long-term approach works to ensure your continued independence down the road, such as learning about joint protection, exercise and strengthening, and assistive devices.

Short-Term Approaches

• Medication (NSAIDs, analgesics, analgesic creams/rubs, injectable medications)
• Heat and cold
• Massage/ultrasound
• Rest

Long-Term Approaches

• Exercise (water and land aerobics, flexibility, strengthening)
• Weight loss
• Assistive devices
• Surgery

About the author:
Jan Revella, R.N., Arthritis Nurse Specialist, is founder and director of Arthritis Education by Professionals, Inc., based in Phoenix, Arizona. She is among the most prominent speakers and educators on the subject of arthritis in the United States. Her mission is to empower people with arthritis to use knowledge as power when making decisions about their personal healthcare. Arthritis Education by Professionals, Inc. provides educational programs and services to people with arthritis.

© Copyright 2005. Arthritis Education by Professionals, Inc.