Osteoarthritis – Frequently Asked Questions

1. What is osteoarthritis and what does it do?
2. What puts you at greater risk of osteoarthritis?
3. What are the most common symptoms of osteoarthritis?
4. What tests are done for osteoarthritis?
5. How is osteoarthritis treated?
6. Why should you consider surgery?

What is osteoarthritis and what does it do?

Osteoarthritis – known among physicians as OA – is a disease in which cartilage breaks down. Cartilage is the spongy tissue that coats the ends of bones in joints. It acts as a shock absorber. Normally, damaged cartilage is constantly being repaired as old cartilage is degraded. When the balance between degradation and repair is thrown off, cartilage breakdown occurs. As a result of cartilage breakdown, damage to bone occurs. The result can be painful, tender, creaky joints and limitations on joint movement.

What puts you at greater risk of osteoarthritis?

We don't know all the answers, but some of the risks may include:

• Age, because the prevalence of osteoarthritis increases in older age groups
• Genetics, because some sub-types of osteoarthritis seem to be inherited
• Hormones, because post-menopausal estrogen replacement therapy helps protect women from developing osteoarthritis
• Trauma, especially injuries of the knee
• Possibly occupational injuries, because studies report an increased incidence of osteoarthritis among workers who use certain joints repetitively, such as jackhammer operators (wrists, hands and elbows), coal miners (knees), cotton pickers (fingers), and farmers (hips)
• Overweight, because obesity in women has definitely been shown to be a risk factor for development of knee osteoarthritis
• Nutrition, because lack of vitamin D may predispose patients with established osteoarthritis of the knee to further progression

What are the most common symptoms of osteoarthritis?

Pain is the most common symptom, and it occurs primarily when the joint is moved, rarely at rest. Pain is often accompanied by crepitus (a crackling sound). Some patients experience a "gelling phenomenon" – the perception of stiffness, usually lasting less than 20 minutes in the affected joint. Why some people have pain with osteoarthritis and others do not remains unknown. The perception of pain depends not only on the disease process and the brain's processing of main messages, but also on cultural, gender, and psychological factors. The joints most commonly affected by osteoarthritis are:

• The last and middle joint in the fingers
• The joint between the thumb to the wrist
• The hip
• The knee
• The neck (joints of the cervical spine)
• The lower back (joints of the lumbar spine)

Osteoarthritis is not associated with the presence of fever, weight loss, anorexia, severe muscle atrophy, or symmetrical joint involvement. That is, when the left knee is affected, the right may not be – in contrast to other forms of arthritis where both are apt to be affected, called symmetrical involvement.

What tests are done for osteoarthritis?

Laboratory tests in osteoarthritis are important for the absence of any positive findings. Routine tests such as complete blood counts, urinalysis, sedimentation rate (also known as the erythrocyte sedimentation rate or ESR), biochemistries, and specialized tests such as rheumatoid factor and antinuclear antibody (ANA) are useful simply to exclude other diseases that cause joint pain.

As we age, we sometimes develop a low level positive test for rheumatoid arthritis (rheumatoid factor) or ANA, and elevations of sedimentation rate (ESR) without obvious illness. These need not be confusing because, in arthritis, the clinical picture makes the diagnosis; lab tests tend only to confirm what your doctor already knows. The physician should never rely on laboratory tests as the sole indicator of disease when diagnosing arthritis. Other tests that may help confirm the diagnosis are: X-rays, aspiration of synovial fluid from the joint; and bone scans.

How is osteoarthritis treated?

Treatment will depend on the severity of your osteoarthritis, any other diseases you have and what medications you are taking, all of which will be determined by the physician during a complete examination. Treatment is aimed at control of pain by decreasing inflammation in the joint and with analgesics; oral medications may be prescribed or injections into the joint.

With the help of the physician and literature from the Arthritis Foundation, patients should first educate themselves about the disease and the various therapy modalities, such as physical and occupational therapy, especially the importance of exercise to strengthen your thigh muscles, which reduces pain and improves function in patients with osteoarthritis of the knee. It is also wise to maintain good nutrition and, if you are overweight, try to reduce it.

Why should you consider surgery?

When conservative measures for treating osteoarthritis fail and pain in a specific joint disables an active individual, then surgery may restore patient comfort and normal activity. Keep in mind that surgery relieves pain more than it restores range of motion. Thus, the decision to undergo surgery is one more of personal wishes than of medical priorities.

The best candidate for surgery is the patient who has a definite interruption in some activity of daily living (that is, who can't walk more than a block or awakens from sleep with pain in the affected joint) and who has not been helped sufficiently by exercise and drug therapy. For such patients, the result will be outstanding because they will be pain-free in the involved joint. The type of surgery suggested will depend on your age, activity level, and the joint involved. When appropriate, total joint replacements are available for almost every joint in the body.

For detailed information on osteoarthritis, click here to read An In-Depth Disease Overview of Osteoarthritis. (Note: This article is written for medical practitioners.)

Updated: 7/17/2009